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lilfl

•' Ess
, Dis

llE^
i

Jet

TIALS OF

sEs OF THE Skin

W.STELWAGON.M.D.

;

ERS' QUESTION-GOMPENDS.

OPINIONS OF THE PRESS.

'^traet from london Liinaet, Jul; 61
' to Sjdleiaatic lUiuiing.— It ia forlunuti
I uDiiuTtHkec — by cumputent b&nds, by toto who, being tl
... Lwiching, hnaii where (be subjects riiquira most e1
ue cnrefa] to be lUMiurate in

!k^M^

Estate of Dp-E.K. Miller.

iuSrnt^!o?S3n<^^ffl^^QBT

of grent belp to tlie

BjttTMt from Sonttiarit CaUrarniB PractitioMT, Harnli, 18B9.
roit's OwTBTnics.— '■ Di. Asliton's lililo work U o marvol of ooudsiuiitioiij
Q. Jl niJI bu of unqucelion
of tbo miiHitlKlJnuus tuala in the ubftotrionl nrt, whiob will fretjw

Estraot from SonthBiii Cltnlo, JuiMry, 1190.
[ateria UeIiICA. — "The BmngemeutBDi subjeot-TDKlt
to be naked let, cither Tor the etadent or medicBl pnetitiuodT.

Cej&tJfti^juid.JUiqa^e^igiH.^ft^SiJ'*." . .^ , ^-i

'SAUNDERS' 01

OPINIONS or THE PRESS. ^_

Extraott ttom Aiuuli of SnTgery, Jane, ISBd. ^^|

"Tho]' mit} Im iiEcil tu n-) litile iiilviiDtjij(u b; Uin pFuuUtiuner, ia jmiimt]ll£'''fl^l

" Ilia liroTi'iisUiniil ivurlt, iu t. auiWbla rofiit tut rcaii J refof moo and wm-
a .oliMal^wtlDD. Tlie lorm at Uuestluni unit ADinnra U {irsali&ri; (jnal^fl'' <
fiuiUnera uf infgrmntiau. I>r. Nancredg hiu gireu oa k woibiW'innref h .
I ohArniitiir Ituwn aDjlbiiiK of ttie kind.
Tlia HBdiciLl StuilenI hLu aball liftre muatereit ifa ooutEnb, vltl aertalnlj IUT1>

id ftti tht) (»eul.iitl poioU of Auatom;."
"Tha BuenlmU at Pbjsialog; sro moat atoiu'lj' and wmptetusniLivol; ontlliu
r. Itu«."

1 CDEHisTitT.— ^Tlia queatiojit aie dietiuctl; tlatcd, uA Uis ■
imed irith niuk«d alcarnwB, ore full; aii tu the times."
"MAtmii's&iiBaiiiTiWmprrkuiipiveiii eoopoi It ■• lui uiiusa

"Tlie b"(ik pres.

KOltJiHl

Extrtati flam Unlvcrilty Medlod Uagaflse.

J**l«i!B'B6i'n«EHT.— "Tlio niiiil ]irooiinnci>'i r)p[ioa«ntof thosysle
I TOgUB At Ihn present riay, doulil 1Idi[ on groiinil for obj'.iliaiis Vi tbia eia«tlBaljj|
Rhmk, wliinli nl«rir]; B0Uibini4 nil the uierila oCauudunautiiia, wLlIe Hruiding thltt
wrtiilalit; uiit iuMicutncy with nhlvh euiUi Ciiinpenili uanimuuly fthonnd.
IM la Iu ftllo to rworuiDtnd the book nbgoJuldy nod vitlimt r*MrT»Una, itfll
7 hiiaillDg ttiu purjiusa fur wliiob it hu writtui, anil, M Dkr M Surgerylf
n»j, dnitUleillj Ihu biwt »[ lid kinil iritli whioli n* «rv lK)i]u>tiit«d."

ii«l)B'ii An^itomv. — "T(i lusni Anntomyis nut nrnrely tntenniBlMrdit'fil
», uivrio* mil Dcnes, but tu fluJy tlieir origin itiiil laMniaat, tliftlt 4|
dntIUlODe,aD<l iWir UiBtrlhutioD. I>r. !<tiui?rede liu kept tliii ntci

i, will ibe elndpnlwbu imutuni tli« dutniln of thif iitCIn book is oannM

work b lb.1 itiiseiliiiE room, will Hull it ft liHp for wblob h<< Urd

II ithia linvc'olf give tbiolu. Tba qucstiuiiB huve been nitety ude^"

'«ii«oanl« and nouDbwIy coiutrnctod, but <tltl Hith nilSuicnt detain

IhMa tn'UJ Ibr i>r^tt«<*ia Ibiil Uisy un loerBty llf tt of uBiiiia."

EitMdt (ran K«w Toik IE«dloal Becord, Ha;, 1BB9.
" BaiuiJcrt' Series nf Btudonl's Minnnla, lUnUigu'l lu thu turm iif l]aCBt1M|
An*«i<r«, arn w>ii'-iw, wilbuul ibu onilBion of unj ifsvDtiii fli.!U. Ilaudsoiji
yowl |in|iHr ami uliur ly|Ki llioiciux lliKir :itlnictiTBn«sj."

SxtTwt rtom St. JoiBph'i Kidioftl Berkld, Ihrak, It>».

" Wni.l<r'* CncHinKV.— A Ultln luwb tbnl <i«pliuii>, oltuirly anil aiinply, lli^
•Uflln^t putot* in M*4t«I CtiBBiktr?, k< Uiat tbji ncvd do luEEur lo tba i^rwalM
of ■ toodloa) tluiIsDt't allinW

JtXJSm

^Mngo

Elrtracl tram London Lincel, Juljr
eth,l889.

'< UiEfu] Adjuucti ta Hyaleid&tlc
Rcading.—Itisfartunaterortheatu-
Aeai [but theae booki ehould be ^ta-
dflrtakflD by compelfiDt buida, by

In lenchlng, know wbera the sub-
jects require most eluekdadoD^ APit

SsuUMrn Calltomla Prnc-
Utioner, Ns«„l8B9.

"Moms' Materia Med-

buay medical fltudotit to
Materia Medieutban the

From Idurnal at the
Amsrlun Medlcar At-
■ociatlan. No*. 23d,
I8S9.

■■ ll;ire'« PhjaiolDgj.-

miraljlT lliustraUd,

CBUtlcat Era.
7,1890.

islry, >hlcb It will alto
rahablr mtppleiaatit. "

XOW JtEAJlV.

Saiinders'

Nos. lO and II.

No. 10. Essentials of Gyn-
aecology. Profusely Il-
lustrated. By Edwin B.
CltAHlN, M. D.

No. II. Essentials of Dis-
eases of the Skin. 75
IlluatratioiiB. By Henry
W. Stelwagon, M. D.

8YLUABU3 OF

OBSTETRICAL LECTURES

EimimiOII OF THE IIIIIIE,

aiared Plalc and jVuhhtiiui Olliir

CIndnnali Medleil Htm,
January. 1899.

" WoUTaChemistrj.—

Indiana Medical Joun
Decembtr, 1889.
"Semple's Pathalogr

American Prai
■ nd Ne*l.
IEth.l8S9.

ealllard's Medkal li

liledlcal and Surgical Ra-
portar. January Z6tli,
(BBS.

■'Asbton'K Obsletrin.
—A work Ihorougblr
calciilaled <<

PRICE: Cloth, SI.OO; Interleaved, for Taking Notes, SI.2S.

SAUNDERS' QUESTION-COMPENDS.

Arranged fn the form of Quetttotu and Anneers,

JTHB ADVAKTAGB OF HUESTtONa AND AKSWERS.— The ua8t\iln™» of arranging the

No. I.— Essentials of Physiology. Seeand Edition, Revised and

KreaUy enlarKCd. Ej H. A. Hahk.TI.D., SemmiBimtor of Tta«npentl« and InstiuMcr
Pb^ilcsl tilsiinagi8 1q Ibe JiMlIca) Deiartrntot, and luilrudUr in Ph^glology io llie ItiijLuglc&l
Department, of tho Duliorailj of PoDpsjWimis, elc., elc

No. 2.— Es Bent I a Is of Surgery. oantKining >ieD, Enr^aa Lmd-m^ria, nbar md

OpmUlnt Bvatrt, atut a Ommleli Dacr^Him, tognAir •mih /nil lUHitrathm of Ute Smdliachi^ mid
SnUm- Bavdiige. Second Edition, wltli ninoty Illnntratlantt. By £dw:igu
HisTIK, H.V,, Inttructor in OpentlTe Snrger; hdi) L«clarer an Minor Surgrrj, UnlieraiEj of
FeuDsylTsnrB; BnriRUD to tlie Out-Palienis' Departinent of tlie CliUdivn'a Uoapitnl, tod Surgical
Bsglttru of ttiB Pfajladelptiiii Uogpltal, etc., etr.

> bundreil And JlJiy pages^ with one bon-

ne, Bums, llal; ; Lale

sntlal

Toxlmlogy. By Lj
Pliamucy, etc., etc.

No. 5.— Essentials of Obstetrics.

of Ulcbig&D, Add Arbor; Convpondine N
Italy; LaleBarEinn JeSeraDnUHllnimiegi

No. 4.— Essentials of Medical Chemistry. Orguic

*lBO QotHtiona on Medical Phyaici. Chemical PhyslolceT. AnaTyilcal Proceseu, Ur
- ■ ■ " ■ - " - - -'— Jeffenoniledl

llsdelidiiai Uember of FbilndeipUt ColleEe c

IHuetrelHl. By V. Eaeteblt Aihtoh, 1U.I

. __ .Jeniia Mediral ColiBge, «nd Cblef of Cllnloi f

of Women in the Jcfleison Medical Hoeplul. .^Ic, etc.

isentials t

ll^lron. Hachnej; Profuior of Vocal and Aural Pbjdkolu^ and R ^a n iinec la
ty Callage, London, etc, eia.

No. 7.— Essentials of Materia Medics, Therapeutics and Prescription

Writing. By Henrt Hobbh, U.D., Uib Uemonitmor, JelTcnon Medical ColleKe: Fellow
College of PhTBidana, FtidodelpUla; Co-Edllor Biddle-a UalerU Uedlca; Vislling Phyelclaa to
8t, Juaeiili'i HoeidliJ. etc., elc.

No*. 8 and S.^Essentials of Practice of Medicine. (Dmiiiie number, dtu

fire hgndred pages.) By Henbt MonHri', M.D. With an Appendix on Urinary doalysii by
LiwaiNui WtiLrr, H.D. PtDtaaely llliintrued. (lu ptepaiulDD.)

No. 10.— EssentialB of Gynecology. wiibnuuemusniunraMon^. SyEnsi^B.

Ca*8is, M.D., Attending Gynfficulugin, Emj*;vult floapliitl, Uut-J'ailenla' iiepatinieul ; Aiaiilant
Bni^eon, Saw York Cancor Boapital. oto., etc.

No. II.— Essentials of Diseases of the Skin, niaetnt&i. ByBiHiTW. Btki.

uriaoH. M.D. Fbyslclan toPhllailaJptalaDtapeiiury farSktuDlaNueg; Chief of tbe Bkin Dhpen-
•ary in tho Honpltal of CniYeiaily of Pennsyltauia; Physician to Bkln Deintlnifnlof the Howard

No. 12.— Essentials of Minor Surgery and Bandaging, with sn Appendii

on Venereal DIseBseB. Illiuiraled. By Enw.Ko Mibtis, M Caulharof tho"li«en.

No. 13.— Essentials of Forensic Medicine. proreaFiy ninKtrated. By Abhakd

B«ii»l.«,MJ), author of '•EiaenllatB of Pathology and Morbid A nolumy." (In prepanaionO

No. 14.— Essentials of the Refraollon and the Diseases of the Eye. uina-

tmlod. By BnwAHn Jaom.n, A.M^ M.D,. Profeuor ol IHHaan of the Kje In the Philadelphia
Polyclinic and Coltega fer Giadiialn In Hedlcln<^; Menitnr of the American Ophlhalmuluglci.!
Boclely; Pelluwof the Coilegaof Pbyaicianeuf Philadelphia; Fellow of the American Academy

or Medicine, eu.eio.i and Essential Diseases of the Nose and Throat. iimtnted.

ByK BAlDwIsSl,a«»oS,S. B..M.D.,Awin«ntin(heNo«aildThroalDbil>en™ryof Ihellpepilnl
of the UolTanlttof Pennaylviiula; Asitat»Dl In tbe Nuanand Thrxat Deparimenl of the Uulno
HJf^mBnr: Member of the Qennan Uedlcal Bodaiy, Phlladulphia Poly>4laic Medical SsdeQi

SAUNDERS' QUESTION-COMPENDS, No. li.

ESSENTIALS OF DISEASES OF THE SKIN,

IMOLUDUfO THE

SYPHILODERMATA.

ARRANGED IN THE FORM OF

QUESTIONS AND ANSWERS

PREPARED ESPECIALLY FOR

STUDENTS OF MEDICINE.

HENRY W. gTELWAGON, M.D., Ph.D.,

ATTRNDINO PHYSICIAN TO THE PHILADELPHIA DISPENSARY FOR SKIN DISEASES ; PHYSICIAN

TO THE DEPARTMENT FOR SKIN DISEASES, HOWARD HOSPITAL; DERMATOLOGIST

TO THE PHILADELPHIA HOSPITAL; LECTURER ON DERMATOLOGY IN THE

woman's MEDICAL COLLEGE; PHYSICIAN TO THE SBBVIOB

FOR SKIN DISEASES, NORTHERN DISPENSARY, ETa

WITH SEVENTY-FOUR ILLUSTRATIONS.

PHILADELPHIA:

W. B. SAUNDERS,

918 Walnut Street.
London: Henry Renshaw. Melbourne: George Robertson A, Co.

1890.

« ^ «

Entered according to Act of Congress, in the year 1890, by

W. B. SAUNDERS,

In the Office of the Librarian of Congress, at Washington, D. C.

WM. F. FELL & CO.,

Eleotrotypers and Printers,

1eao-c4 san80m st., philadelphia.

• • • • I

• * m • •

■ • • * •

**• • •

'« *

• • •

• • • »

PREFACE.

Much of the preseut volume is, in ii measure, the ootcome of '4
thorough revision, remodeUing aud tiimplificntiuu of the i
articles contributiMl by the a^uthor to Pepper's Syctem of Medicine;!
Buck's Bbfereuce Handhook of the Medical Saenoea, and Keating'k ■
Cyclopeedia. of the SiacHses of Children. Moreover, in the endeavot j
to present the subject as tersely and briefly as compatible with dea
uuderetaiidiug, the several standard treatises on diseases of the si
by Tilbury Fos, Duhring, Hyde, Bobiuson, Anderson, and OrockerJ
have been freely consulted. The space allotted to each disease h
lieeu based upon relative importance. As to treatment, the b
aud approved nicthods only, those which are founded upon th(
aggregate experience of dermatologists, are referred U

For the benefit iif those whirae clinical opportunities are B()mewh!
limited, an apjieudix containing references to colored plates of thftV
several American Atlases of Skin Diseases, by Duhring, G. H. Fi:a,V
Taylor, and Morrow ia added. For general information a statistio*
table &om the Transactions of the American Dermatologicol I
ciation is also appended.

H. W.

nUaiUlphia, March, 1S90.

8'! 25

CONTENTS.

PAOB

Anatomy of the Skin, 17

The Epidermis, 18

The Bloodvessels, 19

The Nervous and Vascular Papillae, 20

The Hair and Hair-Follicle, 21

Symptomatology, 22

Primary Lesions, 22

Secondary Lesions, 23

Distribution and Configuration, 24

Relative Frequency, 26

Ck)ntagiousness, 27

Rapidity of Cure, 27

Ointment Bases, 27

Classification, 28

Class I. — Disorders of the Glands, 31

Hyperidrosis, 31

Sndamen, 33

Anidrosis, 34

Bromidrosis, 34

Chromidrosis, 35

Uridrosis, 35

Phosphoridrosis, 35

Seborrhcea, 36

Comedo, 40

Milium, 43

Steatoma, 44

Class II. — Inflammations, 45

Erythema Simplex, 45

Erythema Intertrigo, 46

Erythema Multiforme, 47

Erythema Nodosum, 5ft

Vi CONTENTS.

Inflammations — Continued. ^^^^

Urticaria, 51

Urticaria Pigmentosa, 55

Dermatitis, 55

Feigned Eruptions, 60

Dermatitis Gangrsenosa, 60

Erysipelas, 61

Furuncolus, 62

Carbunculns, 64

Postula Maligna, 66

Post-mortem Pustnle, 66

Framboesia, 67

Eqainia, 67

Miliaria, 67

Pompholyx, 69

Herpes Simplex, 71

Herpes Zoster, 73

Herpes Iris, 75

Dermatitis Herpetiformis, 76

Psoriasis, 79

Pityriasis Rosea, 87

Dermatitis Exfoliativa, 88

Pityriasis Rabra, 89

Lichen Ruber, 89

Lichen Scrofalosua, 91

Eczema, 92

Prurigo, 106

Acne, 107

Acne Rosacea, 114

Sycosis, 116

Dermatitis Papillaris Capillitii, 119

Impetigo, 120

Impetigo Contagiosa, 121

Impetigo Herpetiformis, 123

Ecthyma, 123

Pemphigus, 125

Class III.— Hemorrhages, 128

Purpura, 128

Scorbutus, 130

Cij.se IV.— Hypkktbophies, 131

Lentigo, 131

Chloaama, 132

Kerato^ PilariB, 134

Mollnscnm Epitbeliale, 135

CalloaitBB, 138

CkvQs, 139

■Comu Cutaneam, 141

Terraca, 143

Termca Necrogeuiea, 145

Na:vHs PigmentoHua, 14g

Ichthyosis, 148

Onjchaaxis, 150

Hypertrichosis, 151

Scleremii Neonatorum, 154

Sflerodenna, 155

Morphdia 156

Elephantiasis, 158

DerniatolyBiii Ifll

Glass V. — ATEOPHiEa, 182

AlbinismnB, 162

Vitiligo 163

Caiiitiea, 166

Alopecia, 166

Alopecia Areata, 166

Atropliia Filoram Propria, 171

Atrophia Unguis, 172

Atrophia Cntis, _ 174

Class vi.—nkw Growths, 176

Keloid 176

Fibroma, 177

Nauioma, 179

Xantboma, 180

Myoma, 191

Angioma, 181

Telangipctasis, 182

Lymphnngioma, 1H3

Jihinostleroma 183

LnpoB Eiythematflans, 184

Vm CONTENTS.

New Growths — Continued. p^^^

Lupus Vulgaris, 188

Scroftiloderma, 195

Alnhum, 196

Podelooma, 197

Perforatmg Ulcer of the Foot, 197

Syphilis Cutanea, 198

Lepra, 213

Pellagra, 217

Epithelioma, 217

Paget's Disease of the Nipple, 221

Sarcoma, 222

Class VII. — Neusoses, 224

Hypersesthesia, 224

Dermatalgia, 224

Anaesthesia, 224

Pruritus, 224

Class VIIL— Paeasitic Affections, 227

Tinea Favosa, 227

Tinea Trichophytlna, 230

Tinea Versicolor, . 239

Erythrasma, 241

Scabies, 242

Pediculosis, 246

Pediculosis Capitis, 24()

Pediculosis Corporis, 248

Pediculosis Pubis, 250

Cysticercus Cellulosae, 251

Filaria Medinensis 251

Ixodes, 252

Leptus, 252

CEstrus, 253

Pulex Penetrans, 253

Cimex Jjectularius, 253

Culex, 253

Pulex Irritans 254

Appendix, 255

Atlas References, 255

Statistics 260

Index, 262

OP THE SKIN.

The Epidermis.

i>W\

-'^^^ZiJ^^

e, corneous (hornj

TbeHratumlut

Berra teimlaBtloiw

) laysr; ff, gta
iWumLlhel-y
-•.BfltoenlnBi

er Just nbote the griDular ]
TB;».tapmiiialaBrTabulb.i

lyer {reW Mnlpigl.U).

; (, cell of LaugerhauB.
lAflff fimvtor.)

ANATOMY OF THE SKIN.

The BloodveBselB.

ttepMermls, &,iiarinni, P,tiiplll(e,

Df«P pleiup Eb phrtif hHdwd *t I
dlB» pIciM, BU oulgrowlli tror

1^^ glri=B»

glTlDg > loop to tulc ptpllU. {Aflir Bamlar.)

?, *w*a.-glaod dDct.

erfli;!*], or papillair plelus) of Ihe pRpllI
ver margin of the d^agnini ; iu— ad Inlflrn
upplylng iweiii-gUiids, ■.

DI8E.i8ES OP THE 8

The Nervous and Vascular PapillBB.!

DISEASES OP THE BKIN.

SYMPTOMATOLOGY.

The MJinptom
OT both ; und in

IS disoanu may be ijlijective, aubJctive
a, abto, tliore may he syateiuic disturb- J

What do you mean by objective symptomB ?

Thdse Hyaiptfliua visible to the eye or t*jueh.

What do you understand by subjective symptoms I

Those whii;li relate to seusutiou, such as ifcliiug, tiiighng, burning,

puin, toudemeaa QDd heat '

What do you mean by systemic symptoms ? '

Those generJ ayia])tuma, alight or [jrofuuud, which are iwmetimea J

aasuciated, primarily or aocondari]y, with the eutaneuuH diaease, as

mplc, the Hystemio diatorbojiue in leproay, pemphigus, aud purpnni J
heiuorrhugica.

Into what two classes of lesions are the objective symptoms
commonly divided t

Primary (or elementary), aod
Secondary (or consecutive).

Primary Lesions.
What are primary lesions ?

Those objective leaioiin witliwliieh cutaneous diaeaaes begm. They
may continue us such or may undergo modification, piisaiug into the
secondary or consecutive lesiomt

Enumerate the primary lesions.

Macules, papules, tubercles, wheals, tumors, vesicles, bleba and
pustules.
What are macules (macnlsB)?

Varioualy-sized, ahaped and tinted spots and discolorations, with-
out elevation or depression ; as, for ciamplo, freckles, spota of
purxnuu, macules of cutaneous syphilis.

sntPTOMATCii^aY. 23

What are papules (papols) t

Small, ciFciimscribed, solid elevations, rarely exceeding the size of
a gplil-pea, and usually saporfidally seated ; as, for example, the '
jjapulea of eczema, of aiHie, and of cutaneous ayphilia.
What are tuhercles (tnbercula) 1

Circumscribed , auliil elevations, coromonly pca-siEcd and usually I
deep-aeattd ; aa, fur example, the tuberclea of syphihs, of leprosy, [
aud of lupus.
What are wheals (pomphi) ?

Variously-sized itud shaped, whitish, pinkish or reddish elevations,
of an evanescent eharact^T ; as, for example, the lesions of urticaria,
the lewuna produced by the bite of a moiKiuito or by the Bdag of a I

What are tnmon (tnmores) ?

Soft or firm elevations, usually large and prominent, and having I
their sent in the corium und suhtiutaneuus tissue ; as, for example,
sebaceous tumors, gummata, and the lesions of fibroma.
What are yeBicles (vesicnlffl)?

Pin-head to ]K!ft-sized, eircuniscrihed epidermal elevations, contain-
ing serous fluid ; aa, for example, the ai-called fevcr-blistere, the
lemons of herpes zoster, and of vesicular eczema.
What are blehs (bnllEe) 1

Rounded or iiTcguliirly-shaped, pea to egg-sized epidermic eleva^
tions, containing serous fluid ; in short, they are essentiully the same
as vesicles, except as to size ; as, for example, the blebs of pem-
phigus, and of rhus polsoolDg. *
What are pustules (pnstnlee) 1

Circumscribed epidermic elevations containing pus ; as, for ex-
ample, tho pustules of acne, of impetigo, and of aycoMS.

Secondary Lesions.
What are secondary lesions ?

Tliose lesions resulting from accidental or uatumi chau
cation or termination of the pruuary lesions.

24 DISEASES OF THE SKIN.

Enumerate the secondary lesions.
Scales, crusts, excoriations, fissures, ulcers, scars and stains.

What are scales (squamae) ?

Dry, laminated, epidermal exfoliations ; as, for example, the scales
of psoriasis, ichthyosis, and eczema.

What are crusts (crustae)?

Dried effete masses of exudation ; as, for example, the cnists of
imi)etigo, of eczema, and of the pustular and ulcerating syphiloder-
mata.

What are excoriations (excoriationes) ?

Superficial, usually epidermal, linear or punctate loss of tissue ;
as, for example, ordinary scratch-marks.

What are fissures (rhagades) ?

Linear cracks or wounds, involving the epidermis, or epidermis and
corium ; as, for example, the cracks which often occur in eczema
when seated about the joints, the cracks of chapped lips and
hands.

What are ulcers (ulcera)?

Rounded or irregularly-shaped and sized loss of skin and sub-
cutaneous tissue resulting from disease ; as, for example, the ulcers
of syphilis and of cancer.

What are scars (cicatrices) ?

Connective-tissue new formations replacing loss of substance.

What are stains ?

Discolorations left by cutaneous 3isease, and which may be transi-
tory or permanent.

Distribution and Configuration.

What do you mean by a patch of eruption?
A single group of lesions or an area of disease.

When is an eruption said to be limited or localized?

When it is confined to a certain region.

vod, witliout nuy intervening

When ia an eruption Bald to be g:eiieral or generalized 1

When it is scattered, imitbnuly ur irreguliirly, over the entire
Burface.
When is an eruption aniversal "(

When the whole iutegumeut is irivi
healthy skin.

When is an eruption said to be discrete !

When the lesions constituting the eruption are isolated, having
more or lees intervening normal skin.
When is an eruption oonfiuent?

When the lesions eonstitutiiifi the eruption are .so elusely crowded
that a solid sheet results.
When is an eruption uniform T

When the lesions constituting the eruiitiun are all of one type or
character.
When is an eruption multiform ?

When the leaons eonstilutiug the ernjition aj'e of" two or niore
types or characters.
When are lesions said to be aggregated?

When tliey tend to form groupa or closely-crowded patches.
I When are lesions disseminated !

When they are irregularly scattered, with no tendency to form
groupa or palehea
When is a patch of eruption said to be circinate ?

When it presents a rounded fortu, and usually t<:ndiug to clear in
the centre ; as, for esamjile, a patch of ringworm.
When is a patch of eruption said to be annular ?

When it is ring-shiiixnl, the ecntral jiortiou being clear ; a.s, for
Bxiimplc, in eiythcwa annulare.
I What meaning is conveyed by the term " iris " t

TliB pateh of eruptiun ia made up of several coueentric rings.
V.Diffcrenee of duration of the individual rings, usuallyHlight, tends to
■pre the iHLteli variegated colorntiou ; us, for example, in erythema

is and herpes iris.

26 DISEASES OP THE SKIN.

What meaning is conveyed by the term " maj-ginste " ?

The sheet of eruption is sharply defined agninst the healthy
flkb; as, for example, in erythema marginutuin, eczema mai^'
Tiatmn.

What meaning' is conveyed by the qnalifying term "circnia-

Bcribed"?
Tlie term in iipplied to siuiill, usually more or less rounded, patches,
when sharply defined ; as, for esample, the typical patches of psori-
asis.

When Ib the quali^dng term " gyrate " employed ?

When the patches arrange thomseives in an irregular winding or
festoon-like manner ; as, for ioHtance, in some cases of psoriasis. It
resnlts, usually, from the coalescence of several rings, the eroptiiM
disajipeariug at the points of contact

When is an eruption said to be serpiginous 1

When the eruption spreads at the liorder, clearing up at the older
part ; as, for iustunco, in the serpiginous syphilodenu.

RELATIVE FREaUETTCY.

Hame the more common cntaneons diseases and state their

Eczema, 30.4%; syphilis cutanea, 11.2^; acne, 7.3^; pedionbeifl,

456; pBoriasis, 3.3J6; ringworm, 3.2J6; dermatitis, 2.6%; scabies,

' 2.6!fe; urticaria, 2.55?.; pniritus, 2.1^; seborrhtea, 2.1%; herpes

"mplex, 1.1%; favus, 1.7^; impetigo, 1.4ft; herpes aoster, I.2;t;

, verraea, 1.1%; tinea versicolor, 1%. Total; eighteen diseases,

represeotiug 81 per cent of all cnscs met with.

(These percentages are based upon statistic^ public and private,
of the American Derraalfllogical Association, covering a period of
ten years. In private practice the proportion of cases of pedicu-
lo^ scabies, favus and impetigo, are almost nil, whilst acne, acne
I rosacea, seborrbcea, epithelioma and lupus, are relatively more fre-
quent)

OOSTAaiOUBNESS— EAPIDITV OP CL'fiE— OINTMENT BASES. 27

coirrAGioTrsifEss. |

Name the cantagioas akin diseases.

Impetigo contfigiDSii, ringworm, favus, scabies and pediculosis;
excluding the exanthemata, erysipelas, syphilia and eertuiu rare and
doubtfiU d

RAPIDITY OF CTHtE.

Is the rapid cure of a skin disease &aag;ht witti any danger
to the patient T

'Jo, It was fortnurly bo considered, especially by the public and
general profession, and the impression still holds to some ezteot, but |
i not in accord with dermatological experience.

OINTMENT BASES.

Hame the Beveral fats in common use for ointment bases.

Lard, petrolatum (or cosmuliue or vaBuliue), ixild cream and
lanolin.

State the relative advantages of these several bases.

Lard is the best all-around base, posstfitiiiig [lonetrating proper-
ties scarcely esct'cded by any other fat.

I^trolalum la also Taluable, having little, if any, tendency to
change ; it is useful bb a protective, but is lacking in its power of
penetration.

Cidd Cream (ongL aqute roste) is soothing and cooling, and may
often be used when other fatty applications diBogrce.

LanaUn is said to surpass in its power of penetration all other

baees, but this is questionable ; unless thoroughly good and fresh it

IS a disagreeable, shecpy odor and irritating properties.

These several bases may, and often with advantage, be variously

DISEASES OF THE SKIN.

What is to be added to these several bases if a stiffer oint-
ment is required ?

Simplo cerate, wax, spermaceti, or suet ; or in some instaDces, a
pulverulent substance, such as starch and zinc oxide.

CLASSIFICATION.

ITpon what basis are diseases of the skin commonly classified ?

Mainly upon pathological and anatomical grounds. A permanent
dajisification is, in the present state of knowledge, impossible.

(The classification here given is that adopted by the American
Dermatological Association.)

Name the classes into which diseases of the skin are com-
monly divided.

There are eight classes : —

Class I. Disorders of the Glands.

1, Of tJie Sweat Glands.
Hyperidrosis.
Sudamen.
Anidrosis.

2, Of the Sebaceous Glands.

Seborrhoea :

a. oleosa.

h. sicca.
Comedo.

Class II. Inflammations.

Exanthemata.
Erythema simplex.
Erythema multiforme :

a. papillosum.

h. bulloeum.

c. nodosum.
Urticaria.

pigmentosa.

Bromidrosis.

Chromidrosis.

Uridrosis.

Cyst:

a. Milium.

h. Steatoma.
Asteatosis.

* Dermatitis :
a. traumatical.
h, venenata.

c. calorica.

d. medicamentosa.

e. gangrseuosa.
Erysipelas.
Furunculus.

* Indicating affections of this class not properly included under other titles.

CLASSOTCATION. 29 ^H

Class n. Inflammations— CojtdVii/ed ^H

Anthrax.

Eczema: ^H

Phlegmoiia diffusa,

a. erytliematosnm. ^^|

Pnatula maligna.

Herpes aimplei.

c. Teaiculosom. ^^H

Herpes zoster.

d. niadidana. ^^H

DennatitiB berpetiformis.

e. pu»tnlo«nin. ^H

Psoriasis.

/. rubrnm. ^^1

Pityriasia macnliita et d

rci- g. sqnamoenni. ^^|

nata.

Prnrigo. ^H

Dermatitis exfliliativa.

^^H

Pityriasis rabra.

Acne rosacea. ^H

Lichen :

Sycosis. ^M

n. plantis.

Impetigo. ^H

6. niber^

Ecthyma. ^H

Fempbigus. ^H

Clabs m. Hemorrhaoes.

a. Bimplex.

b. tia^tnorrb^ca. ^^^

Class IV. Hypeeiteophies.

1. Of Pigment.

Lentigo.

Chlonama. ^^^^^H

Keratosis.

Veriiica ^^H

a. pilnria.

Verrncanecrogenioi. ^H

6. seniJia.

Nscvns pignientoaiia, ^^|

Xerosis. ^1

CalloeitWL

Ichthyods. ^H

Clavua.

ODyrhnnxifl. ^H

Com a CQtanenm.

Hypertrichosis. ^H

5. Of Cmiuxtim Tmue.

■

Rosaceu: ^^H

Scleroderma.

Horpho^a.

6. h}-pertrophica. ^^H

Elephantiaaia.

■^'"^ ^

DISEASES OF THE SKIN.

Class V. Atrophter.

Of Pigment

Leucoderma.

Vitiligo.

AlbinLsmns.

Canities.

Of Hair.

Alopecia.

Atrophia pilomm propria.

Alopecia farfuracea.

Trichorexis nodosa.

Alopecia areata.

Of Nail
Atrophia angnis.

Of Cutis,

A trophia senilis.

Atrophia maculosa et stria

Glass VI. New Growths.

Of Connective Tissue,

Keloid.

Neuroma.

Cicatrix.

Xanthoma.

Fibroma.

Of Muscular Tissue,
Myoma.

Of Vessels.

Angioma.

Angioma cavemosum.

Angioma pigmentosum et

Lymphangioma.

atrophicum.

Rhinoscleroma.

d. tuberculosum.

Lupus erythematosus.

e. gummatosum.

Lupus vulgaris.

Lepra :

Scrofuloderma.

a. tuberosa.

Syphiloderma.

h. maculosa. '

a. erythematosum.

c. ana^thetica.

h, papulosum.

Carcinoma.

c. pustulosum.

Sarcoma.

Class Vii. Neuroses.

HypersBsthesia :

a. Pruritus.

AnsBsthesia.

h. Dermatalgia.

aS DISEASES OP THE SKIN,

acU'riiiil liy iin incrcnKed production of sweat. This
bi! Blight ur eii^ssive, local or gL^iieraL

As a local affeotion, whatpartB are most oommonlyinvoIvedT

The hands, feet, espeoiaUy tlio palmar aud plantar surfaces, the
axilla and the geuitalia.

Seicribe the symptoniB of tbe local fomu of hyperidrosu.

The eaBeutiul, and freiiaently the hoIo symptom, is more or 1
profuse sweating.

If the hands are the parts involved, they are noted to be wet, 1
clammy and sometimes cold.

If involving the soles, the skin often becomes more or lees ia»- 1
cemted and sodden in appearance, and us a result of thiamaoeFatioa J
and continued irritation they may become inflamed, especially about J
the borders of the aflfeeted parts. The Hw«at undergoes change and ■
becomi* offensive.
la hyperidroBis acute or chronic ?

UituaUy chronic, although it may also occur as nn ocut
What is the etiology of hyperldroEls ?

Diibility in ciiiunionly the cause in general hyperidrosi
fiinnti arc jirubably ucurotio in origin.
What is the progrnosiB ?

Tim Jiseiise is UNually persistent and often rebellions U
in niiiny irisfcinrcs i\ poniiHTieiit cure is possible, in other
IWi,i.Ki«arcn.,tuiii'ojniNon.

What constitutional remedies are employed in the treatment
of hyperidrosis t

Ergot, belladouna, gallic acid, mineral acids, and tonics. Conslj- •
tutionul treatment U rarely of benefit in the local forms of hyperi-
drosis, aud external applications are seldom of service in general j
hyijoridi'osis.

What external remedies are employed ij
the local forms of hyperidrosie ?

Astringent lotioTis of zinc Mulphatu, tAJinin a
oral times daily, with or without the supplemi
powders.

; the lot

1 the treatment of
111 ulum, applied si

D180RDERB OP THE GLAND9. 33

Dusting- powders of starch and borio acid, to wliith may be added .
twenty to forty graina of Halitylio aciii to the ounce, to be used freely
and oft«n : —

K. Pulv. ae. Balicylici, gr. xi-xl

PuIt. bc. borioi, 3 ij

Pulv. amyli 5vj. M.

Diachylon oiatment, and an ointment containing a drachm of taa-
nin to the ounce ; more especially applicable in hyperidroaia of the
feet. Tlio parts are first thoroughly washed, rubbed dry with towels
and dusting-powder, and Ibo ointment applied on stripe of musUa or
hnt and bound on ; the dressing is renewed twice daily, the parta
each time being rubbed diy with soft towels and dusting-powder,
and the treatment ountinncd for ten days to two weeks, after which
the dusting-powder is to be uaed alone for several weeks. No water
ia tobe used after the firstwaahiug until the ointment is di3continued.
One Buch course will ordinarily suffice, but not infioqueutly a repeti-
tion is necessary.

What is sudamen 1

non-inflamniatory disorder of the sweat-glands, cbar-
d bypin-point to pin-head-sisud, isolated, sniKrGeiuJ, trauslu-
oent whitish vesicles.

Sewribe the dinioal characters.

The lesiontt develop rapidly and in great numbers, either irregu-

Jariyor in crops, and are UHually to beseenaa discrete, closely-crowdod,

L-whitish, or pearl-colorcd minute elevations, occurring most abun-

iDtly upon the trunk. In appearance they resemble minute dew-

■diopa. They are non-inflammatoiy, without areola, never become

■pumtent, and evince no tendency to rupture, the fluid disap[)eanDg

'y absorption, and the epidermal covering by subsequent de8(tuama-

34 DISEASES OF THE SKIN.

Oive the course and duration of sudamen.

Now owps may appear a^ the older lesions are disappearing, and
the afftvtion jxTsL^t for stime time, or, on the other hand, the whole
pnxvss may oiniio to an end in several days or a week. In short,
the course and duration depend upon the suhddence or persistence
of the cause.

What is the anatomical seat of sudamen I

The vesicles are due to collection of sweat in some paj-t of the
sweat-gland duct or epidermis.

What is the cause of sudamen ?

Debility, especially when associated with high fever. The erup-
tion is often seen in the course of typhus, typhoid and rheumatic
fevers.

How would you treat sudamen?

By (constitutional remedies directed against the predisposing factor
or factors, and the aj^pliciition of cooling lotions of vinegar or alcohol
and water, or dusting-powders of starch and lycopodium.

Anidrosis.

Describe anidrosis.

It is tli(? oj^posite condition of hyperidrosis, and is characterized
})y (liniimition or suppression of the sweat secretion. It occurs to
Honi(! (JxU'-rit in certain general diseases and also in some affections of
tlu! skin, Huc-h as ichthyosis ; nerve injuries may give rise to localized
HW(Mit KUppn^Hsion.

TreatuK'nt is })5ised upon general principles ; friction, warm and
hot vapor }>uths, electricity and similar measures are of service.

Bromidrosis.

{Synonym: Osmidrosis.)

Describe bromidrosis.

IJroniidrosiH m a functional disturbance of the sweat-glands charac-
tcrlKiul by ii HWcMit wicretion of an offensive odor. The sweat produc-
tion may bo normal in (|uantity or more or less excessive, usually the

DlSORDEUa np THE (ILANPS. ^5

latter. The conilition may be liitalorgeuenil, t-ominonly the former.

It is closely allied tii hyijeridroKis, and may oftuii be considered

ideutiual, tiie odor resulciiig from rapid dcoumpotiition of the EWeat

secretion.

What parts are moat commonly affected in bromidrosis t

The fi^ot and the iisIUffi.
What is the treatment of bromidrosis 1

It ia Bssenljally the game aa that of hyperidiusis {q. v.), con-
slating of appiicationa of astringent lotions, dusting- (wwders, espe-
cially those contftining boric acid and salicylic acid, and the continu-
ous application of diachylon ointment.

ChromidrosiB.
Describe ohromidrosis,

This in a rare functional disonler of the sweat-glands charactemed
by a aecrctiua variously colored, and usually increased ia quantity.
It is, as a rule, limited to ii cireuniscribed area. The most common ,
color is red. The condition is probably of neurotdc origin, and tends ]
to recur.

Treatment should be ioTigorating and tonic, with special
toward the nervous system.

TTiidrosis.
Describe nridrosia.

Uridrosis is a rare condition in which the sweat secretion contains
the elements of the urine, eapwiially urea. In marked cases the salt
may be noticeable upon the skin as a colorless or whitiah crystalline
deposiL Id most instAnces it has been preceded or oecomptuiied by
partial or complete suppression of the renal fiinctions.

Fhosphoridroeis.
Describe phosphoridrosis.

ihoridrosis is a rare condition, in which the sweat is phos

It has been obaerred in the kt<!r stages of phthisiB, in

t, and in those who have eaten of putrid fish.

DISEASES np THK BKtir,

Seborrhcea.

{■^)''i*f*»: SSrUf-nbce»; Acur rebtcr* ; IchtliToria M

What U seborriiea T
SoboirboKi is a fiinftkiD)i] disease of the wbaceoog glaods, chantO'

matter, appearing o

\'l perhaps abaonnsl, secretion of sebaoeoiu
llie skin as lui oily oDstiiig, cmsts br ecale&.

At what age la BeborrlitBa usually observed?

OoiiiiMciily ]i<'tw<H<ii t}i(i uKiiH <if flflecn and forty,
uvi'i'i mv'iir ut imy nnv.

It muy, how-

DiaORDERS OP THE GLANDS. 37

Name the parts most commonly affected.

The scalp, laco, and (\aeii frequently) tbe stemaJ and interscap-
ular regions of the trunk. It is rarely seen on other parts.
What varieties of Eeborrhcea are encountered ?

SuborrliflBa oleosa and scburrhcea sieva. ; not iufioiuently the dis-
ease is of a mixe'l type.
What are the symptoms of seborrhoea oleosa ?

The sole Bymptwin is an uimatuml oilinuss, variable as to degree.
Its most common site ia the region of the aose and forehead. In
ooca^uual iostaoces mild rosacea coexists.
Give the symptoms of seborrhcea sicca.

A variable degree of greiiay scaliuess, usually seated upon a pale
or noQ-inflanimatory surfape.

The parts affected are covered scantily or more or less abundantly
with somewhat greasy, grayish or brownish-gray scales. If the scalp
is the i>art involved {dandruff), small particles of scales are found
I scattered through the hair, and when the latter is brushed or combed,
n the shoulders. If upon the face, in addition to the scaliiiess,
the sebaceous ducta are usually seen to be enlarged and filled with
I sebaceous matter, and in some instances the skin is more or less
hyperaetnic ; aod even mild iuflamma^Jry action may be present
(ftae»i« ifborrhmciim).

Describe the symptoms of the ordinary or mixed type of the
disease.

It is common upon the scalp. Theskin is covered with irreguhtrly
diffused, grcafiy, grayish or brownish scales and crusts ; ia some cases
moderate in quantity, in others so great that large, irregular masses
are formed, pasting the hair Ui the scalp. If removed, the scides and
crusts rapidly reform. Tbe skin beneath is found pale or slato-col-
ored. Extraneous matter, such as dust and dirt, collect upon the
parte, and the whole mass may be«>me more or less offensive. There
is a strung tendency to falling of the hair. Itching may or may not
be present.
Describe the symptoms of sehorrhcea of the trunk.

Seborrliuiii corjuiris differs iu a niea»ure, in its, symptoms, from
aeborrhoia of other parts ; it occurs as uue or several irregular or lard-

v^Kiu .*> ^>> ^\.^^ -■ r*i5<>. buuJr 3iii«teraGks In •411SUICUI7. and iipoD
-t>it.t.'0 >kvu ii\,.i .::v >^Lrri;sJ. ?t;rvu Jt Tip«ia diii bat!k between the

N-V«^*Mvo/^\ . .\.'» ...V. .-.u a><;i>K' rriiTTujr in incewiiy from tzme to

t*'»>'»>' x IX' vti.j^n r^>CN ii>;i»ic ^"CLT. GeoeElI ieblEbq^^ ai MK i M J^

vM\i*w^^ '^Nv*''^;** uui >;:ui ;sr a' mil cit'us^ ire w be twm&^ looked

t'» A'MK' N..^.Mvvx^ V**nv\ r .;U" l*>v:i£«*? >«^!m> w be due to loas of
b*»* '■■'^' i';*-»Ws rtxi >K:t, «.u; ro \' jutireiy iihieptaident of any

^Um-^, »>; i^M»»»* »»»^'tt v'k' *iv- •^ \--'t,; v>>irt<*.c:iCvvI .^t the <ebiiceo<Kssecre-
v»»^v» vi'»vti,l».^l v^>;;.^ 'Vv»» ; ■ V ;•;iMv;^ .t'u; .;uvC5\ anil Uioie Of ktSB extn-

V\^\^\\ y\\y ^>\\\\ \\\\\\ xv^<u\ .<mn\ m*Hxi5>b: ir^va tho face, with
\\\y\u s^\\\\\m^\\^\\*' s^\\{ \v-«\«u . .ukI v^vw chc tnuik. with pgori-

I4*'»»v^^\, n^»u.^q|u, \\\\\\ \\\\\\\i^ ovytUom.^tvvKU.^ xirx^ \li!^\i2^'s in which
llu*u» •\u» tlhMuvl ^'A>"«m«iV\*«NV x'^'M^I'^o'H.^ suoh as thiAoniug and
iutllhalUtu t\\\\\ w^Uw^rx^ \\my^^\\^\\ \>9k^v\^\i^ tuul this hokis true as to
Hiiunvmuu uIw», oiH'Uin \\\ tA\m\\\y ^IoAiuh), oit\nu«j^«nlHHl j^Uoht^ and
lupud itv.vtIioiuatitnMM luiM w (Hvulmv viohuHHmi^ tint and an olovateil
uiul muraiuuli* Imhlor, A n»ioi\MiH»pio oxiuninatlon of tho opidermic
MM'u]>inMH would Ih« ornnrml vuhio iti ditloivntiatiug troiu riugwonu.

[

THE GLANDS. 30

What is the progaosis in Beborrhoea ?

Favombla All types are curable, and when upon the non-haiiy
regions, usually readily so ; upon the scalp it is often ubstmate.
Relapses are not uiicoumon.

In those cuaea of aeburrhoea oipitia which have been long-con-
tinued or neglected, and attended with losa uf hair, this loes may be
more or less permanent, although ordinarily much can be done to
prumute a regrowth (see Treatment of Alopecia).

How would yon treat seborrhiBa of the scalp ?

By constitutional (if indiBited) and local remedies ; the former
having in view correction or modification of the predisposing factor
or factors, and the latter removal of the sebaceous accumulationB
and the application of mildly stimulating ointments or lotions.

What remedies are commonly employed in the oonstttntional

treatment of seborrhceai

The variiiuM tonics, such as iroo, i^uinioe, strychnia, cod-hver oil,

senic, the veget^ible bitters, Lisatives, malt iiud similar prepara-

tions. The line of treatment is to be biiscd upon indicatiuna. In

some instances calx snlphurata, in one-tenth to one-fourth grain

five times daily, proves of advantag&

Describe the methods of freeing the scalp &om the sebaceoas

accumulations.

In mild ty]»'s of the disease shampooing with simple Castile soap

(or any other good toilet soa|)) and hot water will suffice ; in those

which there is considerable scale and crust formation, the

tincture of green soap (tinct. saponis viridis) is to be employed in

place of the toilet soap, and in some of these latter casea it may be

neoeasai? to soften the crusts with a previous soaking with olive oil

The irequeni^ of the shampoo depends upon the conditions. lu

mild cases, once in five or seven days will be sufficiently frequent to

^keep the partis clean, but in those cases in which there is rapid
«ale or crust production, once daily or every seoond day may at first
"be demanded.

Name the local applications nsnally most effectual in sebor-
rhcea of the scalp.
Sulphur, amuiuniated miircury, salicylic acid and rcsorein.

40 DCSXASS^ or THE SKIN.

S-sJl'vc:-!.: is> u.?<*.: i=. :h^« :- •cm i.^f aA ointmeiit, one to thiee draohiDS
iv. :h^' .vLU'A. A*^:ii-.<iiuL:oi metvarr. in the form of an ointmeDt,
;wt:-.:^ :v >jt:Y ^ri.iui> to the oaiKe. Salkylic Mad, either alone as
Ail >;:::u:.c:. :w-f.:y :.. f.-rty grains u> the ounoe ; or it may often be
jb^kUv. w*.:h jkiv-jL:-.;x|:t^ i-j. ihe ^uinie piopoitiun, to the sulphur or
jk:uu;.-^'.jh:o.: *jiivr^-ary viuinK'nt al!OTe named. Reaorciii, either as
An o:'.:t:u>;-.::. ;wv":y :o >ixty jcnizks to the ounce, or as aa aloohc^
or AwiUvvu> '.vC;,'£i. jl> the folio win^ : —

K . KecjikWicii. 5 :

Ol rivitti

AUv'tlK'Ii^ f 5 iv. M.

Ix ^vi AK{\x<sMii^ \«Im\ b do:iir:ibk\ then in the ahove fbrmuhi the
\Uoiiiu rioiui i^ r^^pU^wl with ^rlyvx'iine juid the alcohol with water.

How are the remedies to be applied !

A siuaII viu,u«itY v*t* tho k^iiou or ointment is to be gently, but
lho»\ni,»;hl\\ rviMwl into tho ^^.m: in the beginning of the treatment,
oiKV or twkv \hil>\ laor» h5 the dLse;i5e becomes less active, once
evox>' 5<\\nul v»r tlurvl day.

How it aeborrh«a upon other parts to be treated ?

In tho siuuo gx'ih'ntl lUiumeras seWrrha\) of the scalp, except that
tho Kn'id a|»pliOiaious must U* s^nuowhut weaker. The several std-
phur lotions ompK\\\Hl in tho tn\ument of acne {q. r.) may also be
ustnl when tho dis^^a^* is uik»« tht^^ iKUts.

Comedo.

What is oomedo I

Comotlo is u disH>nUT of tho sk»UutH>us jrlaiids, characterized by
yellowish or bhiokish pin-|K)iut or pin-hoad-siied elevations corres-
ponding to tho gland orifices.

At what age and upon what parts are comedones usually
found?

Between the ages of fifteen and thirty, and ui)on the face and
upper part of the trunk, where they may exist sparsely or in great

DlSORDERg OP THE

numbers. If numtrous, tbuj ajij apt to give the iiartti a greiisy or
soiled appiarjni!e.

SeBcribe &a individiiEil lesion.

It is pm-point to piii-hcitJ in size, dark yellowish, ami usually with.
a central lilaiikh puint (henco tho name b/ackhettth). Thare ia
Bcarcely perueptible elevation, unices tte anjuunt of retained secre-
tJun ia excessive. Upon pressure this may be lyected, tho small,
rounded orifice through whlcli it Ls expressed giving it a tlirtiid-like
shape (heuce the namoj^enA-ioomw),

What is the usaal coarse of comedo ?

Chronia The lesiona niay jwraist indefinitely or the condition
may be sutucwhat varuiHt- I ma, y nsta ceactlirjaareslt t
pressure or u consequence f hcinical hange n th stlacei is

I l^ugB, iuflanmint n s ex ted u d a* suits. TIi tw dit una

Rare, io fcct usu lly aaaocmtod

r.To what may comedo often be ascribed?

To disonlorn of difjivstion, constipation, chlorosis, menstnia] dis-
Jtorljanci:, lack uf tone in the muscular fibres of the skin, the infre-
[!4ii(:nt.uue of soap, and working in a dirty or ilu-sty atmosphere.

A Btnall parasite {(fcrnexfec /offiWont/n, acarwi folUcuiiirum) is
lometimes found iu the siobaccous mass, but its presence is nwi-
iM without etiological siguificance. It is also found iu
|healthy ii^lliJes.

liat is the pathology of comedo ?

I The sebaoeoua ducte or glands, or both, become blocketl u|> with
AJoed sooretion and epithelial ccUs. The dark points which
y mark the lesioue arc probably due to accumulation of dirt.

• •

IiISEASfi^ Cff

> lui: wrii-> muiii;;i!i uua iliest mt- dnc- w iStkt jvesaifle of pigment
f:r:uiui^> nsuiMui r-'iiL riituiiiml (duoioe in the flefaaoaoiis nutaja.

Is tberf ATT n'ffimtT tn fhr itii£iiMrii rf ti— uiiLiT

N • :i .-:ii >..:ir:':-\v }« cuinliimidftd whih ndfiim^ as in tliia latter
ii:>. :l^: :!i: i.>^i II h:b^ IK OTH'X idok^. HO Uack poont. tuxi the oun-

Give ibf BTfiiriiosu of octiimId.

Tiu ri^uii ot tri'jiriiit*-ii: i> iisqi&]}t iaTonUe, •V^ongh the disease

How wonid yon treat a ctue of i»Ui»dA ?

TiK v-'iTisriruii.iii:!. muinu:.'.m 2tiiii> la cvorMtian or pftDsatioii of the
]>r-.*;iS:» »iiic cMT).']}ii »ii>. :a)d ibt- txtc^roal apjiBcaiaoos hare in Tiew
hTi'jii vikl c,{' xhi si'ibuVv'Ui^ ]iiGp> ftD.i ^^mnknon of tbe gla&ds imd

Comedo Extrac^^ir.

Vame the systemic remedies commonly empb jed.

C-itd-livfT oil, ii\-»ii. quinine ajs<*nic^ nnx vomka and other toDiGS ;
erp.t in thii^jo caj^o? in which thoro is ld<^ of mu^eolar tone, salines
an»l ajxriont ]iill< in ^v»nsiiivition. Calx sulj^hurata, in doses of one-
tenth to (ine-fiiunh grain four or five times daily, is oocasioDalfy of
advantac"o. Tlie digi^tion is to K? Kx^ked after and the bowels kept
regular ; indigosstiblo f».x>d of all kintis is to W interdicted. * Hvgienic
measures, such as oiK>n-air cxeivi^\ are often of service.

Describe the local treatment

Steaming the fiice or prolonged applications of hot water ; wash-
ing witli ordinary toilet stiap and hot water, or, in sluggish cases,
using tincture of green soap (tinct saponis viridis) instead of the
toilet soap ; removal of the sebaceous plugs by mechanical means,
such as lateral pressure with the finger ends or i>erpendicular pres-
sure with a watch-key with rounded edges, or with an instrument
specially contrived for this purpose ; and aft^r these preliminary

DiaaHnERS riF the oi^nds. 43

(, wiiit-b abnulil be Ciirriecl out cYRry night, a stimulating
sulphur or mercurial uiatnient or lutiau, bugIi as tMuplDytuI iu the
treatment Cif aene {q. v.), ia to be thoroughly applied. The follow-
ing is valuable : —

a . Zinci Bnlphatis,

Potossii sulpbDreti, . ■ . , on . . . . ,^j

Aqum rosiB, 3 iv. M.

Should slight scallnesa or a mild degree of irritation of the skin
be brought about, estemal treatment Ih to be disuuntJuued for a. few
days and Bootliing applicatious made.

MiliuzQ.

(Sgnangmt : GrulDm; Strophuliw Albidui,}

What is Dulinm f

Milium consists in the fonantion of small, whitish or yellowish,
rounded, pearly, non-infliimmatOTy elevations situated in the upper
part of the corlum.
Describe the clinical appearances.

The lesions are usually pin-head in siEe, whitish or yellowish, seem-
ingly more or loss translueeot, rouaded or acuminated, without
aperture or duct, are superficially seated in the akin, and pnyect
sUglitly ubove the surface.

They appear about the &ce, espeeiidly ubout the eyelids ; they
also, although rarely, upon other parts. But one or

■eral may be present, or they may exist in numbers.
What is the conrse of milium T

The leaiuQM develop sliiwly. and may then remain stationary for

Their preaeuce gives rise to no disturbance, ami, unleKa they arc
Urge in size or exist in numbers, causes but slight disfigurement. In
rare instaucus they may undergo calcureuus metamorphosis, consti-
tuting the Bu-called culaiieoiui calculi.
What ia the anatomical seat of milium ?

The WiUicuuus gland (pnjlmbly une or HeVer.il of the supLifieiolly-

44 DISEASES OF THE SKDI.

:»itiuited acini), the duet of whleh is in \sojme manner ofalitemted, the
sebucei>a:3 matter euUeet:^, becomes inspisisated and cakareoos, ^xrm-
ing the pin-heti«l lesion. The epidermis is the external coYering.

Is milimn amenable to treatment ?

Yes ; promptly s»3.

What is the treatment ?

The nsual pLin is to pric^: or incise each lesion and press out the
ct^ntents. In some milia it may be necessaiy also, in order to pre-

¥16, 10.

=^1 -"

Milinm Needle.

vent a return, to touch the base of the excavation with tincture of
iodine or with silver nitrate. Electrolysis is also effectual.

Steatoma.

{Sifnontftna: Sebaceoas Cyst; Sebaceous Tumor; Wen.)

Describe steatoma.

Steatoma, or sebaceous cyst, appears as a variously-sized, elevated,
rounded or semi-globular, soft or firm tumor, freely movable and
painless, and having its seat in the corium or subcutaneous tissue.
The overlying skin is normal in color, or it may be whitish or pale
from distention ; in some a gland-duct orifice may be seen, but, as a
rule, this is absent

What are the &yorite regions for the development of stea-
toma?

Tlie scalp, face and back. One or several may be present.

What is the course of sebaceous cysts ?

Their growth is slow, and, after attaining a variable size, may re-
main stationary. Tlujy may exist indefinitely without causing any
iii(M)nveniencxi Ix^yond the disfigurement. Excei)tionally, in enor-
mously distended groMrths, suppuratiou and ulceration result

What is the piOiiiilogy !

A steatoma is a cjst of the selaiEiKKB Aad sxri 'Iki. f rviaffifl
by retained seoedoD. The comenis masj ht hxri a£id ^skLk^ «r>ft
and cheesy, or eren Ifadd, of si enjKh. vLftM -or j»&/«i^ 9>kr,
and with or without a fiitid c^jt : tbe BUft ^icis^QBf -fjif im dr/fgL
epidemuc edk, chofalftiB, and fooKdiKS haas.

Are sehaeeoos ejsto ffloety to be i <Mfiw Mki witli

No. Gummata grvw wore c^^ijj. «% oi^aaCj pabuM &> tLie
touch, are not fiie^ mofable. and uni v> ir»ak ^/n at&i vjoent^

Describe the treitMent of steatosa.

A linear indaoo w madie. azud tLe uxau* mA ecr^j^rxsz v^ di^
sected out If the sae is yamjwA Vt nfUsnisL. i«^^y2%tMtoi HtufjiSi
invariahly takes plaee:

CLASS IL— ngTiAlfflfATIOML
Erytliciiui Siniplcx*

What do yofa mdenlaiid bj erythefluiiimplex I

Ebytheiiia smplex is a hjpefawLy: di^>r>T f:\*;drw^umM \jt red-
ness, oecorriDg in the ^^rm '/f r^ry^u.^Jj-^^dzi^l ^j'i it\i:ti\AA, diffuis^
or ciiciiinscribed, DOD-ekrra&ed paiuiit^

Vame the two general daases into whieh the simple erythe-
Mata axe divided.

Tdif^Mthie and qrmptoBaatic,
What do jom inelade in tike idiopathie class ?

Those efythemas Ane Ut erumal cuL«#::f^. »if:L a* cr^ and heat
(erythema ealoriemm). xhh avitif/O of th^ son ^*^n^.heina MfMr^). tran-
matism (€rylh0!ma trauma/Acmm)^ aufl th^ Taii>arfp^>ii!<.^Ds or chemical
irntants (eryC^oana vetusMAmm^.

What do jom ToyAmiB in the symptomatic class ?

Those rashes often pr*^:*^iu'4 or arsor^mpjirjTing certain of the srs-
temic dMM>a««i^ aoi tlvj^ da'; U* di^>rieni of the dige^Te tracts and
to the ingestiMi of oertaiu diws.

4f'^ PISEASIS OF THE SKIN.

Describe the symptoms of eiythaiia simplex,

Tiio i^sMiitial spii)<*«m 15 n-dness — simple hjpersemia — ^without
olr\ati.*n «>r ir.iiiinuivn. dii^ppi'^riuff nnder pressure, and sometimes
ntton*u>l by >l;i:liT heat or burning ; it may be patchy or diffused.
In tho ii)i«>]\uhio (.-Li?^ if the cause is continued, dermatitis may

What is to be said about the distribution of the simple erythe-
mata!
T\w idio}\uluo rashes as inferred from the nature of the causes,

iuv UMiulI^v linut<\i.
Tho syniptoniatio orythom:!^ are more or less generalised ; desquap

Describe the treatment of the simple erythemata.

A wMnoxrtl of tho t\uisi^ in idio|v;«hio rashes is all that is needed,
tho ovython^a s^v^nor or lator sul^idinir. The same may be stated of
i\w sy\np<on»ano ovythoni:^;^ but in those there is at times difficulty
in \>NNViniKiivtf <ho o( ioloirioiU taotor; oi^ustitutional treatment, if
niH^^v^iny. i^< to Iv K*s<h1 u^vm* iriMioral principles.

\fi^\\\ \\y':\U\w\\{. \\\\\A\ is ran^ly neoiieil. oi>nsists of the use of
dnMinu powdoiN or nuld tN>^>li]\4r and astrinsrent lotions, such as are
iMnployod in tho t»\^;»tnuMU of aouto oi^ieiua {q. r.).

Erythema Intertrigo.

Whnf ita you nndemtand by erythema intertrigo?

MiylhoniM inlort riM:o is « hyjuMWune dist^ixler ixvurring on parts
wl»iM»» iho nulnnil IoMm of tho ^kin inmio in ixmtact, and is charac-
fiMJ^ii'd liy h»«hioMM, to whioh may W uddini an abraded sur&ce and
titniMM'iHinn nl' (hoopidonniM.

Describe the symptoms of erythema intertrigo.

Tho pkin nl'lho invnlvod n^ji^ion Ki*<)dually becomes hyperaemio,
lint iM withinit (>loviitinn or infiltnition ; a fooling of heat and soreness
iff nnnnlly ox)iorion(HMl If tho oundtiinn mrntiime, ihe increased
poi-f«i)i ration and moistura of ^' omtion of the

INFLAMMATIONS. 47

epidermis and ii mucoid diachargc ; actual inflainmsitiou niiiy uvent-
Uiilly rtsult.

What is the eonrse of erythema intertrigo f

The affuttion may piiss awiiy in a few day» or persist auveral weeks,
the duratiuu depeudiiig, in a great measure, npon the cause.

U ention the causes of erythema intertrigo.

The cuus<B are usually lucaL It is seen chiefly in children, espe-
cially in fat Huhjects, in whom friction and moisture of oontiguoua
parts of the body, umially the region of the neck, buttocks and geni-
talia, are more common ; in such, unclcanliDeee or the too free use
of soap washings will often act ait the esoiting fector. Disorders of
the stomach or intestinal caaa! apparently have a predispoang infiu-
ence.

What treatment vonld yon adrise in erythema intertrigoT

The folds or parts are to he kept from contact hy muans of lint or

absorbent cotton. Cleanliness is essential, hut it is to l>e kept

within the bounds of common sense. Dusting- iiowders and cooling

id astringent lotions, such as are employcdin the treatment of acute

I eczema (g. v.), are to be advised. The following lotion is valuable : —

B I Pnlv. calamiru^.

Paly, zjuci oxidi, U . . . . Jj

Glycerine, tTl;c)tx

Alcoholis, fgy

AqniE, Oas. M.

In persistent or obstinate cases attention Should also be dirocte<l to
I the state of the geueral health, especially its regards the digestive

Itoct.

Erythema Hultiforme.
Fhat is erythema multiforme 1

L Erythema multil'urmc is an acute, iuflanimatory disease, charaist^r-
dish, more or less viiriecated macules, papules, and luber-
ing as discrete lesions or in patches of various size and

4« I>ISEL\SE5 OF THE SKDf.

Upon what parts of the bodj does the eraptiim appear?

IVually n\Hm tlio txtreniities, especially the dorsal aspect, fitmi
tht' kiK*«? and clU.ws duwii ; it may, howeTer, be more or ksB
gt'noral

Describe the sjrmptoms of erythema mnltifiiniie.

With <»r without prccursoir symptoms of malaise, gastric tmeasi-
n<>s8 <»r rlu'uiiiatic i»ains, the eruption suddenly makes its appeaimnoe,
iu^uuiin^^an or>thematouj«, papular, tubeitrular or mixed chaiact^;
3^ a rulo. one tyiK? ()f kvion predomiDate& The lesions tend to
i!KTi»;u«<» in ^ii^c and intensity, remain stationary for several days or a
W(M>k, aii<l thon gradually fade ; during this time there may have
lK^»n outhrt'aks of new lesions. In color they are pink, red, or
vtolacoous. Slight itching may or may not be present.

What type of the eruption is most common ?

The papular, apix'anng usually u|)on the backs of the hands and
fon^anns, and not infrcciuontly, aW>, ujwn the face, legs and feet.
Th(^ papules are usually i>ea -sized, flattened, and of a dark red or
viohuHNms <»olor.

Describe the various shapes which the erjrthematous leaions
may assume.

OHcMi tli<' patrlios an* distinctly ring-shaped, with a clear centre —
nyfhnna nmnitntr.; or they are made up of several conoentaic
ringH, pnwMiting variogatt^d coloring — erythema iris; or a more or
low cxtonsivcj patch may spn^ad with a sharply-defined border, the
old<»r part t<»nding to fade — rn/fhema imirginatum ; or several rings
may (nmlcHcc, with a dis{ip|K>aran<v of the coalescing parts, and ser-
pontin(* liiKjH or bands result — eri/fJiema gyratunu

Does the eruption of erjrthema multiforme ever assume a
vesicular or bullous character ?

Yen. In cxc(»ptional instances, the inflammatory process may be
sui1i(M(M)tly int'twiHo to produce vesiculation, usually at the summits
of tlu^ papules — erythema rvsmdosiim ; or, in rare instances, blebs
may bo i'oruiod — erythrma hdlosum.

What is the course of erjrthema multiforme?

A(nU(*, the Mymptoms disappearing spontaneously, usually in one
U) three weeks.

INrLAJiMATIONB.

Mention the etiological factors in erythema nmltifonne.

The causes are obecure. Digestive diaturbitutic, rheumuticcoiiditiotis,
and the iugestiou of certain drugs are at times influcutial. It is
most frequently observed in spring and autumn months, and in early
adult life. The di)H.'iuie ia nut uueunimon.
What is the pathology of erythema mQltiforme 1

It is a mildly ioflammiittiry disunJer, somewhat Kimikr to urticaria,
and presumably due to vasoniator disturbance; the amount of exuda-
tion, which is'variublo, determines the character of the lesions.
ITaine the diagnostic points of erythema multiforme.

The mnltilbrraity of the eruption, the size of the papules, often
ilj] limitatJon to certain pttrta, its course and the entire or com-
parative abdenoe of itching.

It resembles urticaria at times, but the lesions of this latter disease
are evaneacont, disappciiring and reappearing usually in the most
capriciouB manner, are commonly seated about the trunk, and are
exceedingly itchy.
What prognosis would you give in erythema multiforme t

Always favorable ; the eruption usually disappears in ten days to
three weeks, although in rare instances new crops may appear from
day to day or week to week, and the process last one or two
I months.

' Is the course of erythema multiforme inflaenced by treat-
ment?

It ia doubtful.
What remedies are commonly prescribed in erythema molti-
forme?

Qniniit, and, if constipation is present, saline laxatives ; local
applications arc rarely required, but in those exceptional cases in
which itching or burning is present, cooling lotions of alcohol and
^ water or vinegar and water are to be prescribed.

I W DISEASBi 01- TOE SKIN, ^^^^H

Erythema NodosTim. ^^^|

Wlut is erythema aodoramT ^^^B

ED-thema iiudueuiu is itn iuflammalory affectioD, of an acute type, I

cliunicleridsl hy the fonualion of Tarioiiajy-sized, roundish, more or 1

UsB ek'Valt-d urylheuiatous nodes. I

Za there any special regiion of predilection for the eraptioa I

of erTthems Dodosmn ? I

ti*. Til.' tibml nirfaws, t.. wliicli tlie erufition is often limited ; ]

luK iiifnijuinilly, however, otla'r |i;irt* maj- be iovolved. ' 1

Describe the ssrmptoms of erythema nodosiUD. J

The eruption makes its appearance suddenly, and is TisnoIlT J
ushered iu with febrile distorbunce, gastrio uneasiueaa, maluse and fl
theuiuatia pains and swettiDg about the joiDts. The leaions vaxy in I
siie from a dienr to a hen's egg, are rounded or ovalish, tender and J
pninfUl, hare a glistening and tense look, and are of a, bright red, I
oryailMitaCous «>lor wliich merges gi^duully intn the sound skin. I
AtfinAtheyarosouiewhat hard, but later they soften and appear as M
if about to lireqk down, but this, however, never occurs, absotption I
invnriably biking place In ooiasional instances they are hemoi^ I
rhngle. I^ymphsngitis is sometimea observed. I

Are the lesions in erythema nodosum usually numerous? I

\s II rule Mill move than five tii twenty nodes are present I

What ia the course of erythema nodosum ? M

Aoiile ; the disi'ikio terminntiug usually in one to three weeka, I

As the Itiaions aro disappearing they present the various changes of H

Dolor ulworred in an ordinary braise. H

What is known in regard to the etiology ! I

llio affection is closely allied t*) erythenin multiforme, and may, I
indcwl, hf eonsideri-d an u torin of that iliseiise. It oucure most m
fVef)neiitly in children iind young iidulls, and usually in the spring
and autumn moiitha. Digestive disturbance and rheumatic jiains
and swellings are often a

MATI0N8.

What is the patholog? of erythema nodoBHiu ?

The disease is to be yiewod as an inflammatory oedema, probably
resalting, in some iimtances at lea^ from aa inflammation of the
n embolism of the cutaneous vessels.

From what diseaseB is erythema nodosum to be differenti-
ated^
■ Frum bruises, ahsce-sscs and guiumata.

How are the lesiooB of erythema nodosam to he distinguished
from these several conditions^
By the bright nui or rosy tint, the apparontly violent character of
the procesti, the number, situation and course of the lesions.

State the prognosis of erythema nodoanm.

Favorable, recovery usually taking place in ten days to several

State the measures of treatment to be advised in erythema
nodosum.

»Rest, relative or absolute, depending upon the severity of the
case, and an unstimukting diet ; internally qninia and saline
luatives, and locally applications of lead water and laudanum.

Urticaria.

Oive a definition of urticaria.

Urtienria is an inflammatory affection characterized by evanescent
whitish, piukish or reddish elevations, or wheals, variable as to size
and shape, and attended by itching, atioging ur pricking sensations.

Sesoribe the symptoms of urticaria.

e eruption, erythematous in character and con^sting of isolated
» or bean-sised elevations or of linear streaks or irre^lar patches,
mted or more or less general, and usually intensely itehy, makes
peamnce suddenly, witli or without symptoms of preceding
; derangement. The lesions are soft or firm, reddish or
Jsh-white, with the peripheral portion of a bright red color,

52 DISEASES OF THE SKIN.

and uro fugnciuiLi in characC^r, disappearing and iBappearing in the
mast oaprit'iuu:^ mauuer.

What is the ordinary conrse of urticaria!

Acute. The dLsea^e is usually at ao end in several horns or daya

Does urticaria always pursue an acute eoune!

No. In excoi>tional instances the disease is chronic, in the sense
that now Icsinns continue to appear and disappear irregularly fiom
time to time for months or several years, the skin rarefy hein^
iMitiivly free {chronic urticaria).

Are subjective symptoms always present in

Yvfi. rtching is commonly a conspicuous symptom, although at
tin]o.«i pricking, ntinging or a feeling of burning constitutes the chief
sensation.

Is the eruption of urticaria invariably of typical character!

Nn.

In what way may the eruption be atypical!

Kx(M'nt inn«lly tlio whc^als, or lesions, are peculiar as to formation, or
fiii'ifli'T cdtniitinn or disease maybe associated, hence the varieties
ttK.wfi MS intieMrin pnpulosti, urticaria haemorrhagica, urticaria tube>
nisM. Mini nrfienriji Imlhwi.

fiftfjrfJbfl tirtlcflria papulosa.

iUI \':\ih\ |ifipnloMM (formerly called licfwn urticatus) is a variety in
^vl,|.!i f!i«» l.siniiM are smnll and i)apular. They appear as a rule
, ipM. nly, tMnly in finnihei's, are si'attered, and after a few hours,
,., ,„,.,r iMf,.inMf,ly, days, gradually disiippear. The itching is
;,j. I. . I II' I ffi r'*ifi«pfpi»'tiee their npi(V» wns excoriated. It is seen
, \, ,,/;, h!m»1v hi III careil for and badly nourished young children.

^n..n<Hi^ <ffM^rtHn Hff-ttitirrhAgioa.

h.'/? ...;, I.'. (Mouli'irrlfM |u chMraet^'rimHl by lesions similar to ordi-

.; .«, '. I f.l Heif Micy Mt-f> fxittiewhnt hemorrhagic, partaking,

I.'' /^ ' H. niliHr III \\,\\\\ fitflfaria and purpura.

M»fN».Hh»i <hM»*HHh hftfhf-HNM.

id iMii-KHii \\\\u\\u>»\ f|<»< lhi4|HMM« ilM^^d ul* luiiiig pea- or bean-

INFLAMMATIONS.

! large aud iiude-Iikc (alsii Liillpd

1 wliicli the iiiflamiiiiikiry aetiuti hiis
sudatiiiM, the wlieals re-

HJzed, afl in typical urticaria, i

giant urticaria).

Sesoribe nrtacaria bullosa.

Urticaria huUosa ie a variety
beeti sufficiently great to give rise U
eultinK in tho fbrmatiou uf lilebe.

What is the etiolo^ of urticaria t

Any irritatioQ from disease, functioQal or organic, of any interoal
organ, may give rise to tbe eruptioD in those predisposed. Gastric
deraDgemeot from indigeatibie or peculiar articles of food and
the ingestion of certain drugs are often provocative, Variims rheu-
matic and nervous disorders are not intrequently assodated with it,
and are doubtless of etiological significance. Ezt«nial irritants, also,
in predisposed subjects, are at times responsible.

What is the pathology of nrtioaria 1

Anatoinicjilly a wheal is seen to be a more or less firm elevation
consisting of a circumucribed or somewhat diffused collection of semi-
fluid material in the upper layers of the skin. The vaso-motor ner-
vous system is probably the main factor in its production ; dilatation
following spasm of the vessels results in efluaion, and in consequence,
the overfilled vessels of tlie central portion are emptied by pressure

li of the eiudatiou and the central paleness results, while the pressed-

■ lack Mood gives rise to the bright red periphery.

From what diseasea is urticaria to be differentiated T

From erythema simjiles, erythema multiforme, erytheuia iioiloaum,
and erysipelas.
Keation the diagnostic points of nrticaha.

The acuteness, character of the lesioTjs, their evanescent nature, the
irregular or general distribution, and the intense itohing.

I What is the prognosis in urticaria ?

The acute dis<:a»i ii? usually of short duration, disappearing spon-
taneously or as the result of treatment, in several hours or days ; it
y recur upou ex|)osure to the exciting cause. The prognosis of
_ ronio urticaria is to Ije guarded, and will depend upon the ability
^^iaoover and remove or modify the predisposing condition.

54 DISEASES OF THE SKIN.

What lyitemio measures are to be prescribed in acute urti-
caria?

Il(uii<»val of the etiological factor is of first importance. This will
Im; found ill most ciiMOH to be gastric disturbance from the ingestion
of improper or indigestible food, and in such cases a saline purgative
in t-o lie giv«'n ; or if the case is severe and food still in the stomach,
an (?iiH't i(s Hui'h as mustard or ipecac, will act more promptly. Alka-
licH, eHp(H^ially sodium salicylate, are useful The diet should be for
the tiuK*. of a simple character.

What systemic measures are to be prescribed in chronic urti-
caria?

T\\v. (iiuHo must ho sought for and treatment directed toward its
n*tiioval or modification. Treatment will, therefore, depend upon
indications. In obscure ciiscs, quinind^ sodium salicylate, arsenic,
piltK'iirpine, atwpia^ potassium bromide and ichfchyol are to be
variously tri(ul ; general galvanization is at times useful, as is also a
change of s(M*n(^ and climatic

What external applications would you advise for the relief
of the subjective symptoms ?

Oooling lotions of alcohol and water or vinegar and water ; lotions
of earl)oli(^ m'id, one to three drachms to the pint ; of thymol, one-
fourth U) one dnu'hm to the pint of alcohol and water ; of liquor
eiir}>otiiH d(;tergeim, one to three ounces to the pint of water, or the
following : —

li. Aeidi carbolici, Sj-^iij

Acidi boriei, ^iv

(ilyecrinu), f^j

Ala)holiH, f 3 ij

Aquu) f^xiv. M.

Alkaline baths are also useful, and may be advantageously followed
by dusting powders of atarch and zinc oxide.

^^^^H INFLAMMAtlONS. 55

Urticaria Pigmentosa.

(.S:,.„,i,,M.;Xiinthcl»3mt.id6n.)

Describe urticaria pigmentOBa.

Urticaria pigmeDtosa is a rare disease, Tarionaly viewed as an
unuauaJ form of urticaria and as an urticaria-like eroption id wbich
there is an elemcut of new growth in the lesions. It begins oaually
in infancy or earlj childhood and continacs for months or years, and
is characterized by slightly, moderately, or intensely itchy, wheal-like
elevations, which are more or less persistent and leave yellowish,
orange- colored, greenish or brownish stains. In some cases sub-
jective ^niplflniB are entirely absent

The nature of the disease is obscure and treatment unsatisfactory.
Ordinarily as early youth or adult life is reached it spontaneously
disap peal's.

Dermatitis.

What is implied by the term dermatitis 1

DermiitJtis, or inflammation of the skin, is a term employed to
designate those casea of cutaneous disturbance, usually acute in
characitcr, which arc due to the action of irritants.

Mention some examples of cntaneous disturbance to which
this term is applied.

The dermatic inflammation due to the action of excessive heat or
oold, to caustics and other chemical irritants, and to the ingestion of
certain drugs.
What several varieties are commonly described t

Dprmatitia traumati(;a, dcnuititis calorica, dermatitis venenata,
and dermatitis mcdicameuUisa.

Sescribe dermatitis traumatica.

Under this head arc included all forms of cutaneous inflammation
due to traumatism. To the dermatologist the most common met
with is that produced by the various animal parasites and from con-
tinued scratching ; in such, if the c;iui« has been long-continued and
pcfdeteut, a vamble degree of inflammatory thickeuing of the skin

M niSEASKS OF THE SKIN.

imii pigmeiitaliuu reMuli, the latter not infrequently being i
lf« pcnuaticiit Tlie iiiflamniation due to tJeht-fittiiig gannei
bonilagea, etc, also illustnitea tliL^ class.

What is the treatment of dermatitis traumatica f

Bcmuval of tL« cause, and, if ne<«s.sary, the aripiiealioi
iiig oiutments or lotions.

What U dermatitis calorica I

CutitntHius inflamiuation, varying from a slight eiTthematous to
u gnngrenous lihanuler, produced by eiiieasive heat (bums) or cold
i/roilbitr).

Give the treatment of dermatitis calorica.

Ill burns, if of a mild dojirw, thu application of aodium b
llU.', iw :i piiwdor or tiiilunito<l solution, iu useftil ; in
Itnulo, It two- Ui five-iKr-t.<ent. solution will prububly be found 6
grontor ndvunttigo. Other soothing applicntiona may also be i
liloyod.

In fr(Mtliit<!, MXin imm(>diat«ly after eixposore, the parts are to be
brought Bradually lnu-'k t»i a normal Unuperature, at firat by rubbing
with tiniiw or tipplyiiig i-old water. Subsequently, in ordinary chil-
blttins, Ktimulnting npplioations, such as oil of turpentine, balsam of
i*eru, tinoturo of iodine, iuhthyol, and strongly curboUzod oijitnieDts
an of ffioRt benefit. If the frostbite is of a vesicular, pustular,
liullowi, or mwharotJo olmnictcr, the treatment consists in the ap-
{iliuutioii iif (Uiotliinjt riiiiiudies, such us are employed in other li
iiiflammiitory eoiiditinnti.

What do yoQ nnderstand bjr dermatitis venenata 1

All inflnminatJiry conditions of the skin due to contact with d
terioui BubNtAUwM iiru included under tliis head, but the n
mon cauMW tm tlio rliuit pliiiitti — -poimm ivy (or pmmon oak) and ji
»o» minuieJt {jmiMiin diiffWKul ), Mere proximity to these plants w
in Bonio iudividualH, provoke cutaneous disturbance (rAuflpowwrnifffl
although tlioy miiy be haudled by others with impunity.

Describe the symptoms of rhus poisoning.

The syni|)t.inis »]i]ii'iir usuiilly miuii iillcr fXpusure, and consist oi
an inflammatory couditiuu ul' the akin, of an ecsematous mituis, i

lNFt,AMMATIOTJS. 57

varyiDg in degree from an erythematous to a bullous chaiwter, and
witliorwitlioutceJeniaaiidswelling. As a rule, marked itching and
1 burning are present. The face, hunde, furearma and genitalia are
favorite parts, although it may in many inetaQues involve a greater
portion of the whole surface.

What is the course of rhns poiaoning?

It ruDS an acute course, temiinating in r

itU'd. h(J« .. ,

it disease.

i, temiinating in rceovery i
wei;ka. 111 thoj* eezematoiwlj inclined, huwever, it may result ii
a veritable and persistent form of thai

How would you treat rhtu poiBoning 1

I By Boothing and aatriugeDt applications, such as are employed in

l> acute eczema (,q. v.), and which are to be nsed freely. Among the

I most valuable are : a, lotion of fluid extract <jf grindelia robuata, one

' to two drachmH to four ounces of water ; lotio nigra, either alone or

followed by the oside-ofzinc ointment ; a saturated solution of boric

add, with a half to two drachma of carbolic acid to the pint ; a

lotion of zinc sulphate, a half to fimr grains to the ounce ; weak

alkaline lotions ; luld cream, petrolatum, and oxide-of-ziuc oint-

uienta.

What do yon imderstaiid by dennatitis medicamentosa ?

L Under this head are included all eruptions due to the ingestion

L'or absorption of certain drugs.

P In rare instauccB one dose will have such effect ; commonly, how-
ever, it rcsiultB only after several days' or weeks' continued adminis-
tration. With some drugs such effect is the rule, with others it is
exueplioual, nor are all individuals equally susceptible.

How U the emption produced in dermatitis medicamentosa T
In some instances it is probably due to the elimination of the drug
through the cutaneous structures ; in others, to the action of the
drug upon the nervous system.

What is the character of the eruption in dermatitis medica-
meatosa f

It may be erythematous, papular, urticarial, vesicular, pustular
r bullous, and, if the administration of the drug m contiuued, even
renoiu.

5S DISEASES OF TIIE SKIN.

Kame the more common drugs liaving sucli action.

Antipyrin, arsoiiio, atropia (or belladonna), liromideH, chloi^
wpaibd, cubeLa, digitalis, iodides, niemiiy, opium (or morphi
ijuitUDe, salitylic a<!id, atrunitiniuin aud turpeutine.

State frequency and types of eruption due to the mgestion of

antipyrin-
Nut tiiKXimmon. En/thcnuitotui, morbillifurm and orytheniato-
pajiuiar; itebiiig ia usually present and moderate desquatoat
miiy follow.

iti«^H
tioit ^

Heation frequency and types of ernption due to the in^festioit
of arsenic.
Kare. Erythematous, erytbeinato-papnlar ; esoeptionally, her-
petic, and pigmentary. Herpes zoster \viA beeu thuugbt to follow
itfl use. '

Kentlon frequency and tj^es of eruption due to the ingestion I

of atropia (or belladonna). J

Not iitinnjiUKJLi. Erylhematoi'a utid satrliitmoiJ ; Ui^ually no fet- 1

rile distiirbaiiec, and deci|UamatioQ seldom follows, I

Give frequency and types of cntaneoos disturbance following 4
the adnduiatration of the bromides (bromine). M

CiiTiiuKiri. l\iiilidar, Bumetimes furuucukr and carbuncular aii^|
mip<'rlieLitlIy uleeititive, Cii-adniiiiistration of ar^nic or jmlii i liiiiiiB
IjilHt'tratf IP lliiiugbt to liiivo a preventive influcui'e. ■

State frequency and types of cutaneous diBtu''bance due to I
the administration of chloral. I

Owwiotini: SuarJatinoid and urticarial, and exceptionally pnr>.l
jnirie: lu inrM iuRtani^ea, if drug ia continued, eruption becomeftfl
Tttximitur, lieiuurrbagie, ulierative and even gangrenous I

State ft'equenoy and types of ernption following; the adminis- 1
tratJon of copaiba- I

N"t lllH'oriPMiori, Vrlifiiri'il, eryllicmuti)-]iapu]araiKliiC(j/-ia'i'noui I

Mention fVequency and types of eruption resulting from the 1

Inffestioti nf viihobi. I

l<ii(!(iiMi<i>iii. |i!ryiliHii<kliiuit and muiuU pupukr. J

Mention frequency and types of eruption resiUting from the .
administration of digitalis.
KxcKptiwiiiL Sciirlatiiiuiii and paiiuliir.

State frequency and types of eruption resulting from the

iodides (iodine).

Common. I^mliii/ir, liut may be crythemutuiM, papular, vesicular,

bullcjus, tuberous, ])urpuric aud hemiiiThagii^ Cii-ailmiiiiatration of

lio or potiiaiiiuui bitaitrate is thought to Imvc a jirevoutive influ-

Ufla-J.C.iSeQvlTe^

rOive the frequency and types of eruption observed to follow
the administration of mercury.
Eseoptiituiil Eiylhcniatiius and cryhittelat' lua.
Qive the frequency and types of the cutaneons disturbance
following the ingestion of opium (or morphia).
Not ULifuuiumu. Erylhftuiituua iiud (TOTc/affVioiV?, aud siimetimea
urticai'iitL

Kention the frequency and the types of eruption fpUowing the
administration of quinine.

I'suiiliy riyl/ieiiti'lous, but lUiiy bu urticarial,

OF TRE SEIN,

-papuiiir, aud uvcb purpuric. Tliere is, in suiue instances,
or !U'(Miupaiiyinji; sysl*niic disturbuiioe. Furfiiniceoua or
Ji/nijuaiuiitidn iift«a followa.

Bu. jequency and types of eruption resnltiiig bom the in-
gestion of salicylio acid.

Nut oonimiiii. Erj-tiiciuatous and urti«iri:il ; esceptJonally, vesi-
culiir, (lustular, bullutis, uciJ eij;liymotit.

Give frequency and type of cntaneons disturbance due to the
adminiBtratiOH of Btramonium,
Not ouiiiuiuii. Erythematous.
State frequency and types of eruption resulting from the ad*
ministration of turpentine.
Nut uin'ipiumon, En/lkeiii-'liji"^, mul small -papular ; exception-
ally voaieuliir.

Feigned Eruptions.
What do you understand by feigned eruptions ?

Feigned, or Bjlificial, eruptions, occasionally met with in h;aterical
females and in others, are produced, for tLu purpose of deception,
"hy the action of friction, cantharides, acids or strong alkalies ; the
cutaneous disturbance may, therefore, bo erythematous, vesioalar,
bullous or gangrenous. It is usually limited in extent, and, as a rale,
seen only on parts easily reached by the hnuda.

Dermatitis G-angreenosa.
What do yon understand by dermatitis gangrsenosa ?

Demiutitis gsngrffinosa is uu exi:eediugly iiire ufiection, charactei-
iicd by the fomiatiou of gangrseuous spots and patches. It ma;
be idiopathic or syoiptomBtic

As an idiopathio disease, it begins as eo'thematous, dark-red
spots — usually preceded and accompanied by mild or grave syst«iiiic
disturbance — which gradually pass inta gangrene and sloughing ; the
eventual termination may be fatal, or recovery may take place. Aa
a symptomatic disease, it is oceasionally uict with in diabetes and in
grave cerebral aud spinal affections.

Treatment is baeod upon general principles.

IFLASIMATIONS.

Erysipelas.
Wliat is erysipelas ?

Eryaipelas is an ai^ute Hpeflific inflammation of the skin and sabentA-
neons tissue, pommonly of the fate, chaRicterisied by ahiniug red aess,
Bwelting, cedeiua, heat, and a tendency in eome cases to reside and
bleb formation, and accompanied by more or less general febrile dis-

Describe the symptomB -and oonrse of erysipelas.

A decided rigor or a feeling of chilliness followed by febrile action
usually ushers in the cutaneous diaturhance. Tbe skin at a certain
point or part, commonly where there is a, lesion of continuity, be-
comes bright red and swollen ; this spreads by peripheral extension,
and in the courae of several houra involves a portion or the whole
legion. The parts are shining red, swollen, of an elevated tciuper-
Bture, and sharply defined against the sound skin. After severnl
days or a week, during which time there is usually continued mild
or severe febrile attiou, the process begins lo subside, and is fol-
lowed by epidermic desqujtmatiun.

What is erysipelas migraiu (or erysipelas ambalans)?

tA variety of erysipelas which, after a few hours or days, disap-
^pears at one region aud appears at another, and so continues fijr ooe
\ia several weeks.

Is tlie cntanBDiis disturbance always simply erythematous in
character ?

No. In some case.s veaicU's and blebs may be present ; and in
others the disease seriously iovolves the deeper parts, and is accom-
panied by grave constitutional symptomB. In cxceptioiial instances
sloughing t^es place.

What is the cause of erysipelas ?

The disease is thought to be due to a specific microbe. Depression
uf the vital forces and loeal abrusious are predisposing.

■ State the diai^ostic points,

1 The character of the onset, the shining redness and swelling, the
iarply-defined liorder, and the accompanyiug febrile disturbance.

62 DISEASES OF THE SKIN.

What is the prognosis in erysipelas?

In most instances the disca^ mns a favorable conrse, terminatiDg
in recovery in one to three weeks. Exceptionally, in severe cases,
a fatal termination ensues.

What is the treatment of erysipelas?

Literncdly, a purge, followed by the tincture of the chloride of
iron and quinia, and stimulants if needed. LocaUy^ a mild dusting
powder, or ointment, a saturated solution of boric acid, or a ten-
to twenty-per-cent. ointment of ichthyol may be employed.

In some cases the spread of the disease is apparently controlled
by painting the bordering healthy skin with a ring of tincture of
iodine or strong solution of nitrate of silver.

Fumnculus.

{Synonyms : Furuncle; Boil.)

Define fnmncnlns.

Fumnculus, or boil, is an acute, deep-seated, inflammatory, cir-
cumscribed, rounded or more or less acuminated, firm, pain^ forma-
tion, usually terminating in central suppuration.

Describe the symptoms and conrse.

A boil begins as a small, rounded or imperfectly defined reddish
spot, or as a small, superficial pustule ; it increases in size, and when
well advanced appears as a pea or cherry-sized, circumscribed, reddish
elevation, with more or less surrounding hyperaemia and swelling ;
it is painful and tender, and ends, in the course of several days or a
week, in the formation of a central slough or ^^core,^^ which finaDy
involves the central overlying skin {pointing). One or several may
be present, gradually maturing and disappearing. Insignificant
scarring may remain.

In some cases sympathetic constitutional disturbance, more or less
marked, is noticed.

What is a blind boil?

A blind boil is a boil sluggish in its course and which exhibits
little, if any, tendency to point or break.

INF LAM Jl ATI ON S. 63

What is furuncuIoBiB ?

Fiimticulosis ia that condition in which hoila, singly or in trops,
continue to appear, irreEuIarly, for weeljB or months.

State the etiology of flinmcle.

A depraved Etateof the general health isofl^n to be ranMdered aa
a prcdiBpesing factor. The immediate, exciting cause is, according
to receut investigation, the entrance into the follicle of a peculiar
microbe.

What is the pathology of foruncle?

A boil is an iofiammatijry iiirmatiun having ita starting point in a
sebaceous-gland, sweat-gland, or hair-follicle. The core, or central
dough, ia composed of pus and of the tissue of the gland in which
it had its origin.

How would you distingniBli a boil from a carbimcle 1

A boil is comparatively amall, rounded or acuminate, and haa but
one point of suppuration ; a carbuncle is large, flattened, intensely
painftil, often with grave systemic disturbance, and ha.s, moreover,
several ecntros uf &n|)|)uratiuii.

Btate the prognosis.

When occurring in crops (ftiruncniosis) the affection is often rebel-
lious ; recoveiy, however, finally resulting, sooner or later, in every

H Wl

^^^e-

What is the method of treatment of f^inmcnlasl

If there be but one lesion, with no tendency to the appearance of
others, local treatment alone ia usually employed. If, however,
several or more arc present, or if there is a tendency to successive
development, both roustitutional and local measures are demanded.

Hame the internal remedies employed.

Such nutrients and Ionics as cod-liver oil, malt, quinine, strychnia,
ic ; in some instances eaU sulphurata, one-tenth- to
le-fourth-grain doses every three or four hours, is of service.

What ia the external treatment ?

Local treatment cfinpists in the beginning, with the hope of abort-
ing the lesion, of the application of carbolic acid to the central por-

64 DISEASES OF THE SKIS.

tjon, or ihe iise i>f a tweciy-five-per-ceot. ointment of iclttlijt
appUed aa a planter :—

8. Ichthyol, 5j

Emp. plnmbi, gy

Emp. resinffi 3j.

Or the injection of a five-per-cent. solution of carbolic acid into tb
apes of the boil niaj be tried if the formatioD is more advanced.*
If suppuration is fnlly established, evacuation of the contents, .
followed by antiseptic applications, constitutes the best method.

A satnrated solution of boric acid or a lotion of coiroEive snUi-
matc (one to three grains lo the ounce) appUed to the
neighborhood of the boil or boils tends to prevent the formation a
new lesions.

CarbTUCQlns.

(S'jiionjiiM ; Anlhrns; OBj-bnnole. )

What is carbuncle ?

A carbuncle is au acute, usually egg to palm-sized, cimunsraibed^^

phlegmonous inflammation of the skin and aabcutaneoua stmctorea,. I

terminating in a slough.

At wltat age and upon what parts is carbuncle naaally ob- I

served?

In middle and advanced life, and more commonly in men.

It is seen most frequently at the nape of the neck and upon tl
upper part of the back.
What are the symptomi and conrM of carbuncle ?

There is nirely more than one lasion present. It begins, usaalljrv J
with preceding- and accompanying malaise, chilliness and febrile dift- T
turbanoo, as a firm, flat, inflammatory infiltration in the doe;
and sobcateneous tissue, spreading laterally and finally involving t>a/M
area of one to several inches in diameter. The infiltration and swel- fl^
ling increase, the skin becomes of dork red color, and sooner or later, \
usually at tlie end of ten days or two weeks, softening and suppur*- 1
tioD begin to take place, the skiu finally giving away at several [xitnts, I
through which sauious pus exudes ; the whole ouue finally sloughs 1

away either in portions or in its entirety, resulting in a deep ulctr,
which slowly heala and leaves a pertnanent cicatrix.

In some cases, espiicially iu old people, Bympathctit; uoaatitutional
diRturbance of a grave character is noted, and a &tal result may

VHiat is the cause of carbuncle t

The same ciuBes are cunaidertal h> be operative in uarbunenlus as in
fiiruncle; general debility and depression, from whatever cause, pre-
disposing to its formation, and the introduction of a peculiar microbe
being at present looked upon as the exciting factor.

WKat it the pafliology ^

The inflammation starts simultaneously from numerous pointa,
from the hair-follieleR, sweat-glands or sebaceous-glands. The inflam-
matory centres break down, and the pus finds its way to the surface ;
finally the procees ends in gangrene of the whole area.

How would 70n distingnisli oarbimcle from a boil?

By its flat character, greater size, and multiple jioiiits of suppura-

What is the prog^iosis of carbuncle?

Oecmiing in those greatly debilitatJid or iu lat« life, and in thrjse
Aaaca in which two or more lesions exist, or wheu seated about the
head, the prognosis is always to be guarded, as a fatal result is not
uncommon. In fact, in every instance the disea.se is to be oou-
Mdcrod of poaaible serious import.

What constitutional treatment is usually employed in car-
buncle ?

Aftill nutritious diet, the use of such remedies as iron, quinia, niix

I Tomiua, with malt and stiuiuknts;, if indicated. Calx sulphurata,

I one-tenth tit ime-fuurth grain every two or three Iwurs, appears, in

' eomc instauces, to have a beneficial ofitiet. If the pain is severe,

morphia or chloral should be given.

What external measures are employed ?

In the early jiart of the formation, injection of ii five or ten per
ant OBrbtilic acid solution, or covering the whole area with a twenty-
t per eent ichthyol ointment, may be employed. When it baa

broken down the pns niny Iv itrawn oat with a cnpinng-glaes, aois
oarboliied glycerine or carboliied wut«r introduced into each open* ■
ing, nnd the iehthyol oiotiuent superimposed. If tlie whole part hail
sloughed, it shuuld be removed as rapidlj as possible, and antiseptisfl
dressings used. Or, if its progre^ is slow, and grave sj^temic diE^ J
turbAiice be present, the whole part may be incised and curetted, aadl
then treated autisepticullj.

Pnstnla Maligna.

{Syiom'/m': AnthiBI; MaligDaot Tustulcr.)

What is malignant pnstnle f

Malitniant pustule is a fumneic- or caibnnele-like lesion resni^'l
log fmu) inoeuUition of the vims generated in animals suffering fi
splenic fever, or "charbon," aod which is accwoipanied by o
tutiunal syiuptutus of more or less gravity. A filial te
HiiusuaL
What is the cause of ptistola maligna T

The disease is duo l.i [he iireseLii.-e of the biifillus anlbrj
What is the treatment of mal^nanl pustule !

Knrly exin^ou or deslnirtii>n with i^iustle potiish, with s
antiaeptia dressiugs ; luid iuterunlly the free u.<ie of stjuulanis
tunics.

Post-mortem FuBtole.

l>>.K^«i,»i .■ PiiSfttiou Wound.)

Describe post-mortem pustule.

Pusi-uiDrteui pustule develops at tbe point of inocuktion, b^in- ]
ning as an itchy red spot, becoming ve^oo-puslular, and lat«r postiif
lar, with usually a broad inflammatory ho^., and accoinpanied with
more or less pain and rediie^ and u«>t iutroquenlly lymphangitis,
cryaipeliilous swrlliug, aud slight or severe sj'm^Kithetie coostitu-
tiouid dlsturbauee.
What is the treatment of post-mortem pustule t

Treatment consists iiHipeniiic the puslule mid thoixmgh eautcrtsa^
lioQ, and the suWi)ueDt use uf aiitiseplle apphcutious or dre^nga.
Inlerualij/ quiuia and stironlanUt if Indit M ted.

Framboesia.

Describe frambteBia.

FrumlxBEJ!! is itn eDdeniic, (Nutagioua disease met with in tropioall
countriiis, characterized by the ftppcaraDCtiofTBTiuuaiy-siKedpapiOee, M
tuberdea, and tamon, wliiah, when developed, resemble curranUl
and Boiall niflpbemes^ajid finally break duwn and ulcerate,
aocompanied by coDstitutioaal symptoms uf variable eevcrity.

Hygienic measures, good food, tonics, aod antiseptic and stimulatioirfl
applicatioDB are curative.

Squinia.

(.Vjnonyin*; Fany; GJaiido™.)

What is eqninia, or glanders ?

A rare contaginua specifie disease of a malignant tj'pe, derived A
from the borae, and characterized by grave constitutional symptomB, *
infiammationuf the uusalaud reapiratury passages, and a deep-eeated
papulo-pustular, or tubercolar, nodular (Jdrq/ bu/Li), uluerativo
eruption. A fatal ii^uti is not unciimmon. It is due te a
organism.

Treatinout, both lonil and con^litutiuual, is biu^'d ujiiin gen(!ral J
principles.

Miliaria.

(4;VM0",V«n .- PriubljUcat; Iluaf Riisb.)

What do yon understand by miliaria t

Jliliaria is an acute inflammatory disorder of the sweat-glands,
cbanM:ti:rizLil I13' the appearance of minuU^, discrete but eloselj' j
crowded pajiules, vesico-papules and veaielcs.

Describe the symptoms of miliaria,

The eruptiiiii, coiisiHting of |)iQ-[>uint to millel^Beed-siaed papules, i
vesieo-papulcrt. vesicles, or a mixture of these lesions, discrete but J
usUAlIy numerf.ua and cli)sely crowded, appears suddenly ; oocuniug.J
upon a limited portion of tbe surface, or, as uommonly observed, I

DESF.ASES OP THE SKIN.

inToIvitig a greater part or tbe whole integiimeDt. The trank ii
favorite lucalit^. TIji; pupukr lesions are piukish ur reddisli, aod
the vesicles whitish or yellowiBb, snrrounJed by inflammatory areola,
thus giving the whole eruption a bright-red appearance — mSiarut
rubra. Liter, the areolse Me, the transparent contents of the
ycGiclea become somewhat opaque and yellowish-white, and the
eruption has a whitish or yellowish cast — miliaria alia.

Itehing, or a feeling of burning, slight -ftr int«D3c, is usually
present

What u the coune of the emptioii T

The vesiclea show no disposition to rupture, but diy up in a few
days or a week, disappearing by absorption and with slight subse-
quent dcBquamotion ; the papular lesions gradually fade away, and
the affection, if the exciting cause has ceused to act, termioates.

What la the canse of miliaria I

Excessive LeaL Debilitated- individuals, especially children, are
mure prone to an attack.

What is the natnre of the disease 1

Tiie affection is c**L'ntiaUy an inflammatory disorder of the sweat-
glands, eongestion and exudation talking place about the ducts,
giving riiM to papules or vesicles, according to tbe iutcnaity of the

How would you distingTuah miliaria from papular aud vesic-

nlar eczema, and &om sudamen ?

The jia|iulcri of cczi'ina arc larger, dvsto elevated, firmer, slower
in their evulution, of loiig('r duration, and are markedly itchy.

The vesicles of ecsema are usually larger, tend to become conflu-
ent, and also to rupture aud become crusted ; there is marked
itchiness, and tho inflammat^iiry action is usually severe and persst^

III sudamen there is absence uf inflammatory symptou

^K cni

■ '

^H What is the proguosia of miliaria t

^H The afl'ection, under favorable eireumslauoes, disappears in a fei

^^1 days or weuka. If the cause persists, ns for instance, in infants u

^^^ young children too warmly ctad, it may result in eczema.

INFLAMMAHONS.

What is the treatmeiLt of miliaria t

RemoTiil of the cause, and in debilitated subjects the administra- 1
tiou of tonica ; together with the application of cooling and ttHtritt- 1
gent lotions, as the following ; —

B. Acidi carbolic!, 3s*~3iij

AcJdi borici, 3 iv

Glycerinie, fgj

Alcohol is, f^ij

Aqaie, 5 xiv.

Lotions of alcohol and water, or vinegar and water, and dusting's
powder of starch, lycopodiom and talc are often employed, witbl

Fompholyx,

(5yjioni/m« ; Djairlriisi? ; -CheirD-pompbolys.)

What is pompholyz ?

Fompholyx ia a rare diseiise of the skin of u vesicular and hullotu J
cLarai^r, and limited to the hands and feet.

SeBoribe the symptoiiiB of pompholyx,

In most instuacea the hands only are afiected. It be^ns usuallj J
with a feeling of burning, tingling or teudemesa of the porta,.!
followed rapidly by the appearance of deeply-seated veacles, espe- 1
cially between the fingera and on the palmar aspect These begin- f
niiig lesions look not unlike sago grains imbedded in the skin. In some I
iustances the disease does not extend beyond this stage, tho ve
dxBappearing after a few days or weeks by absorption, and naually
without desquamation. Ordinarily, however, the lesions increase in
HiEe, new ones arise, become confluent, and blebs result, the skin iu
places appeuring as if undermined with serous exudation. Tlie
parts are commonly inflamed to a slight or marked degree. The
skin comes off in flakes, new lesions may appear for several days or
two or three weeks, and the process then declinca, recovery grad-
Oaliy taking pkce.

There are do institutional symptoms, although it is usually
notiood that the general health is below par.

DISEASES OP THE SKIN.

What is the character of the subjective BymptomB in pom- I
pholyz ?

The Bubjeetive ^Tnptoina eonsiat of a foeling of tuusion, burning
and teiwlemeBS, and oomctiniea itching. Nut iufrequentiyi «
there U neuralgic pain.

What is the cause of pompholyx 1

Tlic eruption is ttought to ho duo to a depreBsed state of
ncrvuua Nyh-t«ui. It ia mure uuiuniiiii iti wunien, and m met with
chiefly in Lidult and midUlu life,

What is the pathology f

Opinion is ciivided ; some cunsidoririg it a. disease of the sv

glande and other

INFLAMMATIONS.

L inflaiuaiatjjry diseHse iudopeodtnt oF those 1

State tlie diagnostic features of pompliolyx.

The distribution and the peculiar characters and course of

It is to be difierendated from eczema anil pemphigna.

What is the prognosia ?

For the immediate attack, favorable, recovery taking place in I
several weeks or a few months. Reourreuces at irregular intervala |
are not uni^mmou.

What is the treatment of pompholyz f

The general health is to be looked aAer, and the patient placed '
under guod Lygieniis conditions. Remedies of a tonie nature,
directed especially toward improving the state of theuervoaseyetem,
are to be prescribed. Loadly, soothing and anodyne appliisitiona,
such as ]ead-wat«r and laudanum, boric acid lotion, oxide of zinc,
boric aiad and diachylon ointnaenlfi, arc most suitable ; or the parta
may be enveloped with the following : —

B . Pnlv, ac. Bdlicylici, gr- i

Pnlv. ae. borici,

Pnlv. aniylt ai g ij

Petrolati, jiv. M.

In fact, the external treatment is similar bi that empiuycd in acute

Herpes Simplex.

^_ tue miis
^^1 Descrit

What is herpes simplex t

An acute inflammatory disease, chiiraiit^rized by the formation of '
pin-head to pea-siacd vcsielcs, arranged in groups, and occurring for
part about, the f:ice anil gimitalia.

Describe the symptoms of herpea simplex.

nialairio and pyrexi^i may precede the eruption, but i

I
I

UMially it appears without any precursoiyor cuDstitutional symptoms.
A feeling of heat and burning in tlie parta is often eumplained of
The vesicles, which are commouly pin-head in size, are usually npon
B hypersemic or inflammatory base, nud tend to occur in groupa or •
duBtera. Their conbiuts are usually clear, Bubscquently becoming
more or less milky or puriforra. There is no tenilency to spontane-
ous rupture, Imt should they be bruken a superficial esouriatjon
results. In a short time they dry to crusts which soou fall off, leav-
ing no permanent trace.

Ib the emption in herpea simplex abasdant?

No. Ah a rule nut more than one or two clusU^rs oi' groupa are
observed.

ITpoa what parts does the ernption oooar ?

Usually about the fece {herpe» facialis), and most frequently about
the lips (}ierpe» lahiii)l») ; on the genitalia {herpei progen%tcdi»), the
lesions are commonly fouitd ou the prepuce (herpes praputM^w) in the
male, and on the labia minora and labia m^'ura in the female.

State the causes of herpes simples,

Her]jes facialis is often observed in a*isociation with febrile and
lung diseases. Malaria, digestive diatuxbance, and nervous diwr-
dera are not infrequently prediapo^ng factors. Herpes progenitalis
k said to oo^r more frequently iti those who have previously had
some venereal dianase, especially gonorrhcca, but this is questionable.
It is probably often purely neurotic.

What are the diagnostic points %

The appearance of one or several vesicular groups or clusters about
the face, and especially about the lips, is usually sufficiently charac-
teristia The same holds true ordinarily when the eruption is aeea
on the prepuce or other parts of the genitalia ; it is only when the vesi-
cles become rubbed or abraded and irritated that it might be mis-
token for a venereal sore, but the history, course and duration will
iisually serve to differentiate.

Give the prognosis.

Tliu eruptjiin will iwually dinappoar iu several days or one or two
weeks without treatment Remedial applications, however, exert

a favorable iufluenw. Herpes progenitalis esliiIiitM u striiog ilispod-
tion to ri

What ia the treatment of herpes facialis ?

ADointiug the parts with (^iuj)liorat4^d colil cream, with spirits of '
cjiinphiir or mrailar evaporating and stimulatine; applications will at j
times afford relief l« the liuriiiug, and alwrten the tourse.
What is the treatment of hei3MB progenitalis?

Ill herpea about the genitalia cleaulineSH is of first iinportatice.
A saturated solu^otL of boric acid, a dusting-powder of calomel o
oxide of zine, and the following lotioD, contuimag calamine and oside j
of ztuo, are valaable : —

B- Zinci oxidi,

Calamine aft gr. v

Aleoholis, fia iri,vj

Aqtue, ,^,j fi

In ohatinatdy recurreot eases, frequent appUc'^tious uf a r
galvanio current will have a fuvurable influence.

Herpes Zoster.

Oive a definition of herpes zoster.

Herpes zoster is an acute, self-limited, inflamniatotj disease, char-
acterized by gTOupa of vesielea upon inflammatory bases, situated
over or along a nurve traut.
Upon what parts of the body may the eruption appear ?

It may appear iijion any part, fuiiowin^ tile i.'iiurse uf a nerve
is therefore always limited in extent, and confined to one side of the
biidy. It is probably most common about thu intcruostal, Inmlmr \
and supraKirbital regions.
Are there any subjective or constitntional symptoms in herpes
zoster ?

Yes; there is, as a rule, nuuralgie jiiiin [jreeeJinf;, during, and

following
beginning
of tenderu

Dn ; and in sume kibcs, also, there n:
mild febrile disturbante. There is also a variable degree J

What are the characters of the

Several or more hyper
course iippeiir, upon whicb
grouped ; these veaico-papule
1 pin-head to a pe», and

eruption 1

or inflammatoiy patches over a nerve
TC seated veaico-papulea irregnkriy
beeome distinct vesicles, of ase from
dry and give rise Ui thin, yellowish j

or brownish crusts, which drop off, leaving in most iiistanoes a
manent trace, in others more or less scarring. In some cast
lesions may become pustular and, on the other hand, the eruption. 1
may be abortive, stopping short of full vesiculatiun.

What is knowQ in regard to the nature of the disease ?

An iuflamod and irritable state of the spinal ganglia, nerve tract, ^
or peripheral branches is directly responsible for the eruption, t
this state may be due to atmospheric changes, cold, nerve iifjurieB ]
and ramilar influences.
Give the chief dia^ostic features of herpes zoster.

The prodromic neuralgie pain, the appearance of grouped vescles
upon infliUnmatory bases following the course of a norvo tract, and
the limitation of the eruption to one aide of the body.

What is the prognosis 1

Favorable; the symptoms nsoally disappearing in two to four
weeks. In some instances, however, the neuralgic pains may be per-
sistent, and in zoster of the supra-orbital region the eye may suffer
permanent damage.
How would yon treat herpes zoster ?

C'onntitiiti'omil Irealment, if any ia called for, ia to be based upon
general principles. Tonics, large dnsea of riuiuia, and the phosphide
of zinc in one-fourth -grain dose every three iiours, Mometimes prove
of advantage.

Local treittment shouH bo of a soothing and protective chajv
octcr. A dusting powder of oxide of zinc and stareh (to the ounce
of which twenty to thirty grairs^of camphor may be added) proves ,
useful ; and over this, in order that the parta he further pnJlJJcted,
a bandage or a layer of cotton batting. Oxide of sine ointment.

INFLAMMATIONa. 75 |

n tliose cases ta which then; is much pain, oiotments coDtaiaing
powdered opium or belladonna, may be used. A mild galvanic cur-
rent applied daily to the parts is often of great advantage, both in
ita influence upon the course of tbe eraption and upon the nouralgio ,

Herpes Iris.
What do yon understand by herpes iris ?

Herpea iria ia an ai:ute iufluuimatiiry disease eharart?rjze<l by one 1
or more groups of voaiclea or blebs arrauged usually in the form of i
more or lesR complete conccutric rings, the whole efflorescence being :l
somewhat variegated in color.
SeBcribe the symptomB of herpes iris.

A patch of herpes iris nsuiiUy begins a^ a simple vesicle or papule ;
this partly disappears, while around the periphery a ring of discrete
or confluent vesicles makes its apiHiaranee ; the process may stop I
here, or one, two or more such rings may be added. Several or more. J
patches are usually present, and when fully formed present variegated I
colore due to the difference in age of the individual rings making up ^
the eruption ; new patches may continue to appear one or two weeks,
or longer, and the disease come to an end, the leaiona dtying to
crasta, which, falling off, leave transitory redness and piguientatioo.

The subjective symptiims, of heat, burning, and sometitlics itch-
ing, ura r.iTv\y Irouliluisome.

TTpon what parts of the body is the eruption commonly ob-
served 1

Upon the backs '.if the htinds and forearms; it may, however, be |
scon upon other jiartJ*, more especially the legs and feet.

Are blebs ever produced in herpes iris ?

Yes. In exccptiiirjal iiii^nces the inflammatory actior
deutly severe to give rise to bleb formation.

What ia the nature of the duease ?

It isutciselyallicd, inita cause, distribution and course, tocrytliema .1
sndtifarmc, and may indeed be looked upon as a modification or 1
advanced stage of that disease. It is somewhat rare.

^^ It
^^M snd^rai
^^H advance

U&y herpes iria be confounded with other diseaseB T

It might possibly bear resemblance to ringworm, herpes z
uiid jiemphigua, but its uhardi-ters, mode of formation, distrilmtion f
and cause are Jiffereut, aud will serve to prevent em

What pro^osis is to be given in herpes iris 1

Favorable. Thu diseaae, while at times markctily iDflammatory, ]
iisuiilly siilssideM at the end of one t*) three weeks.
I'ocun'uucuM, usually at yearly iutervala, are not '

What treatment is to be advised T

Coustitutioiial treatment is rarely required ;
tonics may be prescribed if indicated.

LacaUy, soothing and protective applications should be made;.*
oiide of zinc ointment, calamine lotion as prepcribed in eczema {q. u.), J
cold crcimi ur the like may be used tor this purpose.

Dermatitis Herpetiformia.

{St/Kontimn: Hjfir.on: Uerpoa l3ratu.Liuuiai ]Paui]ihigu3 Pi'urigLnusuB;
Duhrins's Uidoase.)

Give a definition of dermatitis herpetiformis.

Dermatitia herpetiformis is a somewhat rare inflammatoiy disease,
characterized by an eruption of an erythematous, papular, vesieulHr,
pustular, bullous or mixed type, with a decided disposition toward
grouping, accompanied by itching and buniiag getisations, and pur-
suing usually a chronic course with remissions.

Describe the erythematouB type of dermatitis herpetifbnnii.

The character of the eruption in the erythematous tyjje n
closely that of erythema multiforme aud of urtioj
former. The efflorescences usiiidly midte their appearance in crufts,
and are more or less persistent ; fading sooner or later, however, and
giving place to new outbreaks. Vesicles are often intermingled,
developing from erythematous aud eiythemato-papular Icsioos or
arising from apparently normal skin.

It may continue in the same type, or change to the vesicular, bul-
lous or other variety.

I
I

INyL.\MMATIONS. 77

Seioribe the papular type of dermatitis faerpetifonnis,

This is rarely men -.m consisting piirely of papular lesionH, bat is com-
monly associated with the erythematous acid vesicular varieties. lu
a measure it resembles the papular maiufestatione of erythema mul-
tiforme, with a distini-'t disposition toward group fonnation. The
papules tend, sooner or later, to develop into vesicles, new papular
outbreaks occurring from time to time ; or the whole eruption
changes to the vesicular or otbcr type of the disease. It is not a
common type.

Desoribe the resictilar type of dermatitis herpetiformis.

This is the common clinical lype of the disease, and is character-
ized by piu-hcad to pea-Hzed, rounded or irregularly-shaped, dis-
tended or flattened and stellate vesicles, occurring, for the most part,
in irregular and segmental groups of three or more lesions, seated
either upon apparentiy normal integument or upon hyperaemic
or inflammatory skin. They exhibit no tendency to spontaneous
rupture, but after remaining a shorter or longer-time, are broken or
disappear by absorption. The lesions tend to appear in crops. It may ,
ae it not infrcr|uently does, continue in the same type, or it may
become more or less erytiiematous or bullous in character. In not a
few instances pustules, few or in numbers, are at times intermingled.

Describe the pustular type of dermatitiB herpetiformis.

This is rare. It is similar in its cliuieiil ehiiracters to the vesicular
type, except that the lesions are pustular. It is met with, as a rule,
in assotiation with the vesicular and liullous varieties of the disease.

Describe the bullous type of dermatitis herpetiformis.

The bullous esiiression of the disease is usually ()f a markedly
inflammatory nature, often innumerable Uebs, small and large,
appearing almost continuously, and in some instances involving the
greater part of the eurtaco. The lesions arise from etTthcmatons
skin, from preexisting vesicles or vesicular groups, or from appa-
reotly normal iutegumeut. There is a marked disposition to appear
in clusters. A change of type to the erythematous or vesicular
varieties is not unusual.
Describe the mixed type of dermatitis herpetiformis.

In this tyjie the eruption is made up oi' erythematous patches.

78 I>!SK.4SEa op THE SKIN.

vcsiolcfi, bull^, iitid uft<:ii with puHtulea iutermiDgled, ^pearing'l
iiTui^lurly or in uropi^, a^ud witlt a. tendency to pn^tch or gnmp for-~T
uutiun.

Suoribe the characters of the vesiole*, poetnles and blebs.

As n rutt!, tlit.>EC several lesiuiia, eBpecluUy the veeicleB and blebs,
are wimewliut pt'cuUar : they are nsuaily of a strikingly irregolar
tiutliiio, ullong, Htellate, quadrate, and wheo drying are apt to have
a puokcrcd appearanc& They are herpetic in that tliey show little J
dispoiition to epontaneous rupture, occur in groups, and a
Beated u]K>n erythematous or inflammatory ekin — in soni'
(uuiilar to tlio groupu of aimple herpes and htrpea zoster.

What is to be said in regard to the sabjective aymptomB?

TlicsuliliectiveRyinptoms arc usually the ui'.i^t troiililcsomc feature j
of tlio disease, eonHiritIng of inU'nse aud pertiist^iit itching and a
feeling of heat and huruiug.

Are there any constitatianal symptoms in dermatitis herpeti*
formis?

As a nde, not, excepting the distress and dcpresaioD ncccesarily ,
consdiueiit tiikiti the intense itchiness and loaa of sleep. In the
pustular ntid Liilloua varietieK there may be mild or grave Bysteniic
^luptnnift, but even in these types the constitutional involvement
is, in most instant'CB, sUght in ooniparison to the intensity of the
cutaneoaB Uisturbmice.

What is the course of dermatitis herpetiformis ?

Extremely chronic, in moat iustaiicea k^tiug, with remissions,
indefijiitely. Tlie skin is rarely entirely free. From time to time
the type of the disease may undergo change. From the oontinucd
irritation and scratching more or less pigmentation results.

What is to be said ia regard to the etiolo^ of dermatitis
herpetiformis ?

Tile disease ia in many instances essentially neurt>tic, awl in excep-
tional instance septiemmic. In other cases no camw can be aKsigncl,
In the ma,iority of patients the generiJ hcjilth, considering the vin-.
Icnoe of the eruptive phenomena, remains cumparatively uadi»-

. INFUMMATIONS. I 'J

Keation the diagnostic features of dermatitis berpetifonnia.

The niultifonuity of the eruption, t)m ithuractera of tlie lesiouB,
the dispoflition to jn-oujiirig, the ahacnce of tendency to form siJid
sheete of eruption (ua in ecaema), the intunse it*;hing, history,
ohronicity and course. In doubtful vases, an olwervation of several
* Veeks will alwaya Buffice to distiuguish it from eczema, erythema
' multiforme, herpes iris and pemphigus, diseases to which it at times
boHTs stroug resemblauoe.
Give the prognosis of dermatitis herpetiformis.

An opiuion as to the outcome of the disease should be guarded.
ia exceedingly rebellirjns to treatment, and relapses are the rule.
1 Esceptionally the hullous and pustular varieties prove eventually

fatal
I St&te the treatment to be advised.

There arc no special remedies. Constitutional treatment must be
[ conducted upon general principles. Externally protective and anti-
I pruritic applications, such as are employed in the treatment of
L ecKcma and pemphigus, arc t« be employed :^

K. Thymol, rt, x\j-)ir. 1

Glycormw, .^M-

Alcobolis, f ,5 ij

Aqlue, q. s., ad .... Oj, M.

Other valuable appliattions are : lotions of carbolic acid, of liquor
f wrbonis detergena, of boric acid; alkaline baths, mild sulplmr oint-
Ltneut and carboliKed oxide-ef-ziuc ointment, and dustbg powdem
■ of Bbirch, ^nc uzide, talc and bono acid.

Psoriasis.
Oive a definition of psoriasis.

I^riasis ia a chronic, inflammatflry disease, cbanicteriKcd by
dry, roddiah, variously-sized, rounded, sharply defined, more or less
^^H inCltratcd. scidy patches.

^^^ At what age does psoriasis nsnally first make its appearance 1
^^K Most commonly betwccu the ages of Glk'cn and thirty. It is

HO DISEASES OF THE SKIN. I

ran^ly Hvv.n Ix^foro the UMith. year, and a first attack is unoommcm
afh»r the age of foity.

Has psoriasis any special parts of predilection?

The extensor suriiices of the limbs, especially the elbows and
knees, are favoritt^ lociilities, and even when the eruption is more or
Ic^ss general, these regions are usually most conspicuously involved.
Tlio fiice olUui es(^a])es, and the palms and soles, likewise the nails,
are rarely hivolvtnl. In exceptional instances, the eruption is limited
almost exclusively to the scalp.

Are there any constitutional or subjective symptoms in
psoriasis ?

There is no syst(mii(5 disturbance ; but a variable amount of itch-
ing may be ))resent, although, as a rule, it is not a troublesome
Hymptom.

Describe the clinical appearances of a typical, well devel-
oped case.

Twtinty or a hundred or more lesions, varying in size from a pin-
hcMvd to a silver dollar, are usually present. They are sharply
dcifined against the sound skin, are reddish, slightly elevated and
infiltrated, and morti or less abundantly covered with whitish,
grayish or nioth(ir-ol-i)earl colored scales. The patches are usually
WMitUircMl over the general surface, but are frequently more numer-
ous on the extensor suriliees of the arms and legs, especially about the
elbows and kncM'S. S(;veral closely-lying lesions may coalesce and a
large, irregular patch ho, formed; some of the patches, also, may be
more or less (^ircinat-i^, the central portion having, in a measure or
completely, disap])earod.

Give the development and history of a single lesion.

Every single pat(4i of psoriasis begins as a pin-point or pin-head-
sized, hypemDmic, scaly, slightly elevated lesion; it increases gradually,
and in the course of several days or weeks usually reaches the size;
of a dime or larger, and then may remain stationary ; or involution
begins to take place, usually by a disappearance, partially or com-
pletely, of the central portion, and finally of the whole patch.

Describe the so-called clinical varieties of psoriasis.

As clinically met with, the patches present are, as a rule, in all

INFLAMMATFONS.

stages of devebpment. lu some iustanci*, liowever, the losioos, or
the uoet of them, progrcH* no liirther than pin-bead in BiEe, and
then remain statiiinary, coiistitutinj; pgoruudi punctata ; in othitT
eases, they may stop shiirt, attet having reached the wze of drops —
ptoriiiu't giitlata; in others (and this is the usual cliiiii»l type) the
patches develop to the size of eoins— pson'iww nummularis. In
Bome cases there is a strong tendency fiw the central part of the
lesions to disappear, and the process tiien remain stationary, the
patches being ring-shaped— p»oritMM drciimta; and occasionally
seTcrul Buch lingB coalesce, the coulescing portions disappearing and
the eruption be more or less eerpentine— jaonam* gyrata. Or, in
other instances, several large contiguous lesions may coalesce and a
diffused, infiltrated patch covering considerable surface results —
p«orKMu( diffusa, psuriagis invderata.

Is the ernption of pBoriasis always dry T

I What conise does paoriaau poTBue f

Ab a rule, eminently chronic Patches may remain almost indefi-
I nitely, or may gradually disappear and new lesions appear elsewhere,
) the disease may continue for months and, aometiniBS, for
I years ; or, after continuing fot a longer or ahorter period, may
1 enbdde and the skin remain free for several months or one or two
I: Teare, and, in rare instances, may never return.

[ Is the oourse of pBoriasis inflaenced by the seasoiu T

Ah a role, yes ; there ia a natural tendency fur the disease to
l(e»ime leas active or lo ilisappear altogether during the wann
months.

What is fcnown in regard to the etiology of paoriasia 1

The causes of the disease are always more ur less obscure. There
■V often a hereditary tendency, and the gouty and rheumatic diatlie-
muBt occasionally bo conadered potentJaL In some instauocs it ia
[apparently inflnejiced by the state of the general health. It ia a rather
disease and is met with in all walks of lifa

Is puriasis contagions 1

What is the pathology?

ALKwriliti^ U) iiiudem investigatiuns, it is an ioflamuiatioQ induce
liy liyi«M'i)laaia of the rule mucosum.
With vhat diseases aie yon likely to confoond psoriasis 1

Chiefly with miuamoua eczema and the papulo-sciuamous syphilo— 1
derm ; and uii tliu sculp, also with seborrhtea.

How is psoriasis to be distin^uiBhed from squamons eczema 1

l(y tliu Bhiiriily-dolined, I'iwmiiscribed, a'attered, BcaJy jmtfhee, and
by liiu liiMtjjry mid cuurso of tlio iriiUviduiil icsioiis.
In what respects does the paptUo-sqnaiiions syphiloderm dif-
fer from pBoriasis t

Th(i wiilrs i.r till! Bi|iiiiiininia syphilidc are usually dirty gray in
color uiid inuru i>r less miiily ; tliu palohea arc ooppery iu Lue, uud
umiully severul or more chara(^teriBtio scok'leBB, infiltruted papnles are
to he fuund. The face, palms and Hulex are oftva the seat of the

INFLAMMATIONS. 83

^fphilitJc eraption ; and, moreover, concomUnvt Kymptum) of xjfph-
Hts, Buch aa sure throat, mucous patches, glanduliLr eulargomunt, rheu-
matic pains, falling of the hair, together with the history of the
initial leaon, are one, several or nil UHually present.

How does seborrhoea of the scalp differ from paoriaeis?

Seborrlicea is usually diffused, with uo redncsa iind iLfiltration ;
I moreover, tbc sculed of sehon-htea are freasy, dirty gray or brown-

84 diseas(:b of the bkin. ■

ish, while those of paoriiisis iire dry aod cwmmotily whitish or motli^H
of-pearl colored. Psoriasis of the Bcalp nirejy vxists indepeDdeitln|
of other patches elsewhere on the geoei-al suriiice. ^t

Give the prognosiB of paoriaBis. I

The prognosis ia usually favorable, so &r as concerns the iiiiiiie«%^
ate eruption, hut ns to rt^urreuees, uothitig positive can be stateds
In some instances, however, the cure reuiaina permanetit. 9

How IB psoriasis treated? I

Buth eoDstitutioual and local remedies are demanded ia moaS

Do dietary measures esert any inflaeace ! I

As ft nile, no ; hut the fuoJ should be plain, au J an excess of I
meat avoided. I

Name the important coustitutional remedies usually em- I
ployed in pHotiasis. J

Areenic is of first im[>ortance. It ix not suitable in acute atm
markedly inflammatory tyx>es ; but is most rtaelul in the shiggiahfA
chronic forma of the disease. The dose should never be puahetf ■
beyond slight phyaiulogical action. It may be given as arseimntii^
acid in pill form, onc-fiflleth to one-tenth of a grain three lamal I
daily, or as Fowler's solution, three to ten minims at a dose. J

AUfalien, of which liquor potassm ia the most eligible. It is to be' I
given in ten to twenty minim doses, largely diluted. It is valuable I
in robust, plethoric, rheumatjo or gouty individuals with psoriasis of |
an acute or markedly inflammatory type ; it is not to he given to
debilitated or auiemic subjects.

Potamitim lodalc, ia doses of t«n to sixty grains, t. d., acts favor-
ably in some instances; there are no speeial indications pointing
toward its selection, unless it bo the existence of a gouty or rheu-
matia diathesis.

Copaiba (and also other diuretics) is valuable in some instances,
and while often failing, sometimes exerts a rapid influence, espe-
cially in those cases ia which the disease is extensive and
inflammatory. It is given in ten to thirty minim doses, three
times daily.

INFLAMMATIONS,

Are Bucli remediea as iron, quiniiiB, nux Tomlca and similar
tonics ever usefU in psoriasis t

Tes. Iq debilitateil Bubjt'cta tliii ailmiQistratioii of Bucli raiiiedies
ia ai tiiuL's attoudcd with iuiprovumcut ia the uutaDcous eruptiotL

That are tlie indications as regards ttie external measures t

Kcmoviil of till) Bwiles, and the use of southiug ur atiiiiulatiug
appliuitiona, uocordiDgto the iudlvidual case.

How are the scales removedl

In ordinal? axaes, either by warm, {iLiio, or alkaUne baths, or hot-
L ira.ter-and-Boup washings ; in those casus in which thfi scaling is
K abundant and adherent, washing with sapo viriUia sod hot water
I Biay be required. The tincture of green soap (tinctura sapunis
i viridis) may also be used, and is espeuially valuable for cleaumtig
purposes in psoriasis of the scalp.

The frequency of the baths or washiDgs will depend upon the
rapidity with whiah the scales are reproduced.

Are soothing applications often demanded in psoriasis 1

In excepliona! cases ; in those in which the disease ia acute,
markedly iuflammalury and rapidly progreasiug, uuld, soothiDg appli-
cations must be tem]iorari!y employed, such as plain or hiiui bitths,
with the use of some bland oil or ointment. As u rule, however,
the conditions, when coming under obseiTation, arc such se to permit

(of stimuiatiug applications from the start.
How are the stimulating remedies employed in psoriasis
applied ?
As oiiitmeuW, oils, and paints (pigmeota).

An ointment, if employed, is to be thoroughly rubbed in the dis-
eased areaa once or twice daily, Tlie same may be said of the oily
apphcatioos. The paints (medicated collodion and gutta-percha
solution) are applied with a brush, onoe daily, or every second or
third day, depending mainly upon the length of time the film
remiUDs intact aud adherent.

Hame the several important external remedies.

(Jhrywarobin, pyrut-Lillic iK'id, tar, animoniiited uicix-uiy, .(-naphthol

M , DtSRASES OP THE HKIN.

An these several exteinEil remedies equally servloeable
all oatetl

Nti, 'I'licir iic'lii'ii (UfforB slijihtly or greiitly according to the case
Btiil Iniliviiliiiil, A ('liiiiLKd from one to tiuothor is ofteu ncceBsary.

Zn whAttiimii onditrength are these remedies to be applied!

t!hn/mii-<Jtin in ii|i|iliril in Byvtmil ways : as an ointniiint, twenty
b) aixty Ki'idiiH In ihu ouiioe, rubbeil in once or twico daily ; thia if
ill)] tiKwt miildbutlcrmtuimiilyanddigiblu method. Asa pigment,
» tmliit, iw ill tlio lljllijwiiig ;—

U. CliTydntnliliii gj

Ariilisulicylld, gr.xx

Utiiorls fgj

(11. rl..liil, iTLx

Ci»I1<mIU, fgvij. H

Or il iiiny U\ tiiuul in liiivuir gutta-porchee (traumatiob), a dradhmto
tbo iniiiw. It iiiity itlmiLw ciiipluycdin chloroform, a. druchmto the ,
BUiiiMt ; thl« i« iMtintod on, the Dhlorororm evaporating, lettying a i
Ihlu film T)f uhrywtnitiiii ; nvur this is paiut^>d ficxibte collodion. If |
tho pntohtM nro few atiil krge, uhi^Burubia rubber-plaster maybe

Ohrysarobin is usually rapid in It« effect, but it has certeia distd-
fBlitngos; it uiny cause an iiiflniiimation of the surrounding akin,
tlld, if used iK'iir tho cyc«, mny givo rise to conjunctivitis. Ab a
nil), It should nut Iki uuiployitil about the head. Moreover, it Htains
the lliii'ii |H>rinnni'ntly and tlie Hktii tcuipururilj.

J^nii/iillw nclil in aki valuable, and is employed in the sa
nniiuor Kiid Artiugth lu ohrysarobin. It is less rapid than that
Mtnody, but il raruly InflamoB the surrounding intcgumenL It
■tuDS tho linen a light brown, liowover, and is not bi be used over
in esUJnsivo surfluw for tbnr of absorption and toxic effect

Tlif iS| all thhigg considered, tho ino(-t itniwrtant external remedy.
It is ooniparutivitly hIoW in its action, but is useful in almost all
oasca. As umplnytid usually il is pnMcrilx'd in ointment form, either
IB tho officinul tar ointment, full atrungtb, or weakened with lard or
petrolatum, It may also bo used ae pix liquida, with oqnul part of
iJouhuL Or the tar cols, uilofoodeCoL wdiai), and oil of birch (oL

INFLAMMATIONS.

rosoi) raay be employed, either tis oily applications or iocorporated
with ointment or with alcohol. In whatsoever form tar m employed
it should be thoroughly rubbed in, oupc or twice daily, the esceea
wiped oiF, and the parts then dosted with starch or Bimilar powder.

Amnwniated merairy is applied io ointment form, twenty to siity
graioB to the ouiioe. Compared to other remedies it is clean and
free irom staining, although, as a rule, not so uniformly efficacious.
It is especially usefdl fur application to the scalp and exposed puts.

p-Naphihol and retorcm are applied as ointments, thirty to sisty
grains to the ounce, and as they are (especially the former) practi'
eally free irom staining, may be uHed for exposed surfaces.

{Sy«o

Pityriasis Kosea.

'/m : Pitjriiuia Muculnta ot Cir

-ji.)

What do yon underBtand by pityriaais rosea t

Ktyriasis rosea is a disease of a mildly inflammatory nature, char-
BCtflriaed by discrete or confluent, pinluMh or rosy-red, Tariously-
aized, slightly raised scaly macules.
Upon what part of the body is the ernption usually foimd ?

The trunk ia the chief seat of the ernjitiun, although not infre-
quently it is mure or less general.
Sesoribe the symptoms of pityriasis rosea.

The lesions, which apjiear rapidly or slowly, are but slightly
elevated, somewhat scaly, usually rounded, except when several co-
aUsee, when an irregularly outlined pat«h results. At first they are
pale or bright pink or reddish, later a salmon tint (which is oflen
obaracteristic} is noticed. The scaliness is bran-like or flaky, of a
dirty gray color, and, as a rule, less marked in the central portion ; it
is never abundant. The skin is rarely thickened, the process being
mnally exceedingly snpeificiaL
^What course does pityriasis rosea pursue t

The eruption makes its appearance, as a rule, somewhat rapidly,
ly attaining its full development in the course of one or two
and then begins gradually to decline, the whole process oocu-
one or two months.

DISEASES OF TliE BKIN,

Id w}iat is pityriasis rosea to be attribnted 1

The cause is not knuwn ; it U variously considered aa allied to
seboirhaea (eczema seborrhoiuum), as beiug of a vegetable-parasitio
origin, and as a luildly itjflummator; affection somewhat «milar to
pHoriiusiM. It is nut a frixiuont disease.

How is pityriasis rosea distinguished from ringworm, psori-
asis and the squamous syphiloderm ?
From ringworm, by its raiiid appearanee, ita (listribution, the
I number of patches, and, if necessary, by microsoopie examiua,tioii
of the Bcrapiugs.

PsunasiB is a more iDflanmintory disease, is seen nsonlly laoK
kbundantly upon the limbs, the scales are proftiae and silvery, and
[ the uudorlying skin is red and hus a glajsed look ; moreover, psoriasis,
ss a rule, appears slowly and runs a chrouic course.
The squamous syphiloderm diffL^rs in its histoiy, distribution, and
|. ibove all, by the presence ofconcomitant symptoms of syphilis, suoh
' as glandular enlargement, sore throat, mucous patches, rhenmatic
puns, and foiling of the hur.
State the pro^osis of pityriasis rosea.

It is favorable, the di^H^use teudhig to spontaneous disappearance,
nsually in the course of several weeks or one or two months.
What treatment is to be advised in pityriasis rosea ?

Treatment is mrely required. In severe eases, simple ointmenla
or ointments eontuning a half to one draelmi of precipitated sulphur
f to the ounce of lard or petrolatum may be used. Saline laxatives,
L Bttd, if indicated, quinine and tonics, may also be prescribed.

(^»..

Dennatitis Exfoliativa.

ml EifuliiLtive Dorinatilii- ; Rucurrenl Eifulintivc Dorina-

; Desqoaniiit

iniform Eryl.heiuBi Aontu Gonoriil Berion-
Eryth.mB.)

[ Seicribe dermatitiB exfoliativa.

Dermatitis exfoliativa is an inflammatocy disease of an acute type,
Lohanicterized by a more or less general erythematous inflammation,
L in exceptional instances vesicular or bullous, with epidormie dea^iuir

INFLAMMATIONS. 89

matioii or exfoliation aoeompanying or following itB developmenL
Conatitutional diaturbance, which may be of a aerioua character, is
UBually present It is a rare and obscure iiffectiua, r unnin g its
course usually in several weeks or mouths, but eshibiting a dedded
tendency to relapse and recurrence.

Oiye the tre&tment of dermatitis exfoliativa.

General treatment is bused upon indiaitiotis, and externidly sooth-
ing applications, such as are eujiloycd iu acute and subacute eczema,
are to be used.

Pityriasis Bnbra,
What is pityriaslB rnbra ?

HtyriasLs rubni is au iufluumialory disease, characterized by hyper-
semia and abundant and continuous epidermic exfoliation.

Describe its symptoms, course, nature and treatment.

Making its appearauee as one or more small, red, scaly patches, it
is not long before the whole or greater portion of the body is in-
volved. The skin Ja pale or violaceous red, hut is rarely thiekeoed,
continued exfoliation in tbe form of thin flakes taking place. The
snlgcetLve symptoms of burning and itching are usually slight ; con-

I stitutional Bynptoms may or may not be present in the beginning,

^ but later, duUiness, febrile disturbance, and general depression usii-

Eilly ensue, and death may finally result The course of the disease

is variable, lasting tor years, with remiaaoua. It is extremely rare,

and almost unknown in this country. Its nature is obscure.

General treatment should be tonic iu character. Locidly, mild and

. soothing applications, mtch as cold cream, oxide-ot-Kiuc ointment

■ and petrolatum are t ~

Lichen Ruber.
What is lichen ruber?
lichen ruber is au inHammatory disease chamcterized b; small,
I flat and angular, or acmuiuateil, smooth and shining, or scaly, dis-
ir confluent, red or violaceous red papules, having a lUstinctly

80 I>1SEASES OF TUB SKIN.

piipuliir or papulo-squaiuoua ooursu, aDtl attended witli more or leas
itchiug.

What two varietiflB of liclieii mber are met with ?

The acimninat*: (lichen ruber acuminatiis, lichen, riiher) and the
plane [lichen, ruber planm, lichen plfwm). The former ia ex-
tremely rare ; the latter, while not fr»iaent, ia not uncommon. The
pathological identity of these varietieB is at present questioned.

Describe the aymptoms of lichen mber aoaminatiu.

The acuminate variety is characterized hy the appearanoe of
Hmiill, pin-jiuiut or pin-head, pointed or rouoded, reddish, scaly, dia-
aeminated or closely crowded, sohd papules, showing no dispOBition
to group ; Hpretkding rapidly, pursuing a chronic cuurRe, and attended
with more or leas serious involvemeut of the genera! hetilth, with,
sometimes, a fatal termination.
Describe the BymptoniB of lichen mber planus.

The plane variety, as a rule, btgius slowly, usually showing itsdf
upon the extremities ; the forearms, wrists and legs being &Torita
localities. It may appear as one or more groups or in the form of
ehort or long hands. Occa^oually its evolution is rapid, and a coo-
aiderable part of the surface may be invaded. The lesions are pin-
head to small pea-sized, irregularly grouped or bo closely crowded
together as tu form suUd patches ; they are quadrangular or poly-
gonal in shape, usually flat, with central depression or nmbilication,
and are reddish or violaceous in color. At first they have a glased
or shining appearance ; later, becoming slightly scaly, the scslineae
being more marked where solid patches have resulted. New papoles
may appear from time to time, the older ledons disappearing and
leaving persistent reddish or brownish pigmentation. There is, as a
rule, considerable itching. There are no constitutional symptotus.
What is the etiolo^ of lichen mber %

In some cases the disease is distinctly ucurotia in chanicter, in
others no cause can be assigned. It is more especially met with at
middle aga

Does the disease bear any resemblance to the miliary papular
syphilide, psoriasis, and papular eoiema?

In some iustaucea, hut the irregular and angular outline, the

INFLAMMATIONS.

Blightly mubilicated, flattened, smooth nr Boaly summita, and the
dwll-reJ or violaccoufl color, the hiatoi? and course, of licheu ruber 1
planus, wi]] acrve to difiereutiate. Lichen ruber acuminatns can '
scarcely be confounded, if its clinical appearances, history andcourso
are kept in niiml.
State the prognosis.

Under proper management both varieties, although often obstinate,
yield U> treatment.
What treatment would 7011 prescribe in lichen ruber ?

A general tonic ])laii of medication is indicated in most cases, with
such remedies as iron, quinine, nux vomica, and cod-liver oil and ,
other nutrienlfl. In some instances, especially in the acuminate va-
riety, arsenic has a epecial influence. Locally, antipruritic and stimu-
lating applications, such as are used in the treatment of eczema,
are to bo Employed, alkaline baths and tarry appUcations deserving
special mention. In the plane variety, particularly if the disease is
limited, external applications alone often suffice to bring a.bout a cure.

Lidien Sorofolosns.

Seioribe lichen Hcrofulosns.

Lichen sinufulosuH is a, chronic, inflammatory disease, characterized
by millet-seed-sized, rounded or flat, reddish or yellowish, more or
less grouped, desi]uamating papules. The lesions have their start
about the hair-follicles, occur usually upon the trunk, tend to group
and form patches, and sooner or later become covered with minute
scales. A* a rule, there is no itching. It is a rare disease, scarcely,
if at all, met with in this country ; it is seen chiefly in children and
g people of a scrolulous diathesis. Scarring, alight in oharacter,
may or may not follow.
Wliat is the treatment of lichen scrofnlosus ?

The condition resiiuuda tu tonics and auti-stnimoos remedies.

DtHEASKS Oe THE BKIN.

i.Ss..o„s.i. : TctUr.)

What is eczema t

All actttg . subacute or clirpnic inflammatoiy disease, chsratStenxeS
in the beginning by tbe appearance of erythema, papules, vcsiclt«or
pustules, or a cuuibinatiun of these )<3^uDa, with a vaHa^ble amount
of infiltration and thickening, terniiuatiog either in discharge with
&e formation of crusts, iu absorption, or in desquamation, and
pauied by more or less intense itching and a feeling of heat or
bnrning.
What are the several primary types of eczema t

ErjthumatuuM, papuhir, vesii^ular and pustular ; all eases begia as
le or more of these types, but not infreijueuHy lose these charao-
rs and develop into the common clinical ursccondaiytypea — eczema
ifnbnun and eczemu squamosum.
What other types are met with clinically?

Eczema rubrum, cczcwn sfiuamosum, ecKemii fissuiu, of/i;ma scle-
rosom and cczi

Describe the symptoms of erythematous ecsema,

Erythematous ecaema (^eczema erythematimmi) begins im one ta

more small or large, irregularly outlined byperffioiio miiculea or

patches, with or without slight or marked swellbg, and with more

lor less itching or burtiiDg. At first it may be ill-defined, but it

mds to spread and its features to become more pronounced. It

iaay be limited to a eert^n region, orit may be more or less gener&L

'hen fully developed, the skin is harsh and dry, of a mottled, red-

tiah or violaceouB color, thickened, infiltrated and usually slightly

, with, at times, a tendency toward the formation of oosing

Punctutc and linear scratch-marks may usually be seen soat-

■tered over the affected region.

Its most common site ia the faee, but it is not iiifrc(|ucnt upon
P«ther parts.
What course does erythematous eczema pnrsne ?

It tunds to chrouicity, w.-ntinuing as the erytliL-mat'ius form, or
Uie skill may biicoioe eousiderubly thickened and murki'dly scaly,

I NFLAMMATIONS.

conntituting cczcnia KquiiuiDsum ; or a mnist oozing smrfaci!, with, i
more or lu'ss <;ni.'»ting, iJiiiy take ita place — uczenia rubnmi,
Describe the symptomB of papnlar eczema.

Piipuliir ocaema {ctsciiui papillosum) is characterized by the ap-
pearance, usu^y in numberH, of discrete, aggregated or closely-
crowded, reddish, pin-head-^zcd acmuinatcd or rounded papules.
Veaiclea and vcsico-papulea arc often intenningled. Tho itching if
commonly intense, aa oft«n attested by the presence of scratdi-
marks and blood enutte.

It is Been most Irequcntly upon the extremities, eKpeciidly the I
flexor surfaces
Wliat course does papular eczema pursue ?

Tile lesiiinH tend, tujoncr or later, to diaipiiear, but are uanally re-
placed by others, the disease thus persisting for weeks or months ;
in pliuxiB where closely crowded, a sohd, thickened, scaly sheet of I
eruption may result — eczema squamosum.
Describe the symptoms of veBicnlar eczema.

Vesicular ecaema {eczem/i vrxiculi>mLm) usually appeani, on one
or several regions, as more or leas diffused inflanuuatory red-
dened patches, upon which rapidly develop numerous closely-
crovded pm-point to pin-head-sised vcsioles, which may become I
confluent and form a solid sheet of eruptioa The vesicles si>OB |
mature and rupture, the discharge dtying to yellowish, honeycomb-
like crusts. The oozing is usually more or less continuous, or the
disease may denliiic, the crusts be cast off, to be quietly followed by
a new crop of vesicles. In those cases in which the pro
markedly acute, considerable swelling and oidcma are present.
Scattered papules, vcsico-papulea and pustules may usually bo seen i
upon the involved area or about the border.

The face in infants {enuta Uicbn, or miS; cruM, of older writers),
the neck, Scsor surfaces and tho fingers are its favorite locahties.
What course does Tesieolar eczema pursue f

Usually chronic, with acute esacerhaljons. Not infrequently it
ses intti ei'zi'Uja mbruni.
Describe the symptoms of pustular eczema.
PuMtubir (Kacma {eczemn puslvioxam, eczema impetiginm

OF TtlE HKIN.

probably tho least coniinon uf all tlie varieties. It is Hiinikr,
althougliiiBuallyleasa^livelyiuflummatorjr, iu its symptums to eczema
yesieuloaum, the leaione being pustular fruin the start or developing
from preexisting vesielea ; not infrequently the eruption ia mixed,
the pustules prediiminutiug. There is a marked tendency to rnp-
buing of the ledous, the discharge drying Ui thiijk, yelluwish, brown-
ish or greenish crnsta.

Its most common sites are the scalp and fiice, eapeciaUy in yoang
people and in those who are ill-nourished aii<l Btrnmous.

What course does pustular eczema pursue!

UbTiiilly chronic, continuing as the same type, or passing into
eczema rufjrum.

Sesoribe the symptoms of squamoiiB eczema.

Squamous eczema {eczema squamosum) may be defined as a
clinical variety, thB chief symptoms of 'which are a variable degree '
of Bcaliness, more or less thickening, infiltration and redness, with i
commonly a tendency to cracking or fissuring of the skin, especially
when the disease is seated about the joints. It ia developed, as &
role, from the erythematous or papular type. Itching is slight or
intense.

The disease is not uncommon upon the scalp.

What is the coarse of squamous eczema ?

Essentially chronic.

Describe the symptoms of eczema mbrom.

Eczema rubrum ia characterized by a red, i
oozing or discharging surface, attended with n
i toiy thickening, infiltration and swelling ; the exudation, coosiating
t of serum, sometimes bloody, dries into thick yellowish or rcddish-
■"brown crusts. At one time tho whole diseased area may be hidden
ft under a mass of crusting, at other times a red, raw-looking, weeping
■ surface {eczema inadiduTU') is the most striking feature. Itching is
K slight or intense, or the subjective symptom may be a feeling of
f burning. It is an important clinical type, usually developing from
I the vesicular, pustular or other primary variety.
I It ia common about the face and scalp in children, and the middle
^fod lower part of the leg in eldeiiy people.

T-looking, weeping,
' idomma-

INFLAM51ATF0NS,

What is tlie coiirse of eczema rnbrnml

ChroTiic, varj'iiig in iiitfLiMity fruiii tiiHC! Ui time. [

Describe tbe symptoms of Pastured eczema.

In fissared eczema (I'czenia Jtngiim), the pnnapiLiioTis symptom H'
a marked tendency to tiBsuriug or cracking of the skin. This ten-
dency is usually a part of an on'tbematoua or tiqiiamous eczema,

BcEsou ot thi FMS BIkd Scalp ( i/lir Fifftird

the SsBOimg constitnting the most consptcaous and troublesome
' qrmptum. Cliappinij is nn extremely mild hut familiar exai;
f this type.
It is especially common about the hands and fingers.

What is the course of fisEnred eczema?

8 persistent, the tendency to fissuring varying oon-
sidembly according to the state of the weather, ofleu disappearing
fflonttuieouely in the summer months.

1 Wnatli

^K ItisB

^^HsponttuK

Ufi niSEASEB OF THE BKIN.

DeicritK the symptoms of eczema BcleToiom.

In this variety the eraemntoua patch ia thickened, infiltrated and
haid, and almugt honjy. It is lumummon, and Ls usually seated
about tbu ankle or fitot, developing from the [japular or sqnamous
type.
What is the oonrae of eczema sclerosum 'i

(_Histiiiiit*.:ly ehrunii.'.
Describe the symptoms of eczema yerrncoBiim.

This is somcwliiit wimilar to eczemu, ficleroauni, the patch being
haul, thickened atjil infiltrated, with a tendency to papillary orwart-
like liypertruphy. It develops uwu^illy from the pariular or sriuam-
ous type, and is met with about the aukle and foot. It h lUuxumnaQ.
What is the coarse of eczema verracosiim ^

Ohstinately ehronic.
What do yoti trnderBtand by eczema seborrhoicnm?

A niljineous inflammation exliihitiiiR Hymptoma of both eczema
and HelmrrlKca. Ah yet it can BWireely be said to be a well-^iefined
or reeoguized tyjie.
State the nature of the sabjective symptoms in eczema.

Ittjliirig, [.Hiumionly intense, is uauidly a conspicuous symptom ; it
may Iw more or less paroxysmal. In some cases burning and beat
oouHtitutu tlie main subjective phenomena.
Is eczema accompanied by general febrile or constitiitioaal
symptoms I

No. Ill niro inctjoiec,'', in iuaite uiiiverreil ecaenia, slight felniie
aotiiiii, or olInT syNteujic di.'Jturb.'iuct;, may be noted at the time of
tlui outbmik.

Is the eoxematoua eruption (patch or patches) sharply defined
against the neighboring sound skin ?

N'.i. In iihinwt all instioioes the dineiwd area luergeB gradually
ami iinpiiii'i'iilibly inUi the aun'onnding healthy intt^gumeut.
What ii the character of eczema as regards the degree of
inflammatory aotioni

The iiitl:iiri[itiiti>ry lu'tion may be acute, subacute or sluggish in
chiinii'tf'r, luid may bit mi from ibu sfairt aud ao cuniinoe thruugbout

8 usually tLe ease, vary in iotensity

its whole course ; or it

State the character of eczema as regards daration.

As a rule, it is a persiatcnt disease, showing little, if any, tendeniy
I to spoatancous disappearance.

Ib eczema inflnenced by the seaioiu 1

Yes. With comparatively few exceptions the disease is most com-
mon and luucli worse ia cold, windy, winter weather.

To what may eczema be ascribed ?

Eczema, tauy he due to constitutional or local causes, or to hoth.

Name some of the important eonBtitnttonal or predisposing

Gouty diathesis, rheumatic diathesia, disorders of the digestive
I bract, general debility or lack of tune, an exhaiut^d state of the nerv-
F ous system, dentition and struma.
Is a oonstitntional canse sufficient to proroke an attack T

Yes ; but often the attack is brought about in those so predla-
posed by some local or esteruaJ irritant.

Hention some of the external causes.

Heat and cold, sharp, biting winds, excessive use of water, strong
soaps, vaccination, dyes and dycstuffs, chemical irritants, and the
r like.

Contact with the rhua plants, while producing a pecuUar dermatitis,
Uly ninning an acute course terminating in recovery, may, in
■those predisposed, provoke a veritable and persistent ecsema.
Els eczema contagions 1

No.
||What is the pathology ?

The proce^ is an inflammatory one, characterized in all oases

■^ hyperemia and exudation, varying in degree according to the

tenMty and duration of the disease. The rete and papillary layer

B efl]ieciiilly iiivolveil, although in severe and chronic cases the

r part of the conom and even the suboutaaeous tissue may

e ia the process.

8«W would f on txeinA* pioriMli in a impected ean of •
Hma (»qwtttu>a§ «czema) 1

I*«)rin«(« fdn-iits in vtiri'rtwly •iwi, ronn'kfl, tharjjly-c
jml/'li'is, u»(i»lly Kii«flJTi«l irri'KHlrifly hvit tho gonnral Harface, with!
(■IHX'Jul irTiullliu'tli'ii fiir tlii> isllxtWN iin'l kim-n. They iire covered'^
ticrn "T lew iiliufnliuiHy with whitJMi, nilvory w njothur-of-pearl od-
(irnil liiiiirliiit>i"l wfilnn, Tlio iMiUihtxi nre alwayH dry, uml itching ia, |
nil n mil', NliKhl, itr iriuy Ihi niitimly itbMint Buiicma, on the con- '
tiiii'y, \n ottMi liii'iillin"), ntiiiKiiriiiK iw unci (ir tnoro Urge, iiregiiiarly i
'IIITiimiil iiiitiihrm ; ll. iiinrKoo liiiiiun!it[itibly iuto the «oiind skin, and
HmhU utWu % UytHty at ihuaetuxith mnmi or fumtuyooungi

weTgcaliiig is nsunlly slight and itching almnflt iiiTariabS; a promi-
nent Hymptoin.

How would you exclude seborrhoea in ,a. suspected case of
eczema t

Seboirhtoa of the scalp (in which locality it may resemble eczema)
is commonly over the whole of that region ajiii is free from inflamma-
toiy sympttims ; the scales are of a greasy character and the itching

ID of th« ikln of th« forMum {JIW fi^MnfJ
0i hypflr pl^mflnt«d lafar of TV\e. iL enlHrra
la EUnd ; /, Mropbled IiBir-folLlcl

is oenully slight or nil. On the other hand, in ccEema of this
regioD the parte are rarely invaded in their entirety ; there may be
at timee the characteristic serous or gummy oozing ; inflammatory
Bymptoms are usually well-marked, the scales are dry and the itch-
ing is, as a rule, a prominent sympUim.
How does Bcabi^s differ from eczema 1
Scabies differs from eczema in its jjeuoUar distributiou, the pre-

wmaBfmnAn* nOta inrto «f tke bee, aad iidnf mms

TIh: cliwjft U, under ^rrjciUe OKBMe
yitUiaiC lUiire 'jV Ion re^diiy, odiefB p wm ng e
Tlw IcOKtli ''f tin': t(> hnng abciat a resnlt is alvays n
H (^liidefi 00 tin* iMnt ilionld be giiuded.

Vpan wbtt VoaU 70B baae yotir pn^aiMU in tite i

Till >rxti!Til Iff iJiMwK, iba duration and previoai^ bebarior,
mainitWAf iit the cxuliog and pre^nmnp causes, and the al
tiim Uus iM>ii(!iit can giro lo the treatnteot

In MSUiuik invulvitig tlie lip«, face, acrutom, and leg, aad «
wlivti ihlK Iwt-naniud nxhibita a variimw onDdilioD of ihe reins, i
vuri! w xfleuted, w n rol«, ouly tkrungh persL>teDt and prol

Doai ecuma ever leave loan T

Hn, I ^iHiii till: li'UH, in long-iuiitieiuud cai^es, q
talinn UKunlly ti-.iuaiuiL

How ii eczema treated t

Ah 11 m\f, uru-un riKiuircd Tor its rcmuval both cuasUtudunal nod j
(tit'^rnul Iniulniciit.

Ci^rtairi imM--ii, liiiweror, wem to be entirely local in tlii'lr natore,
UT thn iireUiHixming fxctora maj' havo disappeared and tliu disease
p«ni«t, m it wcro, flum furoo uf halnt. Sudi ioiitauoes are not

INFLAMIIATIOSS. tOl

I iu tlieae caaea esteriLiil treatiueut nloiio will liavc
satistiutory results.

What general measuieE as to liy^ene and diet are commonly
advisable t

Fresh air, exercise, moderate indolgenco in calisthenioe, tegniar
habite, a plain, natritioaa diet ; alistention from Euch articles of food
OH pork, salted meat, auid fruits, imstry, gravies, aauees, chccso,
pickleB, eondiments, excessive coffee or tea drinking, etc. As a rule,
iilw), beer, wine, and other Htimnlants are to be interdicted.

ITpou wliat ^onnd^ la the line or plan of oonstitntioiial treat-
ment to be baaed ?
UpoD indications in the individual catie. A careful e^xaminalion.
into the piitiout'a penenil health will usually give the eue to the line
of treatment to hu itdopti;d.

Hention the important remedies varioiisly employed in the
constitutional treatment.

TfMw'c*— such 08 cod-liver oil, quinine, nus voraica, the Tegeta.l)le
bitters, iron, arsenic, malt, etc.

Alkalii's — sodium salicylaite', potassium bicarbonate, liquor po-
tasssa, and litliium carbonate.
Alterative^ — calomel, colchicmu, araenje, and potassium iodide.
I Diuretic* — potassium acetate, polaaaiiim citrate, and oil of copaiba.
Laxative* — the various salines, aperient spring waters, oistor-oil,
I caacara sagrada, aloes and other vegetable cathartics.
[ Digativeg — pepsin, pancreatin, muriatic add and the variuus bitter
I tonics.
[ Are there any remedies which have a specific influence 1

No ; although arecnic, in exceptiuuiil instaiious, seems to exert a
special lu^tiun.

In what class of cases does arsenic often prove of service ?
In the slug^i."!!, dry. fiythiimiitmu, souly and papular types.

In what cases is arsenic usually contraindicated t

It shijuld never he employed in acute cases ; nor in any instance
1 (Doless its action is watched), in whieh the degree of inflammatory
I action is marked, as an aegravatluu oi' thu disea^ usually results.

-f*

■-' ^. T

INFLAMMATIONS. 103

A lotion made of one or twodriuimaof Uguor carbonisdeterguBB*
to four ounises a£ water.
Tlie following wash, eapecialiy in tho iliy form of the diseaso : —

Aqa»

. .q.8

ad. .

. .Oj.

Dusting-powders, of starcli, ziiic oxide and Venetian talc, alone or
BTeraLy combined, applied freely and often, bo as to afford protec-
tion to the inflamed surface : —

TaM venet,
Zlaci oxldi, .

If washes or dusting- iiowdera should disagree or are not desirable
-OT practicable, ointments may be employed, such as —

Oxide-of-ziuo ointment, euld creum, petrolatum, plain or carbo-
hted, diachylon ointment (if fresh and wel] prepared), and a paste-
fike ointment, as follows :—

R, Ac, salicylid, gr. y-x

Pulv. amyli,

Pulv, zindosidi, . . . . aa gij

Petrolati, giv M.

* the following ointment ; —

B. Culotuinffi, Si

Ungt. zinci oxidi, Svij. M.

Vame sereral external remedies and combinations useful in

eczema of a subacate or mildly inflammatory type,

The various reuiLiliw and i.-<jiiil>i]i.itiwis us.'1'ol when (he i-ymptoms

LJqDor carbonis detergenii is made by mixing together nine onncee
tincture o( soap bark and Ibnr onoces of coal tar, allowing to digest
dgbt days, oiid filtering.

104 DlSE.taES OF THE SKIN.

ate acute or markedly inflaiumatory (mentioned above), and mora J
especially the several following ; —

B. Zinci Dxidi gij

Liq. platubi Babacetat. dilat., . . . . fSxJ

Glycerina', fjij

iDfbs. picis liq., fSMJ M-

A lotion coDtaining resordn, five to ttiirty grains to the ounce. I

Solution of liuc sulphate, aue-half to three grains t^i the ounce.
An oiutment coutainitig calomel or amiuoniate<l mennuy, aa in
the annexed formula : —

B . Uydrargyri amiuouiat. seu Hyclniig.Tri

chloridi mil., gr. x-m

Ac. carbolici, gr. v-x

Uugt unci oiidi, S3-

Another formula, more especially useful in eczema of the handa
and legs, is the folluwiug : —

B. Ac. BoKcylici, gr. us

Emp. plonibi,
Emp. sapoiiia,
Pettolati, aa ■ S.i- M.

^his is to be applied as a plaster, spread on strips of lint, obA
ohauged every twelve or twenty-four hours.)

The pnete-like nintiuent, referred to as useful in acut« eCEemn,
may also be used with a larger proportion (20 to CO grains to the
ounce) of sal icy lie add.

The followiug, oontaiiiiuK lar, may often be empluyed with advan-
tage :—

E. Ungt. picis liq., ^j

Uiigt. ziinio.>:idi, 3 vij. M.

What is to be Baid in regard to the use of tarry applications T

Ointments or lotions containing tar should always be tried at Grst
upon a Umitcd surface, aa occuaonally skina are met with upon
which this remedy acts aa a moro or less violent initBAt

INFLA.M STATION 8. 105

What external lemedies aie to be employed in eczema of a
alnggislitype^

ITiB various remedies and combinations (mentioned above) usefol
in jiente and subacute eczeoia may often be employed with benefit,
but, as a rule, stronger appliuations are necessaiy, espeeially in tiie
tbick and leathery patcbes. The following lae tbe most vuluable : —
An ointmeut of calouiet or ammouiated mercury ; forty to sixty
grains to the ounce.

Strong sa!icylic-aeid ointment; a balf to one drachm of saUeylio
acid to the ounce of lard.

Tar ointment, officinal strength ; or tbe various tar oik, alone or
with alcohol, as a lotion, or in ointment form.

Liquor picis alkalinua * is a viduable remedy in chronic thuikeneil,
hard and vemianig patches, but is a strong preparation and must be
used with caution. It is applied diluted, one part with Irom eight
to thirty-two parts of water ; or in ointment, one or two drachms to
^ the ounce. In such eases, also, the following is usefiil : —
^ . Saponis Tiiidia,
Piclaliq.,

Alcoholia, SS. giij. M.

Sra. To Iw well rnbticil in.
In similar cases, also, the parts may be thoroughly washed or
scrubbed with sapo viridis and hot water until somewhat tender, -
rinsed off, dried, and a mild ointment applied aa a plaster.

Liictic acid, applied witli one to ten or more parts of water is also

of value in the stclerous and verrucous types.

Is there any method of treating eczema with fixed dresBingB?

Several plana have been advised from time U> time ; some are costly,

I and some require too great attention to details, and are therefore

I uupracticable for general employment. The following are tboso id

^ more common use ; —

The gdatin dretting, as originally ordered, is made by melting over

•B- Potasare, 3j

Picislici,, ,^ij

Aqme, gv.

Slaeolve the potasb in the water, and gradually add to the tar in a
;, with thoruDglt Btirring.

106 DISEASES or THE SKIN.

a water-bMhooe part of gelatin mtwoparteoFwatei^-quicklj' painb-J
ing it over the disea^ area ; it dries tapidly, and to pi^vent erack'^
ing glyceriite ie brushed orer the mr&ce. Or the gljoeiiae m^l
be incorporated wilh the gelatin and water in the following propOT'l
tion : glycerine, one part ; gelatin, four parte, and water eight parta.1
Tarioos medicinal substances may be incorporated with the gelatio I

Ftagter-m«R and ffulta-penJia ptruler. The plaster-moll, con*
aisting of Qiaslin incorporated with a layer of stiff ointment, and tl
gutta-percha plaster, consiBtiog of mnalin faced with a thin layer of I
India-rubber, the medication being spread upon the robber coating. ]

Rubier and gdaliAe platter. These are medicated with the Ti
ons drugs used in the eKtemal treatment of skin diaeaeea, and a
often of great service.
In what types of eczema m&j these several fixed dressings 1
be used ?

The plaster-mull in all types, especially the acute; the gelatin J
dressing, the gatta-{ieteha plaster and the gelatole plaster h
mbacule and chronic ; and the rubber plaster in chronic, si
patches only.

Prurigo.

Btfine prurigo,

I'rurigo is a chronic, inflammatory disease, eharaeteriied by dis* J
Crete, pin-head- to »mall pea-sized, Holid, firmly-heated, slight
raised, pale-red papules, aecompaoied by itching and more or li
general thickening of the affected skin.
Sesoribe the lymptoms and course of prurigo.

Tlie disease first np|)cars upon the tibial regions, a
iUelf by the development of small, millct-seed-stzed, or larger, finnfl
elevations, which may be of the natural color of the skin or of a pink- f
ish tinge. The lesions, whilst discrete, are in great numbers, ancl'l
eloBcly crowded. The overlying skin is diy, rough and harah ; itch- 1
ing is iirteime, and, as a result of the scratching, excoriations and I
hluoil crusto are commonly present. In consequence of the irritation, (
tbo inguinal glands are enlarged. Sooner or later the integument
becomee considerably thickened, hududmu^, jfliawnirtona aynip-

IStXAMMATIONS.

twius may be superadded. lu severe tusea the entire est^naor surfiieea
of the legs and aitna, and in mtue iuHtunued tiic tniuk also, are ia-
vaded. It is worse in tho winter seaaou.
What is known in regard to etiology and pathology ?

It ia a disease uf the ill-fed and neglected, ueually developing Id
early childhood, and persisting throughout life. It ia estremely rare,
even in its milder types, in this country. Clinically and pathologi-
cally it beara some reHemhlaDce to papular eczema.
Qive the prognosis and treatment of prurigo.

The disease, in its severer types is, as a rule, incurable, but much
can be done to alleviate the condition. Good, nourishing food, pure
ait and esereise are of importance. Tonics and cod-liver oil are
usually beneficial The local management is similar to that employed
in chronic eczema. An ointment of /J-napbthol, one-half to five
per cent, strength, is highly cxtollol.

Acne.
Give a definition of aone.

Acne is an iiifliinimiitory, usuiilly chronic, disease of the sebaceous
glands, cliaracterized by piipiilcs, tubercles, or pus^tulea, or a mixture
of these lesions, and seated usually about the face.
At what age does acne nsnally occur?

Eciw.'cn the ages of fifteen and tliirty, at which time the glandu-
lar structures are naturally mora or lest active.
Segotibe-^e symptoms of acne.

Irregularly scattered over the face, and in some cases also over the
neclc, shoulders and upper part of the trunk, are to be seen several,
fifty or more, pin-head- to pea-sized papules, tubereli'S or pustules ;
commonly the eruption is of a mixed type (nciie vulgaris), the several
kindsof lesions in all stages of evolution and subsidence presenting in
the unglocase. Interspersed may generally be seen blackheads, or
oomedoncB. The lesioae may be sluggisli in character, or they may
bo markedly inflammatory, with hard and indurated baaes. In the
cuurae of several days or weeks, the papules and tubercles tend
gtsdoally to disappear by absorption; or, and a« commonly the caae,

108 DISEASES OP TEE SKIN.

they become pustular, diacharge their (.'outputs or dry, and slowly .1
or rapidly disappear, with or without leaving a penuaneut tracer 1
new lesions arising, here and there, to take their place.

What do yon understand by acne pnnctata, acne papulosa, '
acne pnstnloaa, acne indurata, acne atroptiiea, acne

hypertrophic a, and acne cachecticonun ?
Tlle^ie si'veml toriuri imliciiti' tli:it t!it lesiana prosont a
moat part, uf onu jiarticular (.hamcter ur variety.

Describe the lesions §:iving rise to the names of these various >
types.

Blocking up uf the outlet uf the sebaceous glaod (uomedu), whichuiJ
nsually the begiuniug of au acne lesion, miiy cause a. moderate d^
of hyperemia and inflammation, and a slight elevation, with % oeo'
tral yellowish or blackish point resulte — the leson of acne puni^xta ;
if the inflammatioii is of a higher grade or prugresses, the elevation
is reddened and more prominent — acne papuluaa ; if the inflamma-
Wry action continues, the interior or central portion of the papule sup- -,
purat«s and a pustule results — acne pustulosa ; the pustule, in
cases, may have a miirkedly inflammatory and hard base — acne ]
rata; and not infrequently the lesions in disappearing m^le
pit-like atrophy or depression — nma atrophica ; or, on the oon
oonnective-tissue new growth may follow their d
hj/pertrophiea ; and, in BtmraotiH or cachectic individuals, the U
maybe more orlcsslunincular in type, often of the nature of d
ftbecesseSjUsually of a cold or sluggish character, and of muregeDeral'l
distnbutjon — acne cachecticorum.

What is acne artiflcialis T

Acne artificialis is a term applied to an acne or acne-like eruptiOQ
produced by the iugestion of ccrt^n drugs, as the bromides and
iodides, and by the external use of tat ; this latter is also called (or

What course does acne porsne ?

Essentially chronic. The individual lesions usually
in Severn! days or one or two wei^ks, but new lesions
pear fixjm time to time, and the disease thus persists,
lees variation, for uouthe or yow ' "Ww thi

TSrLAMMATiONa. ]

tJie age of twenty-fivi- or thirty, a tendency to spontanuoua c

appearance of the disease.

Ib tlie ernption lit acne nsnally abnndant ?

It varies in different cases and at different periods in the same
case. In some instances, not more than five or ten papules and
pustules are present at one time ; in others they may be numeroua.
Not infrequently seyeral lesions make their appeuranco, gnidually
run their W)urse, and the face continues &ee for days or one or two
weeks.
Does the eruption in acne disappear without leaving a trace T

In many instances no permanent trace rentuins, but in others
sUgbt or conspicuous scarring is lefl to mark the site of the lesions.
Are there any subjective B3rmptomB in aone ?

As a rule, nut ; but markedly inflammatory lesions are jiainfiil.

State the immediate or direct canae of an acne lesion.

Ilypei-secreticin or retention of scbacajua matter.
Name the indirect or predispoaing causes of acne.

Digestive disturbance, constipation, menstrual irregularities, chlo-
rosis, general debility, Lick of tone in the muscular fibres of the akin,
BCTiiftiloKiB ; and medimial substances suoh as the iodides and bromidoa
internally, and tar eztemally.

Working id a dusty or dirty atmosphere is often influential, result-
ing in a blocking-up of the gland ducts. Workmen in paraffin oils
or other petroleum products often present a furuncle-like acne.

The disease is more common in individuals of light complexion.

Is there any difficulty in the diagnosis of acne f

Not if it bo remembered that acne eruption ia limited to certain
parts and is always follicular, and that the several stages, from the
oomedo to the matured lesion, are usually to be seen in the individual

a what respect does the pnstnlar gyphiloderm differ from
acne?

By its general distriburion, the longer duration of the individual
lions, the darker color, and the prosence of concomitant symptoms
fqipkiliB.

110 DISEASES OP TUE SKIN.

What is the patholo^ of Hone t

PriiaariJr, acne is a falliculitiH, due to retentiim or decomposition
of the sebaceous secretion ; BubsequeDtly, the tissue ininiediately
surrouuding becoming involved, with the posable destruction of the
sebaceiiua follicle as a result. The degree of inflammatory actioa J
determines the churacter of the lesions. I

State the prognosiB of acne. M

It is usually an obstinate disease, but ctirable. Some cases yieUfl
readily, others are exceedingly rebellious. Succesf* depends in jJ
great measure upon a recognition and remoTal of the prediapoan^B
condition. Treatment is ordinarily a matter of months. ^M

What meaanres of treatment are usmally demanded in acoet.'l

Constitutional and local measures; the fomior when indicated, 1
the latter always. I

irpon what u the constitutional treatment based ? I

Upon, general indications. M

In dyspepsia and constipation, bitter tonics, alkalies, acids, p^)ai^|

saline and yegebihle laxatives, are variously prescribed. Spemafl

mention may be made of the following : — fl

B. Ext. rhamnipnTsb. fl., f.^ij-fSiv ^M

Tiutt. nuciavora., fjiij H

Elis. caJisayiG, q.s. od . . , f^ iij- H. V

Sia.-fgj t. d. I

Or Hunyadi Jauos or Friedrichshall water may be employed for »fl
laxative purpose. I

Iq chlorotio and anseraic cases the ferruginous preparations are of. m
advantage. Cod-hver oil is often a remedy of great value, and is 4
especially useful in strumous and debilitated subjects. Calx sulpha- 1
lata in pill form, one-tenth to one-foiuth grain four or five times |
daily, occasionally acts well in the pustular variety. Krgot is also I
of benefit in a small proportion of cases — in those oases due to |
uterine disturbance nr hui '■]' Imic in the muscukr fibres of the i
skin. In some iiistiiiJi i -, nmn |.,irli( ularly in sluggiab papular acne,
arsenic, espedaUy the bromiii' " ^Wmbly. i

INTL-^MMATIONS. lU

In inflammatoiy caaea occurring in robust iudiyiciuala the follow-
ing is oft«n of eervite : —

B. Potossii Bcetat., g iv

Liq. potaasiB fjij

Liq. niumoniiaeetat,, , , . q.s. ad . . [^iiy M.

SiG.— f 3 j-f 3 ij t A., largely dilnWd.

State the character of the local treatment in aone.

This must vary somewhat with the locd conditiona. Cases which
are acuta in character, in the sense that the lesiouB are markedly
hypenemic, tender and paiafiJ, naiuire milder applications, and in
exceptional inBtances soothing remeilieB are to be prescribed. Aa a
rule, however, stimnlatiiig applications may be employed from the
start,

Tlic remedies are, for obvious reasons, most conveniently applied
It bedtime.

What preliminary measures are to be advised in ordinary
acne cases 1
Washing the parts gently or vigorously, according to the irrita-
bility uf the skin, with warm water and soap ; subsequently rinsing,
and siMjnging for several minutes with hot water, and rubbing dry
with a soft towel ; after which the remedial application is made. In
[■higgieh and non-irritable cases gapo viridis or its tincture may often
advantageously used Ju place-uf the ordinary toilet soap.

^^^L with a aoi
^^■■higgieha
^^^ueadvaot

112 DISEA31S OF THK SSIK.

The blackhead^ »ifia as piactieabic, arc to I
snre vitb the fingers or with a Stable instrument (see uoniedo), aod |
the pustoles ponTturcd and the contents pressed o
State the methods of external medioatioii commonly em-
ployed.

By ointments and lolions. If an oiutment is used, i
thoroughly ruhbed in, in ?niall iiuantily ; if a lotion is employed, ib I
is to be well shaken, the parts IVcely dabbed with it for several I
minutes and then aLowed to dry on.

State the object in view in local medication.
To hast«athemataTation and disappearance of the existing leaons,, I

and to stimulate the skin and gknds to heulthy action.

If shght irritation or scaliness results, the application is to bo I
tntennttt«d one or two nights; in the meantime nothing except I
the hot water sponging, with or without the apphca
BDOthing ointment, is to be employed.

Is it usually necessary to change from one external remedy
to another in the conrse of treatment?
Yes. After a certain time one remedy, iis a rule, loses ita effect,
and a change froui lotion to ointment or the reverse, and from one j
lotion or ointment to another, will often be found neoeaeary ii
to bring about continuous improvement.

Name the varions important remedies and combinatioiia em- '

ployed in the external treatment of acne.

Sulphur is the must valuable. It may often Ije appUed with benefit j

as a simple ointment : —

R. Solphur. pnccip., 3ss-3J

Adipia benz.

Lanolin, aii gjj.

Or it may be used as a lotion, as in the annexed formula :

B. Sulphur. priBcip., giss

Pulv. tragacanthie, gr. Jci

Spta. caiuphoriB, f g ij

Liq. calcis, . . . .q. s. ad fjiv. 1

INFLAiraATIONB. 113

Another lotion, especially uaefiil in those cases ia which an oily
condition of the akin is present, is the following : —

B. Sniphar. pnncip., Jisa

Elheria, fjiv

Aluoholia, f^iijaa. M.

A compound lotion containing snlpbur in one of ite combinations
is also valoahle in many cases :—
B . Zinci HolpliatiB,

Potasaii Hulphnreti, . . . . 5S . . , . ^ss-Jij

Aqate, 5 iv. M.

(The salts should be dissolved separately and then mixed ; reaction
takes place snd the resulting lotion, when shfLken, ismilkyinappear-
:, and &ee from odor ; allowed to stand the pHitii'leii settle, the
sediment constituting about one-fourth of the whole hulk).

At times the addition to this formula of several drachms of alco-
hol or of one half to a drachm of glycerin ia of advantage.

An external remedy, often valuable, is ichtbyol. It is thus pre-
scribed :—

E- Icbtbyol, Sss-SJ

Laooliu, giv. M.

Resorcin as a lotion, ten U> sixty grains to the ounce, is uset\il in .
some cases.

The various mercurial ointmenta, especially one of white precipi-
tate, five to fifteen per cent, strength, are sometimes beneficial

A compound lotion, containing mercury, which frequently proves
serviceable, is : —

B. Hydrarg. chlorid. conos., gr. ii-viy

Zinci aalphotis, gr. i-n

Tiuct.. benzoini, fgij

Aqutt, q, s. ad . . . . f^iv.

In extremely sluggish cases the following, used cautiously, is of
^Tahie:—

B. Ichthyol,

Saponis viridis,

Sulphur, pneeip.,

Lanolin, aa gj.

DI^EASB^ UF THE BEIX.

Obitinate and iaduraled laivtit may be tnnsed, the (

ir touched with carbolic add by a

pressed out, and the ii
a pointed stick.

Wliat precantioii is to be taken in sdviaing a change from a
snlphiir to a mercurial preparation or the reverse T
Several days slmuld be allowed to intfrveoe, othcrwiw a disagree-
able, although temporary, stniDiri^ or darkening of the skin results
— from the fonnatiou of the black solpharet of mercury.

Acne Rosacea.

Give a descriptive definition of acne rosacea.

Acne rosacea is a chrouit, tiyiiur.emii: or iullaminatory d
limited to the face, especially to the uusa aud elieeks, characteiiaect 1
by redness, diUtation Qud enlargement of the bloodTCBselB, more a
law acne and hypertrophy.
Sesoribe the symptoms of acne rosacea.

The diseaae may be slight or well-niarked. Redness, oapill
dilatation, and acne lesions seated on the nose and eheeks, and soi
times on chin and forehead also, constitute in most cases the em
eym ptomatology .

A mild variety eonsiata in simple redness or hyperajmia, inTohii^ 9
the nose chiefly and ofWn excluslTety, and is to be looked upon m
passive congestion ; this is not uncommon in young adults aa
ofWn associated with an oily eeborrhtBa of the same parts. In n
cases the condition does not progress beyond this stage,
cases, however, sooner or later, the dilated capillaries bee
aianendy enlarged {tefanffifctang) and acne lesions are often p:
cODHtitnting the middle stage or grade of the disease; this is thol
type most frequently met with. la exceptional instances, still tar^ J
ther hypertrophy of the bliwdveissels ensues, the glands are eiilwgBd,J
and a variable degree of connective-tissue new growth is added;!
this latter is usually slight, but may be excessive, the nose presentinjf I
an enlarged and lubulated appearance {rhmnphyma).
Are there any subjective symptoms in acne rosacea?

As a nilc. no. l^mue of tlio acue lesions may be tender and pain-
fill, and a^ Jsffl

INFLASISIATIONS.

115

Wliat do yon know in reg:aid to the etiolo^ i

In many oases the causes arc obscure. Cbronio digestive and in-
testinftl disorders, anieinia, chlorosis, continued exposure to heat or
cold, nieustrual and uterine iiregularities, and the habitud use of
Bpirituous liquors, are not infrequently responsible factors.

It is essentially a disease of adult life, common about middle age,
occurring in both sexes, but rarely reaching the same degree of de-
velopment in women as observed at times in men.

Ib acne roBacea easily recognized ?

Yes. The redness, acne lesions, dilated capillaries, and, at times,

the glandular and connective-tissue hypertrophy ; the limitation of

the eruption to the face, especially the region of the nose ; the evident

involvement of the sebaceous glands, the absence of ulceration, taken

r with the history of the caste, are characteristic.

I It is to be distinguished from the tubercular syphiloderm and

I lupus vulgaris, diseases to which it may bear rough resemblance.

State the prognosiB of acne roBacea.

All cases may be favorably influenced by treatment; the mild
and moderately developed types are, as a rule, L-urable, but usually
obstinate. It is a persistent disease, showing little, if any, tendency
to disappear spontaneously.

What is the method of treatment?

Both constitutional and local

^Wo
^Pth<

^4>il,

Upon what is the constitntional treatment to be based 1

The constitutional treatment, beyond a regulation of the diet, is
be based upon a correct apprcMation of the etiological factora in
I individual case- There are no special remedies. Iron, cod-hver

lOil, tunics, ergot, alkalies, saline laxatives, and similar drugs are to

be variously prescribed.

What IB the external treatment t

^^_ In many respects, both as to the preliminary measures and reme-
^^K$es, effientjally the same as that employed in the treatment of sim-
^^^hle aoue (q. v. ). In addition to the treatment there found, however,
^^^BTOFal other applications deserve mention : —

In many coses TJemintkx'a toliition* is viiluable, applied (tinted
with one to ten parts of vrat^r. Also, u mucilaginous paste c
taining sulpLur : —

B . Mncilag aeaciie f 3 iij

GlYcenniE fgu

Snlphnr pitecip Jiy U

Or a similar p istp with the slycenoe m tlie forejroiDp replaced with
ichthyol maj 1 ua 1

In what manner are the dilated bloodTesEels and connective
tisane hypertropliy to be treated?
The enlarged capillaries are to be destroyed by incision or by elec-
trolysis. Properly managed the ycBsela may be thus deatroyed, but ]
onleBB tbe predispo^g causes have disappeared or have bees n
died, a new growth may take place.

If the knife is employed, the Tesaels are either slit in their lengtib 1
or cut transversely at several points. The method by eleetrolyais u

•awe as used in tbe removal of superfluous hair {q. v.). ; tha '
needle may, if the vessel is short, be inserted along its calibre, or if
long, may be inserted at several points in ita length.

Kseessive oonoective-tisnue growth, exceptionally met with, is h>
be treatiid by abktion with tlie scissors or knife.

Sycosis.

(."iyFiuFiyra. .- S.TCoeia Non-punifki™; FollkulilLs Burbio.)

What do you nnderstand by sycosis ?

'cosis ia a chronic, inflammatory affection involving the I
fbllictes, usually of the bearded region only, and cbaraoteriMd 1
papules, tubercles and pustules perforated by huirs.
Describe the symptoms of sycosis.
Sycosis bofins by the formation of papules and pustules abont 1

' B. Cakis, Sbs -

tjulph. Bublimat., Jj

AqniE, >. Ji.

To lie boiled down to § yj aud filtered.

IMFLAMMATI0N8.

117

the hair-follioles ; the letuona occur in Durabers, in close proximiQf,
and together with the accoinpaiiying iiiflammatioD, make up a, small
or large area. The puHtules are small, rounded, flat or acuminated,
Uiscarete, and yellowish in color ; they are perforated by hwra, show
no tendency to rupture, and are apt to occur in crops, dijing to j
thill yellowiah or brownish ci-usta. Papulea and tubercles are often J
iutermingled. More or lees BWelling and infiltratdon are noticeable.

The disease is seen, as a rule, only on the bearded partof the ince, I
either about the cheeks, ehin or tipper lip, involving a small portion J
or the whole of these parts.
Does oonspioaoaB hair loss occur in gycoiiB 1

Ordmarily not ; the hairs are, cspeciuHy at first, nsoally firmly 1
seated, but In those eases in which suppuration is active, and
involved the follicles, they may, as a rule, be easily extracted. In I
some cases destruction of the follicles ensues and slight Kuajring and |
permanent hair lo*^ result.
State the character of the BnbjectiTe symptoms.

Paiu and itehing and ii sense of buiniog, variable a-s to degree,
may be present
What is the course of the disease!

Essentially chronic, the inflainniBtoiy action being of a suhiicula |
or sluggish charact^!!, with at-ute csacerbatioua.
State the causes of sycosis.

The etiology is obscure. It ia not contagious. LooaHrritati(» J
may act as an exciting cause. Entrance into the follicles of a pccu- ]
Bar njicroorganism is suggested as the essential factor.

It is seen in the male 3cx only, usually in those between the ages 1
of twenty-five and fifty ; and is met with iu those in good and bod ^
heulth, anil among rich and poor. It is comparatively infrequent

What ia the pathology of syoosis 1

According to latest investigatjoua the disease is primarily a perifol-
lieuli^ the follicle and ib) sheath subsequently becoming involved
in the inflammatory process.
How would yon distinguish sycosis i^om eczema 1

Elezema is rriioly sharply limited to the bearded region, but is
, to involve other pmta of the foce; moreover, the lesions are usually J

DISlliSES or THZ SKIX.

conflnent, aad tboe is ehber an ooan^ red en

How TonU joa txttnit tines ^eoiu in the diagnosisf

In tinea sycoas, or nngwontL, Ibe history of the ca^ is different.
The parts are distinctlj him|ij and nudalar ; the haits are auoo ui-
Totred artd become dry, brittle. I<x)e« and &11 out, or thejr may be
rvadily eitnu^ted. Indtmbtliil Kises, miisiMeopic examinatitin of the
haii% may be resorte<l to. i

Give the prognosis of sjcodt.

The disease b cniable, but almoEt invamUy obstinate oikI rebel-

Iknu to treatment. The duration, extent and charai^«r of the in- j

fcmmalary proc^^ niust &U be conadered. Ad eipresion of nn I

opinion aa to the length of time Ki^oin.'d fur a cure should ahn^ I

be guarded. I

Hoir is sycosis to be treated ? * I

JIainly, luid oft«n excluaivtly, by external applications. I

Is constitiitional treatment of no avail in sycosis 1 I

In some inatantes; but, as a rule, it is negative. 11' indicated, I

such remedies as tJinics, alterative^ cud-liyer oil and the like are ta 4

he prescribed. CcJx sulpbnrata, in one-tenth to one-fonrth grain I

doses, every three or four hoiUB, is aooietimea of service j

Describe tbe external treatment I

Crusting, if present, is to be removed by warm embrocations. H I
the iiifliim million ift of a high grade, and the parfji tender and ptun- i
ful, B<Mtthing applications, mu-h aa bland oils, black wash and oxide- I
of-3!inc ointment, cold cream and petrolatum, arc to be used ; bono, I
ouid solution, fltlcen gmins to the ounce, may be iulvised in place of 1
black wash. |

In most cases, however, astringent and stimulating remedies ara
demanded from the start, such as : diachylon ointment, alona or
with ten to thirty grainB of calomel to the ounce ; citrine ointment,
witli one to three parts of liird or petTolatum; prBBcipitatcd sulphur,
one lu three drachms to the onncc of benzoated lard, or Lird and
kuolin ; n tvn to twenty-five per cent, ichthyol ointment; and
|;.HeQr(gBlottonflrwatin«mt,teBt6tw6Biyperoait strcaigth.

ISFtAMMATlONa. 119

A change from one apjilicatioti to aiiotlmr will be found necessary
in almost all cases.
Wliat would you advise in regard to ahaving ?

When bearable {iiud after a few days' application of soothing
rmnedjes It almost ulwaya in), it is to be advised in all cases, aa it
materially aids in the trealmuut. After a care ia eficcted it should
be eoLtinued for some moDths, until the htalthy condition of the
parts is thoroughly estjiljlisheJ.

When is extraction of the hairs advisable as a therapeutic
meaaure t

len the euppurative proi!ess is at'tive, in order to save the foili-
1 eles {ram deRtruotion , incising or puncturuig the puatules will often
somplish the same end.

Dennatltla PapUlirlB Oplllilli

Dermatitis Fapillaris CapiUitU.

E Describe dermatitis papillaris capillitii.

This is a [.cculiiir, itiil.lly inflammatory, .-ycuhifonn, ItRloidal,

f 120 DISEASES OF THE SKIN.

aone-like disease of the hairy border of the back of the neck,
often exteudiog upward to the ocdpital region ; partaking, cspecd-
allj later in its course, eomewhat of the nature of keloid. Several
or more acne-iike lesions, papular and puatular in character, make
their appeurance, developing slowly, usually to the aize of peas ;
red, pale red, or whitish, ofWn Gnvelophig suall tufts of hidr, and
attended with more or lesa hair loss. Its course ia gradual and
persistent. It is an exceedingly rare condition, the exact nature
of which is still obscure.
Give the treatment.

Treatment, which is usually unsatisfactory, consists of stimulatiiig j
applications— the same, in fact, as employed in sycosis, the eulphor J
and ichthyol preparations deserving special mention.

Impetigo.

(SJiHOnjm .- Impetigo Simpler.) |

What is impetigo 1

Impetigo is an acute, inftammatory disease, characterized by the
ibmiation of one or more pea- or finger-nail-iazed, rounded and
elevated, usually firm, discrete pustules.
Describe the STniptoms and course of impetigo.

The affection in sometimes preceded by slight malaise. Several
or more lesions may be present, scattered over one part, or mare
commonly over various regions, such as the face, hands, feet and
lower extremities. The pustules are such from the beginning, and
when developed are usually of the size of a pea or finger-nail, el»-
Tated, semi-globular or rounded, with aomewhat thick and tough
■walls, and of a whitish or yellowish color ; at first there may be
a slight inflammatory areola, but aa the lesion matures this almost,
if not entirely, disappears. The pustules show no disposition to
umhilication, rupture or coalescence ; drying in the course of several
days or a week to yellowish or brownish crusts, which soon drop off,
leaving no permanent tmoe.

The disease is benign in character and us-uaily of short dur.ition,
and, aa u rule, without sul^eotive

I SPLA3IM ATIO Na .

121

Wliat 18 the canse of the disease ?

The cause is not known. It may possibly be due tu
of microiirgajiiMnis. Ito subjects, cuumiotily young children, are
often weD-iiu unshed. Microscopically tho contents of the lesions

a found to be composed of pus ciir])uscles, a few red bluud coT-
put^les, epitlielial cells and ccllulur debris.

Vith what diseases may impetigo be confounded ?
With inij)ctign amtagiofia and ecthyma.

In what respects do impetigo contagiosa and ecthyma differ
&om impetigo 1

The lesioua of impetigo contagiosa are vesicular or vesico'pustular,
flattened, thiu-walled, superfidal and often imibilicBteU, aitd, if close
, together, tend to coalesce, drying, in the course of a few days or
I a, week, to thin, wafer-like, light yellowiah crusts.

7he lesions of ecthyma are markedly inflammatory, having a hard

had oflen extensive base, uud a distiuct areola, drying to brownie

I or blackish crusts, beneath which will be found deep excoriations.

I It if, moreover, usually Been in adnltH, in those who are in adepravod

I ooDdition of health,

Btate the prognosis of impetigo.

Favoruble. The disease tends to rapid and spontaneous di3a|>pear-
f Slice, rarely lasting more than a few weeks,

Oive the treatment.

Treatment is seldom demanded ; but the lesions may be incised,

the contents pressed out, and a simple jirotectivc dressing of carbol-

. ized oxide-of-zinc ointment applied. For sluggish lesions, the same

L ointment, with tea to twenty grains of whitfl precipitate, may be used.

Impetigo Contagiosa.

ItKve a descriptive definitioa of impetigo contagioHa.

Impetigo tioulJigiosa is au acute, euutagious, inflammatory dis-
, characterized by the formation of discrete, supertiuial, fiat,
DValish vetncles or blobs, soon becoming vesico-pustular,
A drying to tbin yellowish crusts.

Upon what parts does the eraption commonly appear ?

I'poQ the fare, scalp, iioj hiinds, aud exiasptionally upon
regious.

Describe the s;

e symptoms of impetigo contagiosa.

One, seveialormore small pin-head-sized papulo-yesJcleB orvemi

mate their appearance, iLsuiillj ui)un ihe £ice and fiugera. They I

increase in eizc by extending peripherally, but are more or less flat- 'f
tencd and nmbilicated, and are without conspicuous areola. The
lesions may attaJn the size of a dime or larger, and when cl

together may coalesce and form a large patch. In some eases dis- '
tinct blebs result. New lesions may appear for several days, hat
finally, iu the course of a week or ten. days, they have all dried to
thin, wiifer-lite cmats, of a straw or light-yellow color, hut slightly
adherent, and appearing as if stuck on ; these Boon drop off, leaving

faint reddish spots, which gmduuUy fj.de. As a. rule there are no 1

tiODstitutional symptoms, but in the more severe cases the eruptdon 1

may be preceded by febrile disturbance and malaise. Itching nuy 1

or may not be present. 1

State the cause of the disease. I

The etiology is nut known. It is contagious, the contents of the I

lesiona being inueulable ajid auto-inoculable. At times it seems tO' J

prevail in epidemic form. Microorganisms have been looked apon, I

as causative. A relationship to vaccination has been noted in soma ■

instances. It is commonly observed in infanta and young children. I

From what diseases is impetigo contagiosa to he dii&r- 1

entiated^ I

From eczema, simple impetigo, pemphigus, and ecthyma, I

How does impetigo contagiosa differ &om these several dis- J

eases T i

By the character of the lesions, their growth, their superficial 1

nature, their course, the absence of an iuflumiuatory base and areola, '

the thin, yellowish, wafer-like crusts, and usually it history of coo- ,

tagion. ^
State the pro^osis.

The cffeet of treatment is usually prompt. The disease, indeed,
tends to spontaneous disappearunue in one to two weeks ; in ezoep-

INFLAMMATIONS.

123

r tiooal inKtaDcee, more especiully In thiise ua^es lu which itchiag is
I present, tbc excoiiu,tii>u3 or scratch -marks become iDoculatetl, and
in this way it may peraiut several weeks.
What u the treatment of impetigo contagiosa ?

Treatment eousiats id the des-tructioii uf the autu-inoculable prop-
erties of the contents of tha lesiuns ; this ia effected by removing
the unists by means of warm watar-aud-soap waaliings, and sub-
sequently rubbing in an ointment of ammoniated mercury, ten to
twenty grains to the uunce. In itehing cases, a suturated solntioti
of bono acid, or a carbolic acid lotion, one to two druchms to the
pint, is to be employed iiir general application.

Impetigo Herpetiformis,

. Sescribe impetigo herpetiformis.

Impetigo berpL'tilurmia is aii istremely rare disease, obaeFVed
I usually in pregnant women, and is churoL-temtKl by the appearance
I of numerous isolated and closely-crowded pin-head-sized superficial
I jmatulea, which show a decided disposition to the formation of oireu-
rlar groups or patches. The central portion of these groups dries to
1 omstH, while new ])U8tuIes appear at the peripheral portion. They
I tend to coalesce, and in this manner a greater part of the whole sor-
« may, in the course of weeks or months, bwwme involved. Pro-
fbuad constitutional disturbance, usually of a septic character, pre-
cedes and accompanies the disease ; in almost evei? instance a fatal
termination sooner or later results.
Il is poswbly a grave type of dermafttis herpetiformis.

Ecthyma.
Give a deicriptiTe definition of ecthyma.

Ecthyma ia a disease characterized by the appearance of one, sev-
eral or mora Jiserete, finger-nail-sized, fiat, usually markedly inflam-
matory pustules.
Seaoribe the B3nnptoms and course of ecthyma.

The lesions begin as small, usually pea-sizefl, pustules ; increase

124 DiBEAaEa Of the skin.

somewhat in area, and when fully developed are dime-sized, c
somewhat flat, with a markedly inflammatory base and areola. At I
first yellowish they soon become, from the admixture of blood, red- '
dish, and dry to brownish crusts, beneath which will be fooad Baper^ 1
ficial excoriations. The individual pustules are usually somewhat *!
acute in their course, bat new lesions may continue to appear froiq f
day to day or week t^j week. As a rule, not more than five to twenty 1
are present at one time, and in moat cases they are seated on the f
legs. More or less pigmentation, and sometimes superficial scurring, ~
ma; remain to mark the site of the lesions. '

Itching is rarely present, hut there may be more or lesa pwn and I
tenderness.
What is the cause of ecthyma t

It ia essentially a disease of the poorly cared-for and ill-fed, and, ,J
according to present prevailing views regarding suppurative prtH-l
cesses, the direct exciting cause maybe the introduction of n
organisms into the follicular openings. It is oommonly observed in I
male adults.
From what diseasea is ecthyma to be differentiated?

From simple impetigii, impetigo contagiosa, and the flat pustular
syphiluderm.

How is it distinguished &om these several diseases T

Tlio size, shape, inflammatory action, and the depr.ived g
condition wiil serve to differentiate it fnim simple impetigo ; the sam« J
characters, the distribution and non-contagiousness will distingniakfl
it from impetigo contagiosa ; and tbe absence of concomitant sj
toms of syphilis, and of positive ulceration, as well as i1
tion and more rapid and inflammatory course, will exclude tbe pus- J
tular syphiluderm.
State the prog:iioBis.

The disease is readily uurable, disappearing upon the removal of
the predisposing cause.
What treatment is to be advised ?

Good food, proper hygiene and tunic remedies ; and, locally, re-
moval of the crusts and stimulation of the underlying surface with an
ointment of ammoniated metvury, ten t« thir^ grains to the ounca

INFLAMMATIONS,

Pemphigus.

What do yon imderstand by pempMgiu ?

PempLigus is an acut« or cbrouic disease characterized by the auc-
oeasive formation of irregularly-scattered, variously-sized blebs.
Hame the varieties met with.

Two varieties nre usually described — [leuiphigus vnlgaris and
pemphigus foliaeeus.

Describe the symptoms and course of pemphigus vulgaris.
With or without precursory eymptoms of systemic disturbance,
I iireguiarly scattered blebs, few or in numbera, make their appear-
I ance, arising from erythematous eiiots or &om appaj^ntly normal
I akin. They vary in size from a pea to a large egg, are rounded or
r ovalish, utnially distended, and contaia a yellowish fluid which, later,
L becomes cloudy or purifonn. If ruptured, the rete is esposed, hut
t the skin eoon regains its normal condition ; if undisturbed, the fluid
t usually disappears by abfiorption. Each lesion runs its course in
several days or a week.
What courso does pemphigus vulgaris pursue ?

Usually chrimic. The diseiiac may subside in several months and
the procem come to an end, coniitituting the acute type. As a. rule,
I however, the disease is chronic, new blebs continuing to appear
I fixim time to time for an indefinite period.

I la what respects does the severe form of pemphigus vul-
garis differ &om the ordinary type ?
In the HL-vero iir m:di^'iiaut type tlio eruption is more profilse;
there is marked, and often griivc, systemic depression, and the
" ns are iittendi'd with olwrative ai-tion.
I SeBcrihe the symptoms and conrBe of pemphigus foUaceus.

In this, the grave type of the disease, the blebs are loose and
I flaccid, with milky or puriform contents, rupturing and drying to
I- oniBta, which are cast off, disclosing the reddened cotinm. New
I bleba appear on the sites of disappearing or half-ruptured lesions,

d the whitle surface may he thus involved and the disease con- '
I tinue for years, eompromising the general health and eventually
Kifioding fatally.

126 DISEASES OF THE SKIK.

Vhat ii the character of the subjective symptoms I
pMgus^

The Bnbjei^tive Bymptoius coQsist VHriuusly of heat tendonMiBS, I
pain, burning and itching, anil may }ie hlight or tr ul 1 '* me
Wliat is known in rei^ard to the etiology of pemphigus ^

Tht! causes arc obscure ; goiiura] debility, o rwork shuck d

X^^^

). (Ajler Ooeier.)
of epiflormli; e, sweat dnirt ti
n ofupiicrlireraof IhBo '

nerrouH exhaualion iirc thought to be of iiiflueucu. Hie d
nut cnutiL^'iouB, nor ie it duo to Eyiihilifl. It may uceur at ai

It is a rure disease, especially in this country.
What is the pathologry ?

The lesions are superficially seated, usually between the homy '
layCT and upper part of the rete. Round-cell infiltration and dilated
blood veesels are found about the jwpillte and in the subcutooeooB^^

INFLAMMATIONS. 1

The contents of the blebs, alwaja of alkaline reaction, (
I at first serous, later containing blood corpuaclea, pus, fatty-aisid
' crystala, epithelial eells, and oecaaionaEy uric aeid crystals and fiee
ammonia.
From what diseases is pemphigus to be differentiated ?

From herjjes iris, the bullous syphiloderm, impetigo contagiosa
and dermatitis herpetiformis.
How do these several diseases differ &om pemphifus ?

The acute course, small lesions, concentric ammgement, variegated
colors, and distribution, in herpes iris ; tlie thick, bulky, greenish
cmste, the underlying uleerution, the course, history, and the prcB-
ence of ouncomitaut symptoms of syphilis, in the bullous syphilo-
derm ; the history, course, distribution, the character of the crusting,
and the contagious and anto-inoculable properties of the contents
of the lesions, in impetigo contagiosa ; the tendency to appear in
groax>s, the smaller lesions, the intense itchiness, course, uiuitiform
characters of the eruption and the disposition to change of type m
dermatitis herpetiformis, — will serve as differential points.
State the pro^osis of pemphigus.

Itsduration is uncertain, and the issue may in severe caws he fatal
In the milder types, after mouths or several years, recovery may
take place.

The extent and severity of the disease and the general condition
of the patient aic always to be considered before an opinion is
expressed.
Qive the treatment of pemphigus.

Both constitutional and local measures are demanded. Qood
nutritious food and hygienic regulations are essential Aisenic and
qoinia are the most valuable remedies ; other tonics, such as iron,
Btrychnia and cod-liver oil, are also at limes of service.

The blebs should be opened, and the parts anointed or covered
'With a mild ointment. In more general cases bran, starch and gelatin
'baths, and in severe cases the continuous bath, if practicable, an
used.

Define purpura.

Purfiura is a hcD
aDce of variously- siz
purplish spota or pate

CLASS m.— HEMOBBHAGES.

Purpura.

lorrhagic afftiptiun characterized by the appear-
ized, usually non-elevat^xl, siuuoth, reddish or
i, not disappeanDg under preasnre, ,
Home the Beveral varieties met with.

Three — purpura simplex, purpura rheumatica and purpnra btem-
orrhagica ; denoting, respectively, the inild, moderate and serere
grade of the disettse. The division is, to a great extent, nn arbitrary 1

Describe the clinical appearance and couTBe of an individual
lesion of purpura.

The spot, which may be piu-head, pea-, bean-sized or larj
appears suddenly, and is of a bright red or purplish red color. Its 1
brightness gradually fades, the culor changing to a bhiish, bluish- f
green, bluish- or greenish-yellow, dirty yellowish, yellowiah-white, I
and finally disappearing ; varying in duration from several days to
several week&
Describe the symptoms of purpura simplex.

Purpura simplex, or the mild form, shows itself as pin-point to I
pea- or bean-sized, bright or dark-red spots, limited, as a rule, to the 1
limbs, especially the lower extremities ; fading gradually away and I
coming to an end in a few weeks, or new crops appearing irregolftrir |
for several months. There is rarely any systemic disturbance, and, I
ae & rule, no subjective symptoms ; in exceptional cases an urticariil \
element ia added^>Mrp«r« vrlkam.
Describe the symptoms of purpura rheumatica.

Ihirjiura rheumatica (idso called pe^ibsw rheiinuiticti) is usually
preceded hy symptoms of malaise, rheumatic pains and sometimes
swelling about the joints ; these phenomena ahato and frequently
disappear upon the outbreak of the eruption. The lesions are pea-
tfl dime-sized, smooth, non-elevated, or sUghtly raised, and of a red-

didi or purplish oobr ; the empdoa may be moP; • ir lf:t^ z*:r.
mo6t abniKJant npoa the limbti. or it maj h*: Liioitni d/ cL»:t
It may end in a few weeka, or may per-ist tor r-^rf-zrd mijcz. ,
spots appeanng irregukrly or in the torm of f^rocii.

ScMSiibo tli6 lyn^toflu of pnrpm hcniorrhagica.

Parpma haoinorrhagica (also called iJ^Af/ Jtatnpf) l* rijtnfXfzr^l
usually hy premonitory, and frer^nently si^jm^arif.r^^. '^jzc^iitjjiLji of
general distress, and hy the appearanoe of o»iin t»j lalm-^lx^r^L rh^ior
purplish hemorrhagic spots or patches, -m'^jth. r:/.c-^i-:Tii>:fi ^r
raised. Hemorrhage from the mouth, jram.* vA xh^.r r/'irr.-r, -il^fLr.
or serious in character, may rjofmr. S^w l»T?ri'.fi;- ':*ifit:L:.>: t^. ar.r^Af
for several days or weeks : and in eii>rpti'.ria.l icn'-x^ir^f^. f-.i^i^a^i
relapses take place, and the dLsearie tho.-; {j^zCtL^. t'jr :Lr.t,rJut. b,
may end j&tally.

State the etiology of purpura.

In most instances no caorfe can f^e ^'s-H^TifrfL Thft 'Jl^fl^.*^ '^iifirK
at all ages from chOdhoo^l to arJT^iru.f.-ti life, ^yi In 'jA.'i'A.i^^. \.{,*^mi-
ently in good and bad health aJik*^. TTie \).kux' ,r:\^.<'. Vj ;>; 1*, ofvsf>rf
seen in subjects debilitated or in a dKitr^v^A *v%Xf; of rj:^^r.h.

State the diagnostic characters of pnrptinL

The appearanoe, irregularly or in cTof;-- of r.r!yKf.-f'-/l or f,'*.';,,.*:^
spots, evidently of hemorrlia^ic risiinr*:. >^fA tj,^, diMif/ff^/t n.ojf 't/0^,f*.
preuure^ and as they are fa'lin?, jfoin^ ri.ro Jv^K •{■./; -yr >*:/;** *:t,A4,-j*'A
of color usually obsenreri in any ^:^x:hyr/i'/'.i.'.

How does scurvy (scorbutus; differr fr'>m purpura t

Scurvy, which may resemble the -y:V':f<: >'/</;.': 'y* £;<///'i/* K** *
different history, a recognizable ^ah.-!-:: iiy:'/^./ ^ ;//:-.-*# »\.i^4\irtkyitt*
and is accompanied with {i^tWirA we*kii^;« s^r.'l i^ '^i/w-i?/: 'j'/tt wvi
Heeding condition of the guuiis.

What is the pathology of purpura ' . „ ^. , .

The lesion of purrmm ofiMhiht^ <:«»*ijti;«]]y of a ji<:iii//jrf/;«4/^- w^t/^
the cutaneous tissues. Tlie bUxW i« buf-ciUAriitly i.i«..iVyi, lU
hamatin undergoing cliarigi^ of c..i.>r it^m a i^i U, t^i^uuU ^ui
pale yellow, and finally fading away.
9

130

OP TilE BKIN.

State the prognoBU

The milder varieties disappear in the course of several weeks a
months, and are rarely of serious import ; the
hsemorrhagiua is somewhat uucertain ; although usually favorable, a
fatal result from interual hemorrhage is possible.

Wliat is the treatment of purpura f

Hygienic und dietary moasurea, the administration of tonics a
astringents, and, in severe cases, by relative or absolute rest

The drugs commonly prescribed are : ergot, oil of erigeron, oil o
turpentine, quiuia, strychnia, iron, mineral acids, and gallic ad
Exlemcd treatment is rarely called for, but if deemed advisable, i
tringent lotions may b

Scorbutus.

(%nonjin.,- Sonrry; SenRrarvj: Porpure. Sonrbatioa.)

SeBoribe scorbutus.

Scurvy is a peculiar constitutional state, developed in those livi
nnder bad hygienic conditions, and is characterized by en:
general febrile and asthenic grmptoms, a more or less swollen, torgid
and spongy and even gangrenous condition of the gums ; and con-
comitantly, or sooner or later, by the appearance, usually upon the
lower portion of the legs only, of dark-colored hemorrhagic patches
or blotches. The skin of the affected part may become brawny and
slightly scaly, anil not infrequently may break down and ulcerate.
Hemorrhages from the various mucous surfaces, alight or gam,
may also take place.

State the etiology of Eonrvy.

It is due to long-cimtinuod deprivation of proper food, eapcciaUy-l
of fruits and vegetables. Other bad hygienic conditiona fitvoT h
development It is seen almost eKclusivcly in sailors and otheCB-J
taking lung voyages.

How is scurvy to be distinguished from purpura?

By the aKtlieoic iiud em!u.njiti.><l t'cncnil cuinlilkiu and the peculiar J
pufiy, Hpongy «ate of the gums. The cutaneous mauifeatatiou is ]

HYPERTRnrmES. ];

more diffuMd, iijnuing lu^ually large iialm-aized patehea, and, as
nilf, limitLiI tu the region of tlie arjkles or lower part of the legs.
Give the prognosis of scurry.

The diseaau is rumediablo, and nsnally rapidly so. In those ii
Btanccs in which the same hud hygienic coaditions and the ingeetioD '
of improper food are continued, death finally results.
Wliat treatment would yon advise in sonivy t

Proper food, with an abundance of fruit and vegetables. Lemon or
lime juice ia especially valuable, and is to be taken freely. If indi-
cated, tonics and stimulanta are also to be prescribed. For the rehef
of the tumid, spongy condition of the guuu, astringent and antiseptic
mouth washes are to be employed.

The cntaoeons manifeststiona, when tending to aliMralioii, are to ,
be treated upon, general principles.

CLASS IV —HYPERTROPHIES,

Lentigo.

iSiim.,ii/m: Freckle.)

Describe lentigo.

Lentigo, or freckle, ia characterized by round or irregular,
head to pea-sized, yellowish, brownish or blackish apots, occurring
usually about the face and the backs of the handa. It ia a com-
mon affection, vaiying somewhat in the degree of development; '
the freckles present may be few and insignificaut, or tlicy may exist
a profuMou and be quite disfiguring. Heat and espOHure fevor their
development Those of light complexion, especially those with red
hoir, are ite most common Buhjecta. The color of the lesion is usmdiy
a yellowish-brown.
It is common to all ages, hut is generally seen in its greatest I
' development during adolescence, the diapoaition to its appearuuoe
becoming less marked ua ugc advances.
What IB tlie pathology of lent^o !

Lentigo cuuaista aiuiply of a eircuuiscribed dcpuait of pigmeut J

granules — merely a localized increase of the normal pigmeDt, diffeiiDg
&om chloasma (9. ':.) only ia the size and shape of the pigmeotation.
State the pro|nioBis.

The blemishes ean be removed by treatment, but tbeir retam is
almost certain,

Name the several applications conunonly employed for titeir
remoTal,

An aqueous or alcoholic Bolution of corrosive suhlimatc, one-half
to tliree graioH to the ounce ; lactic add, one part to from six to
twenty parts of watery and aa ointment containing a. drachm each
of bismuth sabititrate and ammoniated mercury to the ounce.

The applications, which act by removing the epidermal and rete
cells and with them the pigment, are made two or three times dailj,
and their use intermitted for a few days as soon as the skin becomes
irritated or scaly.

Chloasma.
What do yoa understand by chloasma?

Chloasma consists of an abnormal deposit of pigment, occurring as
Taiiously -sized and shaped, yellowish, brownish or blackish patches.
Seacribe the clinioal appearances of chloasma.

Chloasma appears cither in ill-defined patches, as is commonly the
case, or as a difiiise discoloration. Its appearance is rapid or gradual,
generally the latter. The patches are rounded or irregular, and
usually sliade off into the sound akiu. One, several or more may be
present, and coalescence may take place, resulting in a. large irreg-
ular |)igtnentcd area. The color is yellowish, or brownish, and may
even bo blackish {iitdtmiui, mdaiwdemui). The skin is otherwise
normal

Into what two ^nersl classes may the varions examples of
chloasma be grouped T

Idiopathic aiL,lM-iu|.t-.mali<.'.
What cases of chloasma are included in the idiopathic group?

All those cases of pigmoututiun ciiuscd by external agents, such
as the sun's rays, sinapisms, blisters, continued cutaneous hyper-
cemia trom scratchiDg or t/Ktvt

HyPERTEOPHlEH. 133

it caseB of chloasma are included in the Bymptomatic
group?

All forms of pigmuut dupuait which occur as a consequence of
vurioug organic and syslt^miu diiieattea, as the pigmentation, fur in-
atance, seen id association with tuberculosis, cancer, makria, Addi-
Bon'a diseaee, utarine aiFi?otiona, and the like. lu such cases, with
few exceptioua, the pigmentadon ie usually more or less diffme.

What is chloasma uterinum T

Chloai^ma uterinum is a t<^nu applied to the ill-defiued patches of
yellowish -hrown pigmentation appearing upon the faces of women,
usually hetween the ages of twenty-five and fifty. It is most com-
monly seen during pregnanuy, but may occur in counectiiin with any
functional or organic disease of the utero-ovariau apparatus.
What is argyria T

Arg3Tia is the term applied to the Blate-like discoloration which
follows the prolonged admiuistration of ailver nitrate.

State the pathology of chloasma.

The soli; change ixiiiniaU irL an increased deposit of pigment.

Give the prognosis of chloasma.

I Unless a removal of the exciting or predisposing cause is posMble,
the prognosia is, as a rule, unfavorable, and the rehef furnished by
local apphcations usually but temporary.

If constitutional treatment is advisable, npon what is it to be
based ?
U^HJU general priiiciplL-s ; there are no speeia! remedies.

How do external remedies act ?

Mainly by removirig the rete cells and with them the pigmenta-
tion ; and partly, also, by stimulating the abajrbeula.

I Are all external remedies which tend to remove the upper
layers of the skin equally useful for this purpose T
No; on the i-nntniry sHiie Mueh applications are I'ull.'WeJ by an io-
creoso in the piymeiit deposit.

Hame the several applications commonly employed.
Corrosive sublimate iu solution, in the stretigth of one to finu

I 134 DISEASES OF THE SKIN.

gnuns to tlie ounce of alcohol and water ; & lotion made ap ai

B. Hydmrgyri chlorid. eorros., gr. iij-viij

Ac. ncet. dilut, fgij

Sodiibotat, 3ij

Aqtue roBOj, f^iv. M.

And also the following : —

B. Hydrargyri chlorid. corroB. , gr. iij-viy

Zinci sulphat.,

Plnmbi acetat,, aa gas

AquiB, f^"- M.

And lactic acid, with from fivu to twenty parts of wat«T ; and an
ointment containing a drachm each of hismath tmbnitrate and white
precipitate to the ounce,

(The application is made two or three times daily, and as soon as
Blight scaliness or irritation is produced, is to Iw discontinued for one
or two days.)

Eeratosia Pilaris.

What ifl meant by keratosis pilaris ?

Keratosis pilaris may be defined as a hypertmpbio affection
characterized by the fonnation of pin -head-sized, conical, epidermio
elevations seated -ibout the uperturea of the hair tbllicles.

Describe the clinical appearances of keratosis pilaris.

The lesions are usually limited bi the eileusnr suitliues of the
thighs aud anus, especially the former. They apjjCiU' as pin-heail-
sized, whitish or grayish derations, consisting of accumulations of
epithelial matter about the apertures of the hair follicles. Bach ele-
vation ia pierced by a hair, or the hair may be twisted and impris-
oned within the epithelial mass ; or it may bo broken off just at the
point of emergence at the apex of the papule, in which event it may
be Been as a dark, central speck. The skin is usually dry, rough and
haieh, and in marked cases, to tho hand paeBing over it, feels not

tttPERTROPHrea.

:e a nutmeg-grater. The disease vaxics in its development, bf^
moat cases being so slight as to eeeape attention, Aa a rule, it is-
free from itching.
What course does keratosis pilaris pnrsnel

It is ajuggish and chruiiic.
Hention some of the etiological factors.

It is not an anconiinoD diseaso, and ia seen usually in those who araJq
unaecustomed to frequent bathuig, being most frequently met with" j
during the winter months. It is chiefly obseryed during early adult \
life.
Ib there any difficulty in the dia^osis ?

No. It is tlmufilit at times to hear some resemhlaneo to gooB©- J
flesh (eutiH anserina), the miliary papular sypliiioderm in its de«iua-
mating stage, and lichen acroiubaus. In goose-flesh the elevations
are evanescent and of an entirely difierent character; the papules
of the syphiloderm are usually generalized, of a reddish color, tend
to group, aje more nolid and deeply-seated, less scaly and are accom-
panied with other aymptoms of syphilis ; in lichen scrofult>sus the I
papnles are larger, incline to occur in groups, and appear usoally J
upon the abdomen.
State the prognosis.

The disease yields readily to treatment.
Give the treatment of keratosis pilaris.

Frequentwannbatha, with the use of a toilet soap or sapoviridis, .1
will usually he found curative. Alkaline baths are also usefiiL In J
obstinate cases the ordinary mild ointments, glycerine, etc, are tobej
advised in conjunetioti with the baths.

Holluscum Epitheliale.

(£>'io»yi>i( .• MullUiioum Coutiigiusuin ; MdluscUDi ^Dbuccuui; Epitheli
MolluecuTu.)

Give a definition of mollusctim epitheliale.

MoUuacum epitheliale is characterized by pin-he-ad to lea-sized, 1
rounded, semi -globular, or flattened, pearl-like elevations, of a whitiah ]
or pinbiah color.

WUR

DISEASES OP THE SKIN.

Beaoiifae the BymptomE and course of mQUnBciun epitiiBlu

The uanal seat ia the face ; not mfrequently, however, the growths
occur on other parts. The lesions begin as pin-head, waxy-looking,
rounded or acuminated clevatjons, gradually attaining the size of
small peas. They have a broad base or occaaionally may lend to be-
come podaacukted. They rarely exist in profusion, in uiost casea
three to ten or twelve lesions being present When ftilly developed

MoUuKum EplthellE

they &rc somewhat flattened and unibilieutod, with a central, darkish
point representing the raouth of the follicle. They aro whitiah or
pinkish, and look not unlike drops of wax or pearl buttons. At first
they are firm, but eventually, in most cases, tend to become soft and
break down. Not infrequently, however, the lesions disappear slowly
by absorption, without apparent previous softening. Their course
fa usually chronic The contents, a cheesy-looking maas, may oom-
monly be pressed out without difficulty.

HYPEHTHOPniES.

What is tlie cause of molliucniii epitheliale t

Its eaufio is obscure. Opinion is divided aa regards contaj^ous-
ncss. It occurs ohiefly in tliildren, and especially among the poorer I
daises.

State tlie pathology.
Aacording to recent inveatipatiunH, molluseiun epithelialc ia to be ,

Bectlon through t]

n ucuiaDladDD o[ mallniicous bodies; o, nib or the ihu In prscea of c
!onlntorao11nseoinrh»iJKBi d, d. cells In Boearllor BlBgaor conTeraion I
UBCousbudlsB; jr, pseiido lob« iif tuDiar. fDrueil tiy Terlical undlalersl cro'
IB lolBrp»pUlaryprocoi«»; /, Bhrcius Mpluin between lolie« or tumor, fort
omprenlou of papllli; e, sebiuieous gland of Binsll bolr-folilde.

regarded as a liyjMirplaaiii of the rete, the growtli prolmbly beginuiDg
ill the hair-follicles ; the so-called moUuBcuui bodieti — pocnliar,
ruuodcd or ovuidal, tihiirply-defincd, futt^-lookiDg bodies found iu
inicroBcopical examination of the growth — arc to be viewed a
form of epithelial degeneration.

DISEASES OF THE SKIN.

What are the diagnostic points in mollnBcnm epitbelialel

The size of the lefiioiis, thait Wiixy or glisteuing ajjpearance, and
the presence uf the central orifice.

It is to be difFerentiated from moUnhoum. fibrosum, warts ai

State the prognosiB.

The growths are amenable to treatment In some instances the
disease, after existing some weeks, tends to disappear spontaneoosly.

Wliat is the treatment of mollnBcum epitheliale 1

Incision and expressioD of the contents, and touching the base of
the cavity with ailver nitrate. Pedunculated growths may he llgated.
lu some cases an ointment of ammoniated mercury, twenty to forty
grains to the ounce, applied, by gently rubbing, once or twice daily,
will bring alHJut a eure.

(S'jiioBiini. .- Tjloaiii Tjloma; Cullua; Calluas; CalloBily; KoraWma.)

What do yon understand by callositas t

A hard, thickened, homy patch made up of the corneous layers
of the epidermis.

Describe the clinical appearances.

Callosities are most common about the hands and feet, and con-
wst of small or large patches of diy, grayifjh-yelbw looking, hard,
slight or exctissive epidermic accumulations. They are somewliat
elevated, especially at the central portion, and gradually merge into
the healthy skin. The natural surface lines arc in a great measure
obliterated, the patches usually being smooth and hom-like.

Are there any inflammatory symptoms in calloaitasT

No; but exception ally, from accidental iiynry, the subjacent
oorium becomes inflamed, suppurates, and the thickened mass is

State the causes of callositas.
Preasm* and friction ; for example, on the hanils, from the u

LS tools and implements, and on the feet &om ill-fitting ahoMl J

HTPERTROPHIES.

L U is, indeed, oil«n to be looked upon as an effort of nature tO.J
pruteiit the luoro dcliratte coriiiin.
Id exceptJoDal instances it arises wit]iout apparent cause.

What is the patholoi^y 1

The epidermis alune is involved ; it consists, iu fact, of a hyper-
plasia of the horny layer.

Btate the pro^OBls of oallositaB.

If the causes are removed, the accumulation, as a rule, graduallf I
disappears; The effect of treatment ia always rapid and poative, [
hut uidess the etiolosical factors have ceased to act, the result is ]
usually but temporary.

How IB oallositas treated?

When treatment is deemed advisable, it consfsta in floftening the
parts with hot-wat«r soakinga or poultices, and subsequently shaving j
or scraping off the callous mass. The same result may also be often j
effected by the continuous appheation, for several days or a week, of
a lU to ] 5 per cent, saheylated plaster, or the application of a sail
cyluted oollodion, same strength ; it is followed up by hat-wat«r i
soaking, the accomalation, as a rule, coming readily away.

Clavna.

(%,.o«3„H.- Cum.)

What is clavns 1

Clavus, or coni, is a small, circumscribed, flattened, deep-seated,
horny formation usually seated about the toes.

Seacrihe the clinical appearances.

Ordinarily a corn bus the apt>earaDce of a small callosity ; the skin j
is thickened, polished and homy. Esceptionaljy, however, o
ring on parts that are naturally more or less moist, as between the
toes, maceration takes place, and the result ia the so-called soft ci
The doisol aspect of the toes is the common site for the ordinary I
variety- The usual size is that of a small pea. They are paioliil I
n pressure, and, at times, spontaneously so.

F 140 Diseases of the ekin.

State the oaases.

CumK are caused by pressure and ftiction, aud may usually be n
ferrod to improperly fitting slioes.
What is the pathology of olavm?

It IB a hypertrophy of the epidemi. Its shape is conical, with
the base external and the apex pressing upon the papilUa It la, in
fWt, a, petuliarly-ahaped callosity, the central portion and apex
heing dense and horny, forming the so-called core.
Qive the treatment of claroB.

A simple method of treatment cousin in shaviug off, after a pre-
liminary hotr-water soaking, the outer portion, aitd then applying a
ring of felt or hke material, with the hollow part immediately over
the site of the core ; thia ahould be worn for aevenil weeta It is
also possible in some ciises to extract the whole com by gently dia-
sectJDg it out ; the after-treatment being the same as the abov&

Another method is by means of a ten- to fifteen-per-cont. BolutJon
of salicyhc add, in alcohol or collodion, or the following : —

B - Ac. salicylici gr. ixjc

£xt. cannabis Ind. , gr. x

Collodii, f3 iv. M.

This is painted on the com night and moraiug for several days, at
the end of which time the parte are soaked in hot water, and the .
mass or a greater part of it, will be found, as a rule, to come readily
away ; one or two repetitions may be necessary. Lactio acid, vrth
one to several parts of water, applied once or twice daily, acts in a
similar manner.

Soft coma, aft«r the removal of pressure, may be treated with the
solid stick of nitrate of silver, or by any of the methods already
mentioned.

In order that treatment be permanently sncoessfiil, the feet are to
be properly fitted. If pressure la removed, coma will commonly
disappear spontaneously,

Oomu Cataneum.

What is coran cutanenm ?

A <;utiiiH!Ous horn is acircuniBcribed hypertrophy of the epidei
forming an outgrowtli of homy conaiBtcnce and of variable size

At what age and upon what parts are ctttaneoas faoma ob-
served ?

Tliey are usually mut with \aUt in hfo, and are niostiy seated upon
the face and scalp.

Describe the clinical appearances.

In appearaucu cutiiin;i>us horns resemble those suen in thu lower
I Bnim&ls, diiferiug, if at all, but slightly. They are hard, Hulid, dry
Band somewhat brittle ; usually tapering, and may be cither straight,
ed or crooked. Their surtaoQ is rough, irregolar, laminated or

I
I

142 DISEASES OF THE SKIN.

fissured, the euds jioiated, blunt or clubbed. The color varies ;
usuiiily grayish-yellow, but may ba even blackish. Aa commonly
aoen they are email ia siae, a fraction of an inch or an inch or there-
a,bi:juta in length, bnt exceptionally attain considerable proportions.
The base, which rests directly npon the akin, may be broad, flat- ■
tened, or concave, 'with the underlying and adjacent tissnea normal j
ur the papillee hypertrophied - and in some cases there is mo
less inflammation, which may be followed by suppuration. They. '
are usually ajlitaiy formations. They are not, as a rule, painfiil, '
unless knocked or irritated.
What ooiiTBe do cutaneoiu homs pursue 1

Tlieir growth is usually slow, and, after hiving attained a certain
size, they notinfrequeutly become loose and full off; they are almost i
always reproduced.
What is the cause of these horny growths t

The ciiuae ia not knowu ; apjwHring aliimt the gcnitalbi, they
usually develop from acumiQBte<l wiirts. Thi^y arc mre formations.
State the pathology of oomu cntanenm.

Iloms (xm.sist of closely agglutinated epidermic cells, forming
small eolnmna or rods ; in the columns themselves the cells are
arranged concentrically. In the base are found hypertrophic papil-
liB and some bloodvessek. Tliey have their starting-point in the
rete mucosum, either from that lying above the papillte or that
lining the fuilii:lea and jilaniLs.
Does epitheliomatons degeneration of the base ever occur t

Yea.
State the prognosis.

(.'iilMiiuouH horns ujHy lie readily and j.iermancutiy removed.
What is the treatment t

Treatment consists in detachment, and subsequent destruction ,
of the base ; the former is accomplished by dissecting the horn away 1
from the base or forcibly breaking it uff, the latter by means of Hny J
of the well-known caustics, snch iw canstio potush, chloride of zino 1
and the galvano-cautery.

Another method ia tocscisethe base, the bum coming away with
it ; this necesutates, however, oon^derable loss of tjssue.

Verruca.

{Syno,.y,n : Wart.)

What is vermcft ?

Verruei, or wiirt, ia a hiird or soft, rounded, flat, atui
filiform, circiuusoribcd epidermal and papillary growth.

Name the several varieties of warts met with,

Verruca vulgarLi, verruca plana, Tcrruui digitata,, verruca filifunnia |
and verruca acuminata.

Describe verruca vulgaris.

This is the common wart, occurring mostly upon the hands. It is
rounded, elevated, circumscribed, bnrd and homy, with ii broad bnae,
and nsually the size of a pea. At first it is smooth and covered with: 1
slightly thickened epiclermiH, bat later this disappears to b
tent, the hypertrojtbied papillsj, appearing an minute elevadons, J
making up the growth. One, several or moro may be present.

Describe verruoa plana.

This is the so-called flat wart, and occurs commonly upon tfaefl
back, especially in elderly people (iKreiica siiiilis. /•■•'ra.l/isis pii/nien- ■
towi). It is, as a rule, but slightly elevated, ia usually dark iu color,. |
and of the size of a pea or finger-naiL

Describe verrnca filiformis.

This ia a thread-like growth about an eighth or fourth of
long, and occurring commpoly about the iace, eyelids and neck,
ia usually soft to the touoh and flcsible.

Describe verraca digitata.

This is a variety oF wart, which, especially about th
marked by digiUitions, extending nearly or i[uite down t^j the baaa I
It ia eommuuly seen ujion the scalp.

Describe vemtoa acuminata.

This variuty l,venervnl wart, poinlfd wart, p-jiiiUti coiitl/jloina)A
osaally oumirs about the genitalia, especially upon the e
muco-cntaneous surfaces. It consists of one or moro groups (^1
acamiiuit«d, pinkish or reddish, ra«pbeny-likc elevations, and, ai

DISEASE.^ OF THE SKIN.

ing to tlie region, may be dry or moist ; if the latter, the Bi
which is osuallj yellowish and puriform, from rapid dccompositjon
develops an offenaiTe and penetratiug odor. The formation may bi
the size of a small pea, or may attain the dimensioas of a fist

What is the c&obg of warts *

The etiology is not kiiiwD They ire more common in adolescent
and early adult life, Imtitiiif, secretions arc thought to be caosa-
tive in the acuminatJiJ lantty

State the patholo^ of warts.

A wart eousists of both epidermic and papillary hypertrophy, the
interior of the growth rontaining a vascalar loop. In the acuminated
variety there are marked papillary enlargement, eiceasive devebi*-
ment of the muixius layer, and an abundant vascular supply.

Give the treatment of warts.

For orilinary warts, excision or destruction by caustica The re-
peated applieiition of a saturated alcohoUc solution of salieylic acid is
often curative, the upper portion being pared olF from time to time.
The filiform and digitate varietdeB may be snipped ofi' with the

HTPF.RTROPHlEe,

145 1

i ligatare '

i, and the bafie touehcd with nitrate of silver ; o
may be iiaed.

Verruca acuminata is to be treated by mainfaiining absolute clean-
linesa, and the application of such astringeota aa liquor plumU J
sabacetatis, tincture of iron, powdered alum and boric acid. The I
salicylic acid solution may also bo used. In obstinate caBes, glaoiil I
acetic add or chromic acid may be etiutloualy employed.

Verruca Necrogenica.

(SgHongnt: Pont-mortom Wart; Anatiiinical Tiiberule; Tuberculosii Vemi- |
.OS. Catis.)

What is Terraoa neorogenioa ?

Verruca neerogeuica is a rare, locdized, papillary or wart-like for- ]

[Aflar Modtl tn Ou^i JTu*

mation, resulting from contact with decomposing animal matter, aiul>4
occurring usTially about the kumiles or other parta of the hand.

Deicribe the aymptoma,
It begins, as a rule, as i

small, paptile-like growth, :

> 14fi DISEASES OF THE SEDC

gradually in area, aad when weB adrBBccd appeus a
med or larger, somewitat "^™™*»'™ 7". drrUed, Sat, warty maaa,
witli naiallf a toidencr to digltt p«s fiximtjon bOween the
hypertrophkd p^nlbe. "Due snrEice nsf be bamy <x U nwy bs .

It tends to enlarge ^wlf and is asBaQr paaatcnt, bat it at times I
tmdergoes involatioD. \

Wbat is the etiology of vemes aecn^eaica t

Acconiing to reoe&t inrcetieatHnB, it i£ ihoaghttobedaetoiiiocD-
latJoD of tJie tobettJe t*""*!"* — anakgoaf, in &ot, in its etiolo^,
to lapus and other fonns of tobramloaa of the ^in.

Oive tlie pn^nosis.
It is usually persistent, aod may be progre^Tg ; exceptionally, it

tends, after a time, to si*onianeoiv> Jisai>jiearatKe,

What is the treatment of Teimca nedogenicat

TVeatmeDt conasts in its reoraval b; means of such caustics an
caustic potash, chromic and nitnc acid ; or by means of thoroogh
curetting and subeequent cautenxatiou of the base with nitrate of
eilver or other caustic. In some cases the oontinnoua applicaticm
of a stiong (25 per cent.) saUcyhc-^dd plaster will bring about »

NsevoB Figmentosns.

^Si

mt MdI<

Seaoribe nserns pigmentoBiu.

Nsevtis pigmentosum, commonly tnown as mole, may be defined
as a divum^ribed increase in the pigment of the akin, usually
dated witb hypertropby of one or all of the cntaneous stracturea,
especially of the connective tissue and hair. It occurs dngly or in
numbers ; is usually pea-, bean-siied or larger, rounded or in^nkr,
smooth or rough, flat or elevated, and of a color varpng fit>m a light
brown to black ; the hair found thereon may be either colodess or
deeply pigmented, coaise and of oonaiilerable length. It is, aa a
ruk, a penntumit finmatios.

I
I

HYPEETROPHIES.

Kajne the Beveral varieties of nffivne pi|:mentoBa8 met with.

Nrevus spilus, iiEBvns pilosus, nse¥us verrucosus, and natvus lipo- J
matxjiies.
What IB neevoB spilns 1

A smooth uud fliit mevus, cousisting esseDtinIly vf augmeuted
pigmeDtiitiuu aloue.
What is DEevns pilosna 1

A Tiffivus upon which there is an ahnormal growth of Lair, ahght I

What is nsems Tenncoaus ?

A naiVTia to whieh U added hypertrophy of the papiDae, giving j
rise to a furrowed aiid uiieven aurface.
What is nsevas lipomatodeB ?

A nscTus with excessive eouuoctive -tissue hypertrophy.
State the etiology of neemis pigmentOBna.

The causes arc obscure. Tlie growths are usually congenital ; but
the smooth, nou-haiiy moles may be acquired.
Give the pathology of naeraa pigmentoBns.

Microscopical examiiiatiun shows a. maj'ked increase ia the pig-
ment in the lowest kyers of the rete mucosum, aa well a£
leee pigueDtatioD in the corium usually following the course of the 1
bloodvessels ; in the verrucous variety the papillie are greatly hy- T
portrophicd, in addition to the increased pigmc^ntation. There ia, 1
aea rule, more or lesa connective-tifisue hypertrophy.
What is the treatment of hegtub pigmentosual

In many instances interference is scan.'eiy called for, but when de-
manded consiste in the removal of the formation either by the knife,
by caustics, or by eleetrolyius. This last is, in the milder varieties
at least, perhaps the heat methoil, as it is less likely to be followed
1^ disfiguring cicatrices. In naevus pilosus the removal of the liai
alone by electrolyMs is not infrequently followed by a decided diminu-
lum of the pigmentation.

J-}*' DTRKAHWP OF 3BE BKJSL

StfMnnwai : Pidk-ddn Difleaoe.)

Dive a descriptive iJwfrmfimi of idiflijMiB.

I(:}ii}i,v(isl.o i> a (rlmmic. hypeitmphic dkeaae, tharmcUajMed hydrj-
1lt•^^ ill 1(1 s<-iiliiii^^ (.if the skin, irith a TuiiUe amount of papiDaiT

ITnWth-

At what age is ichthyosis fint observed!

It i> first n(»U(x{d iu mfiincT or eaily childhood.

What extent of sur&ce is inydlved ?

VsniiDy tlic whr»le snifaoe. hnt it is most muled upcm the ex-
t<']isiir siirfiKts of the anu*; and legs, especially at the elbows and
kiK'(^ ; tilt- iiu%' iind sc^il]!. in mild cases, often remain

Fame the two varieties of ichthyosis usually deteiibed.

l(Oit.hyiisi> siuii)li-.x and ichthyosis hystrix, teims oommon^
ployed t<» di^ifim«t<' the mild and severe fonns respeodvdly.

Describe the clinical appearances of ichthyosis.

Tlio niildor fomis (»f the disease may be so sUght as to give rise to
sini]>le dniioss or harshi u^ss of the skin {xeroderma); bat as oonunonlj
met with it is mon^ developcnl, more or less marked scafiness in the
form of thin or somewhat thick epidennal plates b^g presrat. The
pa]>ill:« of the skin are i»fton slightly h\i>ertrophied. In slight cases
the 01 >h»r of the si^le^i is usually light and pearly ; in the more marked
exam])le.*< it is dark gray, olive given or black.

In the si'ven* variety — ichthyosis hystrix — in addition to scaliness
there is markini papillar>' hyjx^rtrophy, forming warty or spinous
|mt(;heH. Tliis type is rare, and, as a rule, the surface involved is
more or Ichh limited.

Are there any inflammatory symptoms in ichthyosis !

No. I n fjujt, Ixjyond the disfigurement, the disease causes no inoon-
venienciv, in thoHo well-marked cases, however, in which the scales
till', thiek and UKiro or Ichh immovable, the natural mobility of the
pail-H irt eonipromiw^l and fissuring often occurs. In the winter
montliH, in tlm Huvanir casefl, exposed parts may become slightly
eczcmt^iUH.

HYPERTRCIPinES.

149 i

MS ichtliyosis vary somewhat with the season t

Vos. In all cascn the disousc ie better in the warm inonths, and it
tlio milil forma may entirely disappear during thia time. This favor-
able change is purely mechanical — due tu the mut*raticin to which
the iucreaacd activity of the sweat glands gives rise.

Is the general health affected in ichthyosis T

No.
What course does ichthyosis pursue t

Clm>nic. Bcginninginearlyinfancyorehildhood, it usually becomea
pfiiiJually mnre marked until adult age, after which time it, as a
rule, remains stationary.

What is the etiology T

Beyond a hercditaiy influence, wiiieh is oft«u a poaitiTe factor, the
causes are obscure. It is not a common disease.
State the pathology.

Anatomically the essential feature ia epidermic liypcrtrojjhy, with
Ufjually a varying degree uf papillary hypertrophy also.

Xention the diagnostic features of ichthyosis.

The harsh, dry sldn, epidermic and papillary hypertrophy, the i
furfuroceons or plate-like scaliness, the greater development upon
the extensor euriaccs, a history of the affection dating from early '
childhood, and the absence of inflammatory symptoms.

How is ichthyosis to be distinguished from eczema, psoriasis,
and other scaly inflammatory diseases ?
By the absence oi' the itiflnniJTiat<jiy elemeut.

What is the outlook for a case of ichthyosis T

The prognosis is unfevorable as regards a cure, but the process
may usually be kept in abeyance or rondereil endurable by |jn>per

What treatment would you prescribe for ichthyosis 1

Treatment that has iu view removal of the scalinetw and the
majnt4!uance of a soft and flexible condition of the skin.

In mild oases frequent warm baths, simple or alkaline, will suffii
in othora ui appUcadon of an oily or &tty substance, sueh as the j

t 350 DISEASES OF THE SKIN.

Oi^inary oils or ointments, made eeveral hoora or immediately before
the bath may be necessary. In moderately developed caacs the skin
ia to be waabed energetically with sapo viridia and hut water, fol-
lowed by H. warm bath, after which an oily or fatty application 18
made. In some of the more severe cases the following plan is .
often osefiil : The parts are first rublied with a soapy ointment o
sisting of one part of precipitated eiilpbur and seven parts of sapo •
viridis ; a bath is then taken, the skin wiped dry, and a one to f
per cent, ointment of salicylic acid gently rubbed in.

Glycerine lotions, one or two drachma to the oance of water, arc
obo beneficial ; as also the following : —

B. Potassii iodidi, gj

Glycerinm, gj

Lanolin,

01. bubnii, as ^Ns. M.

In severe cases of ichthyosia hystris it mny be necessary, also, to
employ caustics or the knife.

What systemic treatment wonld you prescribe ?

Constitutional remedies are practically iiowerleii-' ; occaaionally
some good ia accomplished by the internal adiuiuistration of liuecod
tnl and jaborandi.

OnycliauxiB.

Describe onycliaiixiB.

Onychauxis, or hypertrophy of the nail, may take phioe in one
or all directions, and tbis increase may be, and often is, accompanied
ty changes in shape, color, and direction of growth. One or all the
nails may share in the process. As the result of lateral deviation
of growth, the nail presses upon the surrounding tissoca, producing
a varying degree of infliiinmation — paronychia.

What is the etiology of hypertrophy of the nail T

The condition maybe cither congenital or aw|uircil. In the latter
instances it is usually the result of the e:

HTPERTBOPHIES. 15.

h eutaneoua diseases as psoriasis and eczema; or it is produced b;
constitutional maladiea, such as syphilia.

Give the treatment of hypertrophy of the nail,

Treatment con»sts in the removal of the redtmdant nml-tissue hy \
means of the knife or ecissors ; and, when dependent upon eczema 1
or paoriasis, the employment of remedies snitable for th
When it is the result of syphilis, the medication ap|>ropriate to this
diseape is lo bo employed.

In paronychia the nail should be frequently trimmed and a pledget
of lint or cotton be interposed between the edge of the nail and the
adjacent soft parts ; astringent powders and lotions may often ba J
employed with advantage; and in severe and pei^istent eas
of the nail, partial or complete, may be found necessary.

Hypertrichosis.

What is meant by hypertrichosis ?

Hj^ertrichosia is a term applied t
either as regards region, extent, age or bbk.

Describe the several conditions met with.

The UDoataral hair growth may be slight, as, for instance, upon a
movus {naxM pSomtr) ; or it may be eioossive, as in the so-called
haiiy people Qiomines pilosi) ; or it may also appear on the face,
arms and other parts in females, resulting from a hypertrophy of the .
natural lanugo haim. J

State the causes of hypertrichosis. I

Hereditury influence is often a factor ; the condition may also be
congenital

If acquired, the tendency manifeate itself usually toward middle
life. In women, it is not inirequentiy associated with discuses of the
utero-flvarian ^Bt«m ; in many instances, however, there
rent cause. Local irritation or stimuktion has at times a causativv
inflaence.

LppO- ^

ativ« ^H

152 IIISEASES or THE SKIN.

I Hot is hypertricIiaBiB to be treated.

For general hypertricboaw there ia no remedy. Small hairy nssTi
I may be excised, or, aa also in the larger haiiy moles, tbe luutB may
I be removed by electroIysiB.

On the feces uf women, if the hairs are coarse or large, eiectrolyEia

I constitutes the only satisfai.-kiry method ; if the hairs are small and

^ lanuEO-like, the operation is not to be adviaed. It U somewhat

painftil, but never uobearable.

What temporary methods are usually resorted to for ths
removal of ssperfiuous balr ?

Shaving, extraction of the hairs and the use of depilatories. As
a depilatory, a powder made up of two drachms of btrium sulphide
and three drachma each of zinc oxide and starch, iti commonly (and
cantioualy) emplojud ; at the time of appliuiitioii enough water ia
added to the powder tn make a pa*''" ■■"d it is then spread thinly
upon the parts, allowed t<i itmf '4eeu miuutea, or until

heat of skin or a burning sensation is felt,
waslied off thoroughly, and a soothing ointment
applied.

Soscribe the method of removal of auper-
flnons hair hy electrolysis.

A fine needle in a suitaLle handle is attached
to the negatwe pole of a gahanic battery, intro-
duced into the hair-follicle to the depth of
the papilla, and the (UTCuit comjiletud by the
patient touching the positive electrode ; in seTeral
seconds slight fciauching and frothing usually _
appear at the point of insertion ; a few seconds ■
later the current is broken by release of the i
positive electrode, and the needle is then with- ;
drawn. Sometimes a wheal>like elevation arises, !
retuains several minutes or hours, and then I
diaappeara : or occasionally (rarely if the opera- I
tor is practiced and skillful) it develops into a ;
pustule. ^

A strength of current of a half to two miili- '
amperes is usually sufficient ; the time necet^fiary {
for the destruction of the papilla varying from I
several to thirty seoonds. !

How are yon to knov if the papilla lias \
been destroyed^

The hiilr will rwidily foiuis out with but little, i

What is the result if the current has been
too strong or too long continued^

The folliele

[id :■.

resuita.

Why ihonld contiguous hairs not be operated
upon at the same sitting T
la onler that ttie chutiees of marked iiiflum-
niatory action and scarring (always posBibililies)
may be reduced to a. miuiiuum.

154 rJISEASES OP THE SKIN. 1

In. case of failnte to destroy an indiridnal papilla, alLonld a
second attempt be made at the same sitting t
As a. rule not, iiiordiT toavnidtliuiiopaibility offJJOiiiueh destruc-
tive Ui-tiun, aud cuiisequeat Htajring. It is far better t^j wait untjl a
subsequent sittmg.

Can scarrii^ always be prevented?

In the average case, with skill and care, the use of an exceedingly
fine needle and the avoidance of too strong a current, percrptible '
scarring (scarring perceptible to the ordinary observer or at ordinary
distauce) need rarely occur.

What measures are to be admed for the irritatioii prodaoed ,

by the operation?
Hot water appUcatiooH and the use of a lotion of corrosive BubK-
mate (gr, ss-j to sij) are of advantage, not only in reducing the
resulting hypersciuia, but also iu preventing suppuration and coose-
quent scarring.

Sclerema Neonatorum.

{HynonymB : Siilcroilerma Naoniitunim ; Soleramu of Ihe Newboni.) ■

Wliat is sclerema neonatorum ? I

Sclerema neonatorum is a disease of infancy, showing itself usually 1
at or shortly after birth, and is characteriaed by a diffuse stiffnetH
and rigidity of the integuuient, accompanied by ooldness, tsdema,
discoloration, lividity and general circulatory disturbance.

Describe the symptoms, conrse, nature and treatment of
sclerema neonatorum.

As a rule the dLsciise first manifests itself upon the lower estremi-
tjes, and then gradually, but usually rapidly, invades the trunk, anus .
and face. The surface is cold. The skin, which is notod to be
reddish, purplish or mottled, is tBdematoua, stiff and tease ; in oon-
scquence the infant is unable to move, respires feebly and usually
perishes in a few days or weeks. In extremely exceptional instances
the disease, aA«r involving a small part, may retrogress and recovei7
take place.

HypERTROPHIES.

156

The disease is rare, and in moat cases is found associated witii ]
pneumonia and with affections of the drculatory apparatus.

Treatment sbauld be directed toward maiutajniug wurmth i
proper alimentation.

Scleroderma.

(.Si"p

\it; DermMciialeruaii.)

What is acleroderma 1

Suleroik'noii is an acute or chronic disease of the skin characterized ]
by a. loealiz<Ml or general, more or less diffuse, usually pigmented,
rigid, stiffened, indurated or hide-bound condition.
Deaoribe the sTrnptoms of scleroderma.

The disease maybe acute or chronic, usually the latter. A portion
or almost the entire suriaoe may be involved, or it may occupy
variously-uzed and shaped areas. The integument becomes more or
leas rigid and indmuted, hard to the touch, hide-bound and in
marked cases immobile. (Edema may, especially in the more at
cases, precede the induration. PigmeutatJou, of uyellowishor bro
ish color, is often a precursoiy and accompanying symptom. The 1
skin feels tight and contracted, and in some instunees numbness and I
cramp-like pains are complained of. In exceptional cases patohes of I
morphcea are present.

The genera] health, as a rule, remams good.
What is the coiirse of the disease ?

Sooner or kter, iLsuidly aft^r months or years, the disease ends in I
rcsfilution and recovery, or in marked atrophic changes, caimug i
traction and deiimnity.
State the causes of scleroderma.

The condition is to be considered as probably of neurotic origin. '
Exposure and shock to the nervous system are to be looked upon as
influential It is a rare disease, observed usually in early adult of
middle life, and is more frequent in women than in men. It is closely
aUied to morphica, and is by some observers considered identical.
What is the pathology ?

Zn typical and advanced cases, both the true skin and the mboit- g

156 DISEASES OP THE SKIN,

taneoiis connective tissue bIiow a marked incroaec
element, with tbickeuiag and iMjinieiiaation of tlie fibres.

Ib there any difficulty in reachiiig: a diagnosis in scleroderma 1

As a rule, uo. The churaetera — rigidity, stiffneea, hordnesa and
hide-bound uonditiou of the skin — are always distinctive.

Give tbe prognosis of scleroderma.

It should always be guarded. In some instances recovery taking 1
place, whilst la others the disease progresses and la^ts throughout
life.

The influence of treatment upon the couree of the diseaae is ques- ,
tionable.

Wliat ie the treatment of scleroderma 1

Tonics, Huoh aa arsenic, quinia, nus vnmiea and ood-liver oil ; con-
jointly with the local employment uf atlmulating, oilyor futty appli-
catjons, fricdou end electriraty.

Morphcea.

(SynoB^BH.- Kolgirtuf Addison; Circumaeribcd Sclcrodorma.)

What is morphcea 1

Morphcea, aa typically met with, is cbaraiiterLied by one or more
rounded, oval or elongate, coin- lo palm-sized, pirJiish or wliitish,
ivory-looking patches.

Describe the clinical appearances.

The patches (one, several or more), occurring most frequently
about the trunk, are in the beginning usually slightly byperfemio,
later becoming pale-yellowish or white, and having a pinkish or lilao
liorder made up of minute capillaries. They are, aa a rule, sharply
defined, with a smooth, oft«n shining and atrophic-looking surface ;
are soft, fine or leathery to the touch, on a level or somewhat do-
preased, and appearing not unlike a jHcce of bacon or ivory laid in
the skin. Occaaionaliy the patches are nul«d to occur over nerve-
tracts. The adjacent skin may he normal, or there may be more or
less yellowish or browuiiih mottling.

HTPEB.TROPETES.

15T 1

iryeare,

■power is probablj ioflD-
t womeD. It is closely
thought by many i

The subjective symptanis of tiugling, itching, mimbness, and
pain, may or may not be present
What oonrss does morphoea pursue?

Ita progresa ia alow, and the disease may last for months
the patches undergoing degenerative atrophic change, in aome
instances with a tendency t« keloidal fbnuation and consequent
deformity. In other cases retrogression takes place, a s|«ntaneou8
cure resulting witiumt leavinj,' a trace.

Wliat other cntaneonS'leBionB are occaBionally seen in asso-
oiation with morphtea ?

True aolerodcnnic areas, pit-like dcprewions or atrophy, telangi-
ectasis and atrophic spots and lines.
State the etiology of moiphsa.

The causes are obscure. Impaired
enlial. It is rare, and ia m
allied to scleroderma. These two affections
authorities to he essentially the same disease.
What is the pathology 1

In the early atagca there is atrophy of the papillary layer
neclive-tiseuc of the curium, with eell-iufiltratbn about the sehiieeoUB I
glands, hair-follicles and bloodvessels. Later atrophy of all the skin 4
structures takes place, the cell-infiltratioa cliuuging to fibrillar tissue, I

From what diseases is morphoea to he differentiated?

FrouJ ."(■!, ■rnik'rma, vitilV' and i)k' an^cstlii-lii/ jat^-hiti of leprosy.

How is morphcea to be distinguished &om these several dii- |
eases ?

By the peculiar appearance, the course and characters of ths |
patches ; in leproay other aymploms are commonly present.

What ia the prognosis in morphoeaT

The prognosis should always* be guarded ; the disease is
tain in its duration and course, aa well as rebellious to treatment, J
oft^u lusting indefinitely.

What treatment would yoa prescribe for morphoea ?

Tonic, with special reference toward the nervous ByHteni

DISEASES OF TBK SKIN.

[ quinine, ood-liver nil, and general and local galvouizaliou o
} tatitin, deserving special mention.

MiiBSitge and fnctitin are also serviceable.

Elephantiasis.

I <fi;y»a"$B»; ElophaDtia6t< Arabuin i P{><:h;<k'nniii.; niirliiidocd I.<?g; Elq^ant

I Oive a deBcriptlTe definitipn of elephantiasia,

I Elephftntiaaia is a cbrouio hypertrophic disease of the skin and
E snbcutaueoua tissue ehar.LcteriKod hy enlargument and dcfijrmit.v,
[ lymphangitis, swelliug, (Bdemii, thickening, induration, pigmeuta-
I- lion, and more or less papillaiy growth.

What parts are commonly involved m elephantiasis f

Usually oni; or li.3(h legs; ot^aaiunOlv thi. giuitalia; other piirts

are Heldoui ufftt-ted.

Describe the symptoms of elepliantiasis.
The disease nsu^ begins witl" "^ "*■ (at intervals uf muutba

HTTEBTBOPHIES. 159

rwyMis) eiTHpelatouB infliimniation, with swelling, pain, heat, red-
ness and lymphangitis ; after each attack the parts remaia somewhat
increased ia size, although at first not notiixably so. After months
or one or two years the enlargement or hypertrophy becomes con-
spicuous, the part is ohronieally swoUen, (edematous and hard ; the
skin is thickened, the normal lines and folds exaggerated, the papillEe
enlarged and prominent, and with more or less fissuring and pigmeu-

What is the further course of the disease?

There is gradual increase in size, the parts in some instanoes
reaching enormous proportions ; the skin becomes rongb and warty,
ecKcmateus inflammation is ol^n superadded, and, sooner or later,
nlcets, superficial or deep, form— which, together with the crusting
and moderate seuliness, present a striking picture. There may be
periods of comparative inacUvity, or, after reaching a certain de-
Telopmout, the disease ua;, for a time at least, retnaia slationiuT.

DISRASEB OF THE SKIN.

An than ai^ subjective aymptoms t

A vui'iiiMo di's-nt'oi' [lain is ufton noted, especially marked dui
l\w iiitliiiiiiiiiiUirj' atuu'ks. Tlie geiienil health is uot involved.

State the cvum of elephantiasis,

Tliu eljiiliigy is oWuns. The disease rarely occurs '
II Ih lUiK^t tiiiumoi] tti tropical cuuutries, more especially among thM
pooriuid m'gliiited. It is uot hereditary, nor can it bo said to ii
ooQlAgions. Inflammation and obstruction of the lymphatJcs, prob>^
ably duo, according to late investigations, to the presence o
nmuU'rs of Glaria (microscopic thread-worms) in the lymph chaimeh
and bIi.)oilvcs*is, is to be looked upon aa the immediat« a
What is the pathology T

All ]iarts of the i^kjii and subeutuneonH conncctjve-tissue are hy'S
[wrtrophicd, the lymphatic glands are swollen, the lymph channels ■!
and bluotlvesscls enlarged, and there is more or less iaflummation, with '
<»dcma. Siwondarily, from pressure, atrophy and destruction of the i
skill-glands, and atrophic degeneration of the fat and muscles result
What are the diagnostic characters of beginning elephan-
tiasis ?

Bpoiirreiit crysiiieliitous inflammation, att<^nded with gradmil en-
largement of ihc parts.

Tlie appearances, later in the course of the disease, are so charao-.
tciiHlio that a mistake is scarcely possible.
Give the prognosis of elephantiasis.

If the Ciise comes under treatment in the first months of its devel-
opment, the [)n>ces8 may probably be checked or held in abeyance ;
when well OMtublushed, rarely more than palliation ia possible.
What is the treatment of elephantiasis T

The infiammatory attacks bire to be treated on geuernl principled
Quinia, putmwnm iodide, iron and other tonics are occasionally UBe- ,
fu) ; and, especially in the earlier stages, climatic change Is often of
value. Between the inflammatory attacks the parte are to be |
nibbed with an ointment of iodine or metoury, together with gal-
vanization of the involved (lart.

Iq elephandasis of the log, u roller or rubber bandage, or the
gum stocking, is to be worn ; oompreasioD luid ligatiuu of the uaii^

HrPERTROPHlES. 161

', and even excision of the K«ia.tiu nerve, have all heen e
ployed, with more ur less diminution in size as a reiiult.
lephajittoitisof thegenitalin, if the disease is well advanced, e.
or amputation of the parts is to be practised.

Ecsematoos inflammatiun, if present, is to l)e treated with the
ordiuaiy remediett,

Dermatolysis.

{S,,,'"";i'" ^ Citl. P.;nduli..)

Give a descriptive definition of dermatolysia.

DenilatolyaiH is a mre diseatie, eoDsLsting of hypertrophy and loose-
ness of the akin and subcutaneous connective tissue, with a tendency
to hang in folds.
Describe the Bymptoms and oonrse of dermatolyBis.

It may be congenital or acquired, and may bo hmited to a small or
large area, or develop Bimultaneitualy at several regions. All parts
of the skin, including the folliel«j, glands and subcutaneous connect-
ive and areolar tissue, share in the hyjiertrophy ; and this in excep-
tional instances may be so extensive that the integument hangs in
folds. The enlargement of the fotlivlea, natural folds and rugso
gives rise to an uneven surface, but the sidn remains soft and
pliable. There is also increased pigmentation, the integnment
becoming more or less brownish.
What conrse does dermatolysis pursue 1

Its development is slow and usually progressive. It gives rise to
no further incouvenience than its weight and consequent discomibrt.
Give the etiology.

The etiology is obscure. It is considered by some authors as allied
to molluscum fibrosuin, and, in fiict, as a manifestation of that Jis-
oa«c, ordinary mulluscum tumors sometimes l)eing associated with it.
It is not malignant.

What is the patholo^ T

The disease cunsiHta of a simple hypertrophy of all the skin siruc-
tures and the subeutanonus connective tissua

Vhat is the treatment of dermatolysit ?

Bxcisiun when adviauble and practicable.

a OP THE SKIN.

CLASS v.— ATROPHIES.

What do yon understand by albinismna?

CoiigouitiLl aU'vricc, t^itliur i«irtia.l ur tumplete, of the pigmeot I
normally present in tlie skin, hair and eyen.

Describe complete albinismns.

lu complete iJljiuismus tlie skiu of the entire body ia white, thai
hair visry fiiic, soft and white or whitish-yellow in color, the ii
are colorless or light bine, and the pnpils, owing to the alwence of i
pigment in the choroid, are red ; this absence of pigment In tbel
eyes gives rise to photophobia and nystagmus. Albinos — a t
applied to such individuals — are commonly of feeble consUtution,]
and may exhibit ini perfect mental development

Seicribe partial albinismns.

Partial albinismns is met with most frequently in the colored nue. 1
In this form of the affection the jiigment is absent in one, several o
mora varioiisly-sizod patches ; nsnaJly the hairs growing theremi |
are likewLse colorless.

Is there any Btructmal chang^e in the Bkin ?

No. The functions of the skin are performed in a perfectly J
natural manner, and microecopical examination shows do departote I
from normal structure save the cumpleto absence of pigment

What is known in regard to the etiology ?

Nothing is known oi' the causes pnxlucing albinism us beyon*
smgle fact tiiut it is frequently hereditary.

Does albinismus admit of treatment?
No i the condition is without remedy.

ATROPlIIEa.

Vitiligo.

(^y.™*

Give a definitiou of vitiligo.

Vitiligo may be defined aa a discaae involving the pigment of the 1
atin alone, uharaeterized by several or more progTesaive, miUty-whita J
patchiis Burroiiuded by increuBed pigmentation.

Deacribe tlie symptonu of vitiligo.

The di^iisc may begin at one or more regions, the backs of the '
hands, trunk and face being favorite parts ; its appearance is usually
insidious, and the Bpols may not bo espedaUy noticeable until they
tue the uze of a pea or larger. The patches grow slowly, are milky
or dead wiiite, amooth, non-elevated, and of roauded outline ; the

' IM blSEAStS OF -THE fStS.

buttleriuif akin U darker than normal, Ehowing- ii
tiuD. Heverid coiitigauo^ spoU nuir onilisce &nJ Tona > 1>IE^ 1
trrcgnlarlf -shaped paldi. Hair giuwmg on the invulred ^aa may i
or may niit be blanchci].

Tlii-re are nu ^-nbj«*ive sjniploma.
What course does ritiligo pursue t

""le eoonie uf the iljaea^ is bIuw, nioiitlid ami luiuctiiDes jean

Villllgo-I

ATRdPUIES. 165 \

developB aften without apparent cause. Alopecia areatii aoii d
phoea have heea ubserved associated witli it.

State the pathology of vitiligo.

The disease cousists, auatomically, of both a diminution and in- ]
crease of the pigment— the whit* patch' regulting from the former,
and the pigmented borders from the latter. There is no testural j
change, the ^kiu in other respects being normal

From what diseases is vitiligo to be differentiated f

From morphcea and from tho ansesthetic patches of lefirosy.

la what respects do these diseases differ from vitiligo T

In morj>h<ea there is teitural change, and in leprosy both testural
change and con.ittitutional or other symptoms.

What prognosis is to be given ?

It should always be guarded, the disease in most instances being
irresponsive to treatment.

What is the treatment of vitiligo?

The general health is to be looked after, and remedies directed ,
especially toward the nervous system to be employed. An^enic, i
small and continued dosca, seems at times to have an influence; when
there is lack of general tone it may be prescribed as follows ; —

B>. Liq. potaeait ameniti.s, f3j

Tinct. nneis vom., fSiij

Elis. calUayie, . . . . ti. s. aJ . . . fjiv. ]

8iG.— fgj t. d.

When upon esjKised parts, stimulation of the patches, with the \
view of producing hyperemia and eonseiguent pigment deposit ; con-
joined with suitable applications to the eurruunding pigmented akin,
with a view to lessen the coloration (see treatment of c/Uaasma), wilt I
be of aid la rendering tho disease leas conspicuous. Or the condition
may be, in a measure, masked by staining the patches with walnut J
Juice or similar pigment-

DISEAHES OF THE S

Canities.

(.%no,,jni .. Oroynesa of the naif.}

Deaoribe otmities.

Cunities, or graying of the hair, may occur in localized areas or it 1
may be more or leas general ; tlie blancliing inuy be slight, ecarcely 1
amumitiag to slight grayness, or it may be complete. It is
to advauciog yeare [canities senilii) ; it ia seen also exceptionally
in ea,rly life (cankies prwtii'ilura). The condition ia usually perma-
nent. The loss of pigment takes place, as a rule, sluwly, but several I
apparently aiithcotic oases have been reported in which the change
ouwrred in the course of a night or in a few days.
What is tlie etioloEry of canities T

Tlie causes are obscure. Heredity is usnally an influential factor,
and conditions which impair the general nutrition have at times an
etiologiuat bearing. Intense anxiety, flight, and other profound ner-
vous shuck are looked upon as causative in sudden graying of the

Give the treatment,

(Jiiiiitii'N iM without remedy. Dyeing, although not to bo advised,
IB oiU'ti pmi'tiscd, and the ixmdition thus masked.

Alopecia.

[S!>..,.

la.)

By alopecia is meant loss of hair, either partial o.
Name the several Tarieties of alopecia.

The so-called varieties are based mainly upon the etiology, and are 1
named congenital alopecia, premature alopecia and senile alopeda.
Describe congenital alopecia.

Congenitiil alopecia is a rare condition, in which the hair-loss is
usually noted to bo patchy, or the general hair-growtli may simply
be scanty. In rare instances the hair has bet^n entirely wanting; in
such cases there is usually defective development of other structures,
eoob aa the teeth.

ATEOPHrBS, 167 I

Seaeiibe prematnra alopecia.

Loss of hair otc-urriug Ju early and middle adult life is not udcdui-
mcin, and may consist of a simple tluQDiiig or of mure or less com-
plete baldnesB oi' the whole or greater part of the scalp. It usually
develops elowly, some months or several years passing before the
condition is well established. It is often idiopathic, and without
apparent oauHe further than probably a hereditary predispositioa It
may also be symptAmatic, as, for example, the loss of hair, usually
rapid [defiumum capiU'innii), following systemic diseases, such as the
various fevere, and syphilis; <jras a result of a long-continued sebor-
rhiBa or seborrhoeic eczema {alopecia furfitraeea).
Describe senile alopecia.

This is the baldness so frequently seen developing with advancing
years, and may consist merely of a genera] thinning, or, more com-
monly, a, geoerul thinning with a more or less complete baldness of
the temporal and anterior portion or of the vertex of the scalp.
What IB the prognosis la the varions varieties of alopecia T

In those cases in which there is a pouttve caiise, as, for instance, in
symptomatic alopecia, the prognosis is, as a mie, favorable, especially
if no family predisposition exists. In the congenital and senile vari-
eties the condition is usually irremediable- In idiopathic premature
alopecia, the prognosis should be extremely guarded.
How would you treat alopecia t

By removing or modifying the predispoang factors by appiu-
priate constitutional remedies, and by the external use of stimulating
applications.

Name several remedies or combinations nsnally employed in
the local treatment

iSulphui' uiiitmeot, lull strength or weakened with lard or vaaelioe ;
a lotion of resorcin consisting of one or two drichms to four ounces
of alcohol, to which is added ten to thirty minims of castor oil ; and
a lotion made up as follovra ; —

K - TinctL cantharidis, f^.^ i^

Tintt. capsid, fSJ

01. ricini, f3sa-f3J

^^^^ Alcobolia, .... q. s. ad f 3 '"■ M. ,

dioroiighlj rubbed iu daUj" or I

Alopecia Areata.

nC«]fi; A1ot>ei^ia Circnmsuripto.)

Wkat d« jm mdentaad by alopecia areatal

Alo|<eaa M«ata is an affectioD uf the haiiy system, in which occor I
MM or more cununsnibed, n.>nnd or oval patches of complete bald- ]
i by ■o;' niarkv*! altention in the akin.

Upon what parts and at what age does the disease occur T

III ibi' hugn uiHJority of oasos tho disease id limited to the scalp ;
but it luaj- iuTude other portions of tho body, as the beardtd region,
eyebrows, uyt-liislies, and, Id rare ioslanoes, the entire integnment.
It lij muel oommon between the ages of ten and fis^.

ATEOPHIES.

Degeribe the aymptoma of alopecia areata.

The diseasii be^DS either suddenly, without premonitoiy symp-
toms, one or several patches being formed in a few houra ; or, and aa ,
is more usually the case, several days or weeks elapse before the bald ,
area or arena arc sufficiently liirge to become Doticeable. The patches
continue to extend peripherally for a variable period, ajid then remain
stutionary, or sevenJ graduiLlly coalesce and form a large, irregular
a involving the entire or a greater portion of the scalp. The skin
of the affected regions is smooth, feintly pink or milky white, and

at first presents no departure from the normal ; sooner or later, how-
ever, the follicles bccflme U'tu pniminent, and slight atrophy or
thinning may occur, the bald jilaijuia being slightly depressed.
What conne does alopecia areata porsne T

Ahaost invariably chronic. After the lapse of a variable period,
the patches cease to extend, the hairs at the margins of the bald
\B beiDg firmly fixed in the follicles ; sooner or later a fine, colorlesB
igo, or down, shows itself, which may continue to grow until it J

3 DISKiSES OF THE SKIN.

13 about a half-inch or so in length aud then drop 6
remain, become eoaxHer aiid pigmented, and the parte resume their
normal oondittoa Not infreciuently, huwever, after growing for a
time, tbe new Lair falls out, and this may happen several timtt
before the tenuination of tbe disease, inoatba or even years some- J
times elapsing before permanent recovery takes place. I

Are there any subjective symptoma in alopecia areata ? I

As a rule, not ; but occaidoually the appearance of the patches is J
preceded by severe beadacbe, itching or burning, or other ma&ifes- I
tatious of disturbed innervation. I

State the cause of alopecia areata. I

The etiology is obicure. Two theoriea aa to the cause of the di*- I
ease exist : one of these regards it iia ])arasitic, and the other coo- 1
siders it to be troidioiieui'otic. |

Soea the skin of the affected area undergo any alterative or

destructive changes ? I

Microscopieal eiamination of the skin of the diseased area shows I

little or no alteratiou in its strueture beyond slight thinniag. I

How would you distii^aiBh alopecia areata^ from ringworm I
of the scalp? 1

The plaques of alopecia areata are smooth, often comjdetelr ■
devoid of hair, and free from scales; while those of ringwom M
show numerous broken hairs and stumps, desquamation, and uanaUy I
symptoms of piild inflammatory action. In doubtful cases reoonrae I
should bo had to tbe microscope. I

What is the prognoali in alopecia areata T I

Tho disease is oiten. rebellious, but in children and young adults I

tlie prognosis is almost invuriably favorable, permanent loss of hair I

being uuoommoD. The same holds true, but tJi a much less extent, I

with the disease as occurring in those of mure advanced age. 1

The uncertain duration, however, must be borne in mind ; months, M

and in some instances several years, may elapse before complete 1

reatjtrafjon of hair tJikcs plapc. Relapses are not uncommon. 1

How is alopecia areata treated? I

By both i-uiiHtitutioriid and local toeasures, the former having in I

ATKOPHIES.

s ^stem, and the latter stimu-

yiew the ivmi^ontioa of the d

lation of the ikfiucCeil areas.

Give the constitational treatment.

Arsenic is perhaps the most valuable remedy, while quinine, nm J
voi^ica, pilocarpine, ci)d-Iiver oil and ferrugiooua tonica may, in suit- \
able cases, often bo adminiatcrecj with benefit.

Kame several remedies or combinations employed in tlie i
external treatment of alopecia areata.

OintuKirits uf tjir auJ sul|iliur uf varying strength ; the yarious
mercnrial ointmeuts; the Uir oils, either pure or with alcohol;
stimulating lotions, containing varying proportions, singly or in
oombiDation, of tincture of cnpsicum, tincture of cantharides, aquA i
ammoniffi, and oil of turpentine, as in the following :-

8. Tinet eapsid,

TiiM't. cantbaridis,

01, terebinthincB, . . . . aa gi

In obstinate patches repeated blistering, or the cautious use of a five
to twenty per cent chrysarobin ointment, is of value. Gralvaniza-
tion or faradization of the affected parte may also be employed, and 1
with, occasionally, bcne&cial effect.

(The strength of the applications will depend upon circumstances,
a mild degree of irritation being desirable ; they are to be thor-
oughly rubbed in, the friction employed being not without value).

Atrophia Pilorum Propria.

(.S>™„j™.- Atrophy of .ho Httir.)

What do you understand by atrophy of the hair ?

An iitrophic, brittle, dry condition of the hiiir, and which may be
cither symptamutic or idiopathia
Describe the several conditions met with.

As a 65'mptoraBtic affection, the dry, brittle condition of the hdr
met with in seborrhcea, in severe constitutional diseases, and ii
various vegetable parasitic affections, may be referred U

IT2

DiaE.13F,S OF THE S

s &a idiopatliic disease it is rare, consistiDg simply of a, brittle-
Dess and an uaeven and irreguJur formation ofUie hair-sbaft, with a
tendency to split up into filaments {fragHitas cmiiiim) ; or there may
be localized swdUng and bureting of the hair-shaft, the nodes thus
produced Laving a shining, semi-transparent appearance {trichorexii i
nodosa). Tbis latter usually occurs upon the beard and moustache. I
State the causes of atrophy of the hair.

The causes of the ftymptomatic variety arc usually erideot ; the
etiology of idiopathic atrophy is obscure.

What would be your prognosis and treatment in atrophy of
the hail T

Symptomatic atrophy usually responds to proper meaenrcti, b
always Blowly ; treatment is based upon the etiological faetora.

For the tdiopa.tbio disease little, as a rule, can be done ; repeated \
shaving or cutting the hair has, in exceptional iDatances, beeo fol-
lowed by favorable results.

Atrophia nn^^s.

;%.,>i.jm,. AtropLy of tUeNailai Onychatrophia,)

Sesoribe atrophy of the nails.

The nails are mft. thin and brittle, splitting easily, and are often '
opaque and luwtrcleiis, and may have a wonu-catcn appeamuce.
SevcKil or mure are uauiilly affected.

State the canses of atrophy of the nails.
The condition may be congenital or Daqnired, usually the ktter.

ATROPHIES. 173

It may lesuh from traimio, or bo produced by certain cutaneooH 1
diseases, notably eczema and peoriasis ; or it may follow inJiirieB or 1
diseascB of the nervea. Syphilis and chronic vastiug constitutiotutl J
diseases may also interfere with the normal growth of the nail-aiih- I
Btanee, producing yaiying degrees of atrophy. The fungi of tine« I
trichophytina and tinea fiivoaa at times invade tliese atmctareB J
and lead to more or less complete disintegration — onychomyaosii.

iphynf Iho Nallu.

What is the treatment of atrophy of the nails ?

Treatment will depend upon the cause. When it is due to ecEema
or psoriasis, appropriate constitutional and local remedies should be
prescribed. If it ia the result of syphilis, mercury and potassium
iodide are to be advised. In onyehomycoaia— an exceedingly obsti-
nate affectJoD — the nails should he kept closely uut and pared, and a
one- to five-grain solution of corrosive sublimate applied several times
a day ; a lotion of sodium hyposulphite, a drachm to the ounce, i
also a valuable and safe application.

Atrophia Cutis.

(^lonyim,- Atro],hoderm:i ; Atroplij uf tbo Skin.)

What do you imderstand by atrophy of the skin ?

By atrophy of the akin is meant an idiopathic or symptomatic
wasting or degeneration of ita eomponent elements.

State the several conditions met with.

Glossy sltin, general idiopathic atrophy of tho skin, parcbmeiit '
skin, atrophic lines and Bpots, senile atrophy, and tLe atrophy fol-
lowing certain cutaneous diseases.

Describe glossy shm (atrophoderma neuriticam), and state
the treatment.

Glossy skin is a rare condition following an injury or diaeaae
■of the nerve. It is usually seen about the fingcre. The skin is
hairless, faintly reddish, smooth and shining, with a varnished
and thin appearance, and with a tendency to fissuring. More or
less severe and peraiatent burning pain precedes and accompanies
the atrophy.

Protective applications are aiUed fur, the disease tending slowly
to spontaneous diBaji])earance,

Describe general idiopathic atrophy of the skin, and give the
treatment.

General idiopathic atrophy of the skin is estremely rare, and is
oharacterized by a gradual, more or less general, degenerative and
quantitative atrophyof the sldu structures, accompanied usuallf wt&
more or less discoloration and pignientiition. I

Treatment is palliative and based upon indiuutiuuH.

Sescrifae parchment skin, and state the treatment. ,

Parchment akin {xeroderma pigmenioiiim, angioma piijmentoniM

, ef atn^Kiatni) is a rare disease, the exact nature of which is not

inderstood. It is characterized by the appearance of numerons

' disseminated, freckle-like pigmeot-spote, telangiectases, atrophied

muscles, more or less shrinkiugand cantraction of the intcgomeiit,

and followed, in most instances, by epitheliomatous tumors and

I nloeration, and finally death. It is ustiuU; dow in its oooise, begui-

i and laiting fnr years. It ia not ii

iu several cliildren of the same iGunily.

TrontineDt ia paJliutive, conaistmg, if necessary, of the use of
protettive applications and of the administration of tonics and
nutrients.

Describe atrophic lines and spots.

Atrophic lines sad spots {ttrve et Tnamdis alrophias) may he idio-
pathic or symptomatic, the lesions consisting of Bcor-like or atrophic-
looking, whitish lines and macules, most commonly seen on the
trunk. Theyare smooth and glistening. Slight hyperaemia usually
precedes their formation. As an idiopathic disease its couree is
inudious and slow, and its progress eventually stayed. The so-called
linae affiicawfes, resulting from the stretching of the skin produced
hy pregnancy or tumors, and from rapid development of fet, may
he mentioned as iliustrtLtiug the symptomatia variety.

In course of time the atrophy becomes less couapiouous.

Sesoribe senile atrophy. , •

Senile atrophy ia not uncommon, the atrophy resulting, as the
name inferentialiy implies, from advancing a^e. It ia characterized
by thinning and wasting, dryness, and a wrinkled condition, with
" !8s pigmentation and loss of hair. Circumscribed pigment-
ary deposits and scborrhcea, with degeneration, are also noted.

What several diseases of the skin are commonly followed by
atrophic changes f
FuviLH, lupus, syphilis, leprosy, scleroderma and morphcea.

DISEASES OF TtlE SKIN.

CLASS VI.— NEW OBOWTHS.
Keloid.

(,S(vF.iJ..,vM*: Keloid of Aliljcrt; Chelmd.)

Give a descriptive definition of keloid.

Keloid ia a fibroK3ellular new growth of the coriuni appearing aiM
one or several varionalr-sized, irregularly-shaped, elevated, smoothi ■
finu, pinkish or pale-reddish eicatriform leaons.

Describe the clinical appearance of keloid.

The growth begins as a small, hard, elevated, pinkish or
tubercle, increaaing gradually, aeveral Months or yeaia usually elaps-
ing before the tumor reaches conepicuoua size. .When developed, it
ia one or more inches in diameter, ia sharply defined, elevated, hatd,
rounded or oval, fungoid or crab-shaped, and firmly implanted in
the skin. It is usually pinkish, pearl-white, or reddiah, commonly
devoid of hair, with no tendency to sijalinesa, and with, osaally,
aeveral vessels coursing over it. In some instances it is tender, and
it may be spontaneously painftd.

The breast, especially over the sternal region, is a favorite B
for its appearance. One, several or more may be presenf
smgle case.

What course does keloid pnrane T

Chronic; usually lasting throughout life. In rare instanoea apoB-'l
taueoua involution takes place.

State the etiology of keloid.

The causes are obscure. The growtli usually takes its start IraiS
some injury or lesion of continuity; for instance, at the sitfi of bi
cutH, acne and smallpox sears, eta — dcatridid keloid, false Jeeloidi^
or it may also, so it is thought, originate in normal akin— <pwi(a-
neons keUiid, true kdm'd.

What is the pathology of keloid t
The lesion ia a cuniioctive-tissue new growth having iu seat in the

NEW QROWTUS. IT"

Ie there any diffioolty in the diagnoalB of keloidT

No. It reseiublea LypertnipMc scar ; but this latter, which ia
essentially toloidal, never estends beyond the line of iiyiiry-
Give the prognosis.

Tin; pruwtb is persistent and usiwlly irresponsive to treatment
What is the treatment of fc:eloid?

Usually palliative, consisting of the continuous application of an
ointment each as the following : —

B . Acidi Balicylid, gr. i-n

Emplast. pinmbi,

Emplast. saponis aa. . . . . 3iij

Petrolttti, gij. M.

An ointment of iehthyol, twenty-five per cent, strength, rubbed
in once or twice daily, ia sometimes beneficial.

Operative measures, such as ponctate and linear scarification,
electrolysis and csci^on, are occasionally practised, but the results

; rarely aatiaiefory and permanent ; not infrequently, indeed,
renewed activity in the progress of the growth is noted to follow.

(Sy-K-

; Molluiu

Fibroma Moll

m.)

What do yoD understand by fibroma ?

Pibrcma is a conneotive-tissue new growth characterized by one or
nore seeaile or pedunculated, pea- to egg-sized or lar^^er, soft or firm,
-oundcd, pamless tumors, seated beneath and in the skin.
Describe the clinical appearances of fibroma.
The growth may be Hingle, in which case it ia apt to be peduneu-
I lated or pendulous, and attain considerable dimeui^ions ; as a result
I of weight or pressure surfaee-uleemtion may occur. Or, and as
I oommonly met with, the lesions are numerous, scattered over large
pmrface, and vary in size from a pea to a cherry ; the overlying akin
I being normal, pinkish or reddish, loose, stretehed, hypertrophied or
^ttrophied.

The tumors are painless. The general health is not involTOd.

What IB the conne of fibroma ^

CliroDic iind pcreistent.

Fibroma. lAJur Octsrlmi/.)

What ia the etiolog? of fibroma ?

The cause ia uot kiiowQ. Heredity ia oftcu noted. Tiic affection
ia not commoiL

NEW GROWTHS. 179

tate ike patholoi? of fibroma.

The growths are variously thought to have their origin in the
connective tissue of the corium, or in that of the walls of the hair-
sac, or in the connective -tissue framework of the fatty tisHue.
I Becent tumors are composed of gelatinous, uewly-formed connective
I tissue, and the older growths of a dense, firmly-packed, fibrous tisBue.

From wlLat growths is fibroma to be differentiated ?

From molluscnm contagiosum, neuroma and lipoma ; the first is
differentiated by ita central aperture or depression, neuroma by its
paiufiilness, and Upoma by its lobulated character and soft feel.

Oire the prognosia of fibroma.

The disease is pereistcut, and irresponsive to all treatment save
operative measures.

operative u

What is the treatment of fibroma ?

Treatment consists, when desired and practicable, in the removal
of the growths by the knife, or in large and pedunculated tumors
by the ligature or by the galvano-eautery.

^H tempo

Neuroma.
Describe neuroma.

Neuroma of the skin isan exceedingly mre disease, characterized by
the formation of variously-sized, usually numerous, firm, immovable
md elastic fibrous tubercles containing new nerve-elements, and ac-
companied by violent, paroxysmal pain. Their growth is slow and
usually progressive. Later they are painful upon pressure. They
are limited to one region.

The tumors are seated in the corium, extending into the deeper
Btructnre, and conrist of nerve-fibres, yellow elastic tissue, blood vea-
Bels and lymphoid cells.

Li the two cases reported, excision of the nerve-trunk gave, in
one instance, permaneat relief j in the other the effect was only
temponuy.

►t^EA^IS or THE etux.

Xantboim b a woiKctiTe-iisme new gn>irl)i characterized hy the I
foraulioii of yeDuwidi. an-am<uibed, trreguUHy-shapeti, TariooHly I
fiit^, Don^induraii^ flit or nised pui^hes or taberdes.

Name the tiro rarieties met vi&

The macnlar or Sat {jantkomtt phtnum) and the tubercular '
{xanthoma tuba-cuttilum or tulxnttum). Id some instances both
Taiietks (z/iM/Ai>inii miJtiplfx) are seen in the same iodiTiduiLL

Describe the clinical sppeannces of xanthoma planum.

The macalar or flat variety is nsoally seen about the eyelids.
It conasts of one, several or more small or large, smooth, opaque,
sharply-defioed. utten shghcly raised, yelluwi:fh patches, looking not
unlike piei'es of cliatuuis-skiD implanted in the skin.

Sescribe the clinical appearances of xanthoma taberosnm.

The tubercular variety is eouimonly met wifh ui>on the neck, J
tniok and extremities. It oocore aa small, raised, isolated, ycllowieh J
nodules, or aa pat^^hes made up of aggregations of millet-seed-eiied' I
or larger tubercles. The lesions may be few or they may ex
great numbers.

What is the course of xanthoma t

Extremely slow; iiflcr reaching a certain development the growtha 1
may remain stationary.

State the etiolo^ of xanthoma.

The canses are obscure. Jaundice not infrequently precedes and 1
aocompaniea its development, especially in the tubercular variety.
The dieease is uncommon, and is usually seen in middle and advanced
life, and more frequently in womea

What is the pathology of xanthoma ?

It is a benign, (wnnective-tissui! new growth, with concomitant or
nibsequent, but usually parUal, fatty degeneration.

NKW OBOWTHS.

Oive tlie prognoBiB of zantboma.

The coiidition is persistent, uisd usually irrespouinivc
nient save destructive or operative mearjures.
What IB tlie treatment of xanthoma ?

TreatmeDt ponsiats, iu suitable eases, of excisioD ;
atuncea, electrolysis is serviceable.

(%""■?"

Hyoma.

.' M^oiasi Cutis ; Dflruuttomfooia ; Llomyoma Cutia-I

Describe myoma.

The disease is rare, auA consists usually of one or several (excep-
tionally nunieruus), variously -sized tumors of the akin, made up of
smootli muscular fibres. They are flat, rounded, ovaJ or peduncu-
liited, and have a. smooth surface and a pale-red color ; as a rule,
they use painless.

The growth is benign, and congistit GBBentially of a now formation
of unstriped muscular fibres ; hat it may also be composed h

of connective tissue {JS/romyomd) ; or it may contain a
of bloodvessels {myoma idangiectodes, anffiimycmta) ; (
be lymphatic involvement {lymphangioniyoma).

abundance
there may

Angioma.

(Hve a definition of angioma.

Angioma is a congenital hypertrophy of the vascular tissues of the
corium and subLTitaiiKous tiHsue.
Into what two classes may angiomata be ronghly grouped T

Describe the flat, or non-elevated, variety of angioma.

The flat, or non-elcvated, angioma (aeErtiv fiammtiis, ninnis sim-
plex, angioma simplof., capiUary naxui) may be pin-head- to beau-
T it may involve an area of several inches in diameter, and,

DISE.^S^ OF THE SKIN.

U(«ptioitallj-, a whole re^on. It is of a brigbt- or dark-reii color,
ath] is met with most (rcqucatly abont tlie face. In eome instances
it^xU'ndsitfterlurth. reaches accrtoin size and then remains atation-
an" ; oivasiinially, whi>n iDTolving a small area, it imdergoes inyolu-
tioD and ilisippears.
The sivcalled pcrl-ici'ne murk- is iutluded la this group.

Describe the promineitt, or elevated, variety of angioma.

The prnmioenlTanety (rcnoiwiMeriM, angioma cavernoswm, ntewa
luhfTofMf) L-i variously -iMed, oft«n oonsiderahly elevated, dearly-
dt'fined, compresilhle, smooth or lohulated, and of a. dark, purple
lAiIor ; it may. also, be erectile and pulsnting. The growth is usually
ft siiiple foruiatiyn, »nd is met with upon all parts of the body.

What iB the pathology of angioma T

It is a new growth, eon^sdng of a variable hypertrophy of the
ouluneoiis nnd subcutaneous art«ri^ and venous bloodvessela, with
or without lui iucrease of the connective tissue.

Give the treatment of angioma.

In wmc instances, especially in infants, painting the parts repeat-
edly with ci'ltmlion or liquor pliuubi subacetatis will act fityorably.
For vrell-i'stiihtislied, small, capillary UKvi electrolysis or puncturing
vriih n rptt-hot needle or with a needle charged with nitric acid may
lN'eniployi-(i; fiw " port-wine mark " frequent and closely contiguoua
i'liTlr\>lj-tic punctures are uuea^nally followed by a slight diminution

Kiir the pmminent groicllis, vucdnation, the ligature, puncturing
with the galvanu-vaut^ry and excision are variously resorted to.

^ Telangiectasis.

Deierihe telangiectasis. '

Telaiiji'wl-'*'!*' 'M'lsi^'s of a new growth or enlargement of the
ciHrttieons I'jipilliiries, ii.-unlly appearing during middle adult life,
itiHl si\it.>it, llir the uiDst part, about the fuoe.
To what extent may telangiectasis develops

It may he limiUiJ to a, roil dot or point, with several small radiat-

NKW lJLlO^^TH8. 183

ing oapilkries {nceinis arantux, spider ncfewi), or a. whole region,
uauaily the face, may show uuineriiu3 scattered or closely-set capillary
eatargementfi or new formations (rrmtcea). The latter is frequently
BBSOciated with iicne (aciie ronacea).
The ctiolugy is obscure.

What is the treatment of telangiectasis T

Destniction of the vessels liy electrolyhis or by the Itoiib. (See
treatment of acne rosacea.)

Lymphangioma.

{Shu.

e,(ode».)

Describe lymphan^oma.

Lymphungiouia is a rare disenae, consisting of localized dilatatioDB
of the lymphatic veasels, appearing as discrete or aggregated pin-
head or pea-sized, compressible, hollow, tubercle-hke elevations, of
a pinkish or funt Ulac color, and occurring for the most part about
the trunk. It ia of slow but usatklly progressive development, and
is unaccompanied by suljective ttymptoma.

A niro condition, probably a variety of this affection, with some-
what Bimilar general features, bnt in which the lesions are more or
less solid and somewhat painfiil, has been described under the name
of lyntphangiirma liihenmivi inultipJa::

Treatment, when demanded, consistjj of operative measures.

Rhinoscleroma.
Sesoribe rhinosoleroma.

Rhinoscleroma ia a rare «nd obscure disense, slow but progressive
in ita course, chanicteriiw?d by the development of an irregular, dense
and hard, flattened, tuiiercular, non-ulcerating, cellular new growth,
having its seat about the nose and contiguous parts. The overlyiog
skin is normal in color, or it may be light- or dark-brown or reddish.
Uariced disfigurement and cloBure, partial or complete, of the u

I 184

CISEASES OF THE S

It ii

I voSkvs gndjtaify rcsnltc.
f'OeniiMiy.

TWalm^nt, cooastiDg i>f partial or complete extirpati
a its Fesnhs, the disease tending to recar.

with chiefly iu AoBtiia. and
rarely

Lapns Erythematosus.

(ffy...mj,».. ; Lu|ms Kr.vtl»>iimt.>.U'j ; Lu|)U3 Sebiii.-cua; .Si-b.irtbuai Cungeitlya.>

Vhat is lupus erythematosus!

Lujius erythcmiiiosus tuny be roughly defined aa a small-celled
Dew growth, charafteriKcd hy_ouc, several ur more circuniHenbed,
variouidy-sixed and Hha}K.-d, pinkish or Jark red pat<:hes, cavered
slightly, aud more or less irregularly, with iidhereut grayish or yel-
loWL?h softies.
Upon what parts is lupus erythematosus observed?

Its eouimon site is tliQ faiii, usmdly the nnsu acd chLvks, with a
tendency toward symmetry ; it ia often limited to those parts, hut

I aitty occasionally be seen upon other regions, more espedally the

\ Ups, ears and scalp.

Describe the aymptoniH of lupus erythematosiis.

Usually the disease begins as one or several rounded, circuinaeribed,
pin-head- to pea-aized lesions ; slightly scaly, sdmewhat elevated, and
of a pinkish, reddish or violaceous color. They slowly, or somewhat
rapidly, increase in area, and after attaining variable size remain
stationary ; or they may progress and coalesce, and in tliis manner
sooner or later involve considerable surfaoe. The patches are sharply
defined against the sound skin by an elevated border, while the i
central portion is somewhat depressed and usually atrophic. More 1
orleas thickening and infiltration are observed. There is nntenilaiq/ I
lo nlceration. The scalines,s is, as a rule, scanty. The gland-ducts are '
enlarged, jmtuloui) or. plugged with sebaceous and epithelial matter.

The snlgective symptoma of burning and it«hing are usually slight
and often wanting.

What conrse does lapos erythematosiu pursue 1

As a rule, the difseaee is persistent, although somewhat variable, I
At times the patches retrogress, involution taking place with OT \
without slight sieve-like atrophy or aciinTug.

State the caaaes of lupus erythematosus.

The etiology is obacnre. It is essentially a disease of adult and I
middle age ; is more common in women, and more frequent in those I
having a tendency to disorders of tbp sebaceous glands. It may, in
fact, begin as a seborrhoea.

What is the patholo^ ?

It was formerly considered a new growth, bat recent opinion tends \
toward regarding it as a chronic inflammation of the cutis, superin- f
ducing degenerative and atrophic changes. The disease in many 1
cases originates in the sebaceous glands. There is no tendency to
pus formation.

Is there any difBculty in the dialysis of lupus erythematosusl

As a nile, not, as the features of the disease — the sharply eircum-
setibed outline, the reddish or violueeoua color, the elevated borvier,
the tendency to central depression and atrophy, the plugged up
patulous sebaceous ducts, the adherent grayish or yellowish Bcalea,
together with the region attacked (usually the nose and cheeks) —
ore ohamcteriatic.

state the pro^osis of Inpaa erythematosTU.

The disease is purable, but often extremely rebellions to treatmeat ;
on the other hand, some cases yield reaxlily, and occa^ouall; a. tend'

I Muiy 111 *|i(iritiitintniN diiinpponninee ia observL'd. Thu disease lu no
' WlwuuiiiilHKiiiiM'ii tliu xutierul health.

How li lupin orythemfttoiui to be treated?
Till' uitiioi'iil Iii'kIiIi in (41 bv l'>uLi'd nfter and systemiu treutmeat

NEW OEOWTIIS. 187

proscribed, if judicated. As a rule, conetitntioRal remndiea exert
Lttle, if any, influence, but exceptionally, eod-livar oil, araanio,
phosphoniB or potaaeium iodide proves of servica

Locally, at^nnling to the case, soothing remedies, stimulating ap-
plit'atioaa and deatruetioti of -the growth by caustics or operative
meuHurea ure to be employed. ( Try ilia milder applications firgt. )

Kention the stmnlating applicatioiu commonlf employed.

Wasliing the parts ouergetically with tincture of supo viridia,
rinsing and a])plying u soothing ointment, aueh as cold cream or
vaseline -

A lotion containing zinc ttulphate and potassium sulphuret
thoroughly dabbed on the partd morning and evening ; —

B . Zind anlphatis,

PotasBiiBalphnreti, . . . , as . . . 3as-3ij

Alcoholis, fgj

GlyceriuBJ, f^aa

AquK, rg iij. M.

Lotions of iehthyol and of rcsorcin, five to sixty graina to the

Painting the patches with pure carbolic acid once every two or
;hree days.

The contjnuoua application of niereuriul pla«t«r.

Sulphur and tar ointments, officinal strength or weakened with
lard, and also the following ; —

E. 01. cadiui,
Alcoholis,
Saponia Tiridis, aa Siias- M.

(This 19 to l>e rnb!x;d in, in small ([Uiintity, oucc or twice daily, and
lttt<?r a Boothing rciuf^Uy ajiplied. )

I When axe destmotive and operative measures justifiable ?

In obstinate, sluggish and lung itersiatcut patches, and then only
[ after other methods of treatment have failed. {Remember that the
ie ma;/ disappear in eourae of tinjc spuntaaeoualy, and ooca-
Batmiilly vnth/mt leaving a gtxir. )

losly used in obsti&ate,
t patc&CT of lapus erTthematoBus.

e of GilT«T, wilii a|i()lii.Titiijns o!' pyru-
D BqiuH' gatbi-ijcrclue, iSteea to tbir^

I
I

ptrwM. SKOfdi, and with satattoi^ (eanticniGlfeu ployed) of ca
tir poUah, and exeeptiaaiXif with ihe galvaiK>-c)Hitei7.

OfetMivt — aiMnSeuxxL, atina punctate or linear, and ei
the niRUe. (^ee bvuneot of Inpns vulgaris.)

IfaWft* Seulft«. {At mt i y i ti if Van HartiivBt.)

Whitt operatiTe method of treatment promises the heat re-
sult with the least lunoont of scarring ?

10 iiu'llnii liy ]mc:it s-.iriti.-;itiiiD. It is a t.-iiions one, but the

lupuB Vulgaris.

Ifhftt do you nudentand by lupus vulgaris T

".ujiuii vulgnris isii wiUuliir new growth, clmractoriKed byvarioiiBly-
[<risMl, soft, iWdiith-hixiwu, tmimlur, tubenmlnr und iiifiltnited potties,
anially t^Miuiimtitig iu ulooratiun and scvring.
Upon what r«(f ion is Inpns vulg^s usually observed 1

'I'lio ln.'o, i-siH-t'iiilly (ho nose. but. any jiart niiiy be invadwl. Tlie
aivii iiivulvci! may hv sniull ar iiuUi: t-'Xtousive, usujJly the tijnuer.

NEW GhOWTHS. If

At what Aga is the disease noted f

In many cases it begins in diildhood or early adult life, but as
is persistent and tends Ui relapse, it may be met with at any ngc.

Sesoribe tlie earlier symptoms of lupus Tulgaris.

The disease begins by the development of several ur raorepiQ-head
to small pearsized, deep-seated, brownish-red or yellowish tubercles,
having their seat in the deeper part of ths corium, and wbich are ■
somewhat softer and looser in texture than normal tissue. As the I
disease progresaeti, varioiisly-siKcd and shaped aggregations or patches |
result, covered with thin and imperfectly-formed epidermis.

What changes do the Inpas tubercles or infiltrations undergo T

The lesions, havicig, atCuined a certain size or development, may
remain so for a time, but sooner or later retrogreasive changes occur ;
the matured papules or tubercles, or infiltrated patches, slowly dis-
appear by absorption, fatty degeneration taking place, leaving an
eifbliating, atrophic or eioatrieial tisaue^^'pii* exfoNat{f«s ; or dis-
integration and destruction result, terminating in uleewlion — lupus
axdenx, hipiis ecukerans. Tliis latter is the usual course.

Describe the clinical appearances and behavior of the lupos
nlcerattons.
They ure rounded, shallow excavations, with soft and reddish
borders. In exceptional instances exuberant granolations appear —
hipug hffpertrupiiicia ; or papillary outgrowths are noted — lupus wer-
TTicogug. The ulcerations secrete a variable amount of pus, usually
slight in quantity, wbich leads to more or less crust formation ; later,
however, cicatricial tissue, generally of a finn a
results.

Is what manner does the disease spread 1

The patches sjiread by the appearance of new
tions at the peripheral portion. New islets and
oontinae to make their appearance from time to time,
oontignoua parts.

Are the mucous membranes of the month, throat and larynx

ever involved?

L'S, and either primarily ur aecouJariiy,

DISEASES OF THE SKIN.

Is the bone tissue ever involved in lupus vulgariBl

What course' does lupus vnlgaru pursue 1

It is eluwly but, aa a mle, Httsiulily progressive. Stvveral years o
more maj' elapse before the area of disease is conspicuous.

What is the cause of lupus vulgaris t

It ia thnuKlit tfi Iw duo tn tliti inviislua of the cutaiieuus stnu'turoa
by the tubercle bacillus ; iu short, a tubercolosk of the slciu. It is

not infrequently observod in the stnimoua and debiiitatj
entirely indejicndent nf Kjphilis.

What U the pathology of Inpiu Tnlg&ris 1

According to recent investigations, the infiltrations of lupus are
due chiefly to cell-proliferation and outgrowth from the protoplasmic
vallfi and odventitia of the hloodTessels and lymphatics. The
fibroua-tisaue network, veBseis and a portioa of the cell infiltration
are thuB produced, the fixed and wandering connective-tissue eella ,
of the inflamed stroma of the cutis being responsible for the other
portion of the new growth (Eobinson).

State the dia^oatio features of lupns vnlgaris.

Til a, typical, di'veloped patch of lupus are to he seen :■ — cicatricial '
fomiatton, usually of a fibrous and tough character; ulcerations ; the
yellowish-brnwn tubercles and infiltration ; and the chiiraoteristio
Boft, small, yellowish or reddish-brown, cutaneous and subcutaneouB
points and papules.

How does the tubercular Byphiloderm differ from lupua vul-
garis 7

The tulwuTilar pyjjhiloderm is much more rapid in its coorse,
the ulceration is deeper and the discharge copious aiid often ofien'
sive; the scarring ia soft, and, compared to the amount of ulceration,
but slightiy disfiguring ; and it is, for obvious reasons, a disease of

I adult or kte hfe. The history, together with other evidences of
previous or concomitant symptoms of syphilis, will often aid in the
difFeruntiation.
;
:

How does epithelioma differ from lupus rulgaris 1

The edges of the epitheliomatoua nicer are hard, elevated and
wasy ; the base is uneven, the secretion thin, scanty and apt to be
streaked with blood ; the ulceration usually sbuts from one point,
and is often painful; the tissue destruction may be considerable;
there is little, if any, tendency to the formation of cicatrical tissue;

id, finnlly, it Is usually a disease of advanced age.

In what respectB does lupus erythematoBus differ from lupus
vulgaris 7
Lupus erythematosus has uo i»tpulcn, lubercles or ulceiiitiua

How does acne rosaoea differ &om lupus vnl^aris T

Acne rosacea is c-hiuucteriKed by hyperjemia, diluted vessels,'!
papuW, pu8tult*, the absea™ of uWratii>n, and a different histoiyj

State the pro^osis of lupus vulgaris.

Lu|m8 vulearis ia always a clirunic disease, often exceedingly

rebulliuns tu treHtmunt, and nne that calk fur a guarded opinioQk.
Rekpsea are not nntommon.

The goiieriil health usually remMns. guod, but in soi
death by tuberculosis of tbe Jungs haa been noted.

Is external or internal treatment called for in lupus Tnlgaris |^

Always external, and not infrequently constitutional t

What is the oonstitutional treatment T

The gcMoriil lic;ilth must be cared fur; goml, iiutritiiius food, J
fresh air and out-door exercise, together with, in many cases, tha |
ad luiniat ration of auch remedies as cod-liver oil, potaBsiuoi iodide, •\
iron and (juinine, are of therapeutic importanoe.

NEW OBOWTHS. 193

State the object of local treatment.

The (l.stnidioii „r remov^il uf tlu^ dlsc^iwl (iwui.-.

What methods are commonly employed for the temovaj or
destraction of lupus tissue !
Cauterization, scarificutioii, craMion mid csciaion are varionaly

' practised ; the paitiMilar metluwl depending, io great n
the extent of the disease, the part involved, and other circumshmoes.

. Name the several oansticB, and state how they are employed.

Nitrate ofniher stick ; this is aripiienble tu small areas or discrete
1 lesionB, and is thiiroughly bored ioto the parts. The operation is
[ iep«at«d every several days.
13

IHSEASES UP THK SKIN.

J)frtigttiHr iirtW, tiaid aa an ointuient : —

B. Ar. pyrngallici, 3ij

Kiiiplast. plambi, ,^j

VvmL nwiuw. gv. M. '

It id upiitityl Kir one or two weeks. Every several days the parts are
poiiUiooil, itii' ttluu^h thus T«uioved, and the ointment reapplied, and
ni (II) nnlil thu diseased tissue has heen destroyed. It is asefiil in
thimi vnrva in which » mild and oomparatively paiuless caustao Is
•dviwtliliv
ArfntivM iteui, emiiloyed as a past«~

B . Ae. nnwuiud, gr. xx

l\\\v. aemi» 3j

Ai|nie, q. a. M.

Tt U |Ht]|)f\i) but ihnrough ; it is permitted to remain ou for twenty-
fhuT tu furt^-Wght huurs, uud the ports then poaltjcod until the

aaoiHBaitiiiNi

idiiiiKh ciinicN iiwny, iiftj^r wliieh ii »iiii]>le dressing is einployed. Its
•ppliimtiun is iidvittuliUi fur ii small urea only as absorption is pen- I
ublo.

Cliih'<nw-aiiutrr}/. — Tlio diseasitd tisnue ii destroyed bynumenKU i
puneturos with a mi-baited pniiit or by lini-iir iiiuifiiim with a red-
lii'iileil koili'. It i.-* iitV'ii (I iinn:tLi^bli- iiiid witisfiictury method.
Describe the operative meaanres employed in the removal of
Inpni tisane.

Linear Sciri/iciitirm.—TWa parts are thoroughly crosft-tracked,
cutting through the di«^ilaed tissue, and Rubae(|uently a simple snli-
eylated omtment apphed. The operation i» repeated from time to ]

NEW GROWTHS. 1Q5

lime, and as a result the new growth undergoes retrogresaiTe changes,
and cicatmatiun takes place.

PiiHc.tiite. ^eanjfcd/ion.^Byiueanspf a simple or multiple-pointed
instrument mmjeroua closely-set punctures are made, and repeated
from time to time, usually with the same action and result as from
linear seiirification.

Erosion. — ^The parts are thoroughly scraped with a curette, and a
supplementary caustic application made, cither with caustic potesh
or several days' use of the pyrogallic-acid ointment. The result is
usually satisfactory.

E^'-ciifioii. — This is an effectiye method if the disease consists of a
small poa- or bcau-sizcd circumscribed pat«h.

State the advantag:e8 of the methods of treatment by linear
and punctate Bcariflcation.

Healthy tissue is not aacrificed, and the resulting scars are usually
snioolh and least disfiguring. The same holds true, but to a much i
less extent, with the method by urasiou.

' Scrofoloderma.

What do you understand by scrofuloderma T

The tvrm s('ro('nlo<lerni.i it* iipjilli'd h.i tlmse peculiar suppurative
and ulcerative conditions of the akin occurring in strumous sulgeeta.

How does the common type of icrofoloderma beg^?

The most common tyiw of scrofbluos ulceration or involvementof
the skin usually results l^ estension from an underlying easeating
and suppurating lymphatic glaod ; or it may have its origin as sub-
cutaneous tubercles independently of these etmctures. It tends to
spread, iind may involve an area of one or several inches.

What are the clinical appearances and bebaTior of acrofa-
lous ulceration^
It is usually superticial, has thin, red, undermined edgeaof aviola-
oeous color, and an irregular base with granulations covered scantily
with pus. As a nilo, it spreads gradually as a simple nloeration,
with but slight, if any, uutlying iofiltratioo. Subjective pheii

rjSS U1fiK\SES OF THE SKIN. ^^^H

gf a painful or troublesome t^humuter are rarely present Its oonra^ |
IB usually progressive but abw and chronic.

Other symptoms of a scrofulous nature are commonly to be found.
State the etiology of sorofUoderma.

Heredity, insufficient and unwholesome food, impure air, and tbe
like, are predisposing. At present, a Bt>ecific baeillns (the tubercle
bacillus) is thought to be tLe immediate esciting cause.

Tliu disease usually appears ia cbildbood or early adult life, and
not infrequently follows in tlie wake of some severe systemic disease.
It is thought by some authorities to be identical ia nature with

lupus.

How is scrofuloderma to be differentiated from lupus vul^arla
and syphilis ?

By the pcculiur cliarjcter of the serofiilous ulceration, the absenoe
of outlying tubercles and infiltration, together with its history,
oourse. and often the presence of other stromous symptoms.
State the prognosis of scrofiilodenna.

It usually responds to appropriate measures of treatment. Ab *
rule, there ia but little, if any, tendency to spontaneous cure.
What is the treatment of scroModerma t

Constitutional remedies, such as cod -liver oil, iodide of iron or otltn
ferruginous tunics, togetherwith good food and puretur; calxsnt-
phurata, in one-tenth grain doses every three hours, and phosphonia
<me-hundredtb to one-fiftieth of a grain three times daily, ive kbo
of benefit in some cases.

The local tieatment consists in thorough curettiug and the sub-
sequent application of a mildly stimulating ointment. Tlie seron^
other plans of external treatment employed in lupus (9. r.) an ■

Jtesoribe alnhnm,

Ainhum is b disease of the African race, met with chiefly in

Braal, the Weft ludies, and Aiiica, and consists of a flow bat

gndnal linear strangulation of one or moiv of the toes, especially

. the smalLefet, resulting, eventoally, in spootuieona unpntation. ^nw

NEW (IHOWTITB.

affected toes themsotves undergo fatty degeneration, often with
increafc in size, and are, when BtraDgulatiun is well advanced, con- ,
sidenibly niisithapen. The nature of ttie disease is obscure.

Treatment eonaiats, in tbe early stages,
coDHtricting btuid ; wheu tlie disea^ is well
the sole recourse.

(.5'j""

of incisioii through the
advanced, amputation is

,».)

Describe podelcoma.

It ia a disease involving WBually the foot, and is met with chiefly in
India. It is eharacterized by swelling and the formation of tuber-
eular or nodular lesions whii^h hreidc down and form the esternal I
openings of Mnnses which lead to the interior of the affected part. |
These discharge, and are studded with, whitish gmuules or black, I
roe-like masses, mixed with a sanious or seru-purulcnt fluid. Tho
whole part is gradually disintegrated, the process lading indefinitely. '
Its nature is obscure ; it ia thought to be due to a fiingus.

TVeatment consists in the early stages, wheu the disease is lim-
ited, of thorough curetting and canteriialJon ; later, after the part '
is more or less involved, amputation, at a poiut well up beyond the
disease becomes oeceasary.

Perforating TJlcer of the Foot.

Sescribe perforating nicer of the foot.

Perforating ulcer of the loot is a rare disease, consisting of an
indolent and usually painless sinus leading down to diseased bone.
The external opening, which is through the ceutre of a corn-like
formation, is small, and may or may not show the presence of grann-
ladons. The affected part is commonly more or leea aniesthetio and
of subnormal temperature. One or several may be present, either
on one or both feet The most common site is over the articulation
of the metatarsal bone with the phalanx of the flrst or lust toe.
The disease is dependent upon impairment or degeneration of the
central, truncal or periphei^ nerves.

^ H

WhU b to W aii ia ngai4 to &• jmgooax and treatment 1

~' fists in the main-

K of antiseptic iiDd stimola-
> refOTted to, but even this is
t niwn the stamp.

SypUHs Cabueft.

STfUMmw^ Pin»rt«nyiihIK' : Sjphilif of (he Skin.)

IjfM Mkj qpphllii nanifett itwlf upon the

9j^>^ ■**?' ^>* ilsdf «s a RUKular, papular (rarely ve^cular),
IwntW. ImIWk. rnbMTttlar and ^mnuuoa^ eroptiou ; or tlie erup-
tion «M,v )>i\ in a iMiuauw, «t • gux«il type.

&I whM TMpcets d« the ecrly (or secondary) eraptions of

tjnihUi) (liftr froB tlioee following several years or

morv lifter the rontractioB of the duease t

■Hii' i-atlj- iir si^viDilsri" ■■wj'tinws are more or less geticrjiized, with

IW^'lj' wy uttompi xt s|>>.vi»l <\t(£jniradon. Their appearance ia

oApii i>t\Ywlrt1 % tE;mii>tiiiu3 of syt*WDic distariance, such as fever,

if ap)irtit(\ lutiJiraUr poina and headache ; and accompanied by

omminiitant rfuns uf the diK'a**, such as t-nlai^-tuent of the lym-

phalki frUniLs »iri> ilir>>a(. uiuixtus pHtcho^ billing of the hair and

rticninatici^ii.-i.

State the distingoishing oharaoters of the late eraptions.
L The laUi cniptiimH (tlioao fiilkiwing one or more years after the
Roontraotion of the diseimi') are nswUly of tubercular, ^nunatoas or
P vloeiativc typo ; am limitt^ in extent, and have a markt.>d tenden^

to appFAT in circular, somicircular or cresccntic forms or groupB,

I^iniu the bones, bone lesions and other ^ijpmptonis uiiiy or may Dot

be present

What is the color of syphilitic lesions 1

Usually, a dull browiiisb-red or bam-reJ, witL iit times a yellowish

NEW GHOWTTia. 199

Are there any snbjeotive symptoms in syphilitic ernptions?

As a rule, no ; but in eseoptional instances uf the generaliaed
eruptions, more eBpeciolly in negroes, there mny be slight itching.

Describe the macular, or erythematous, eruption of lyphiliB.

The macular grfpkihdenn in a general eruption, sbowing ilaelf
iisuiilly sis or eight weeks ailet the appearance of the chancre. It
consists of small or large, commonly x>ea- or beuu-eized, rounded or
irregulorly-Bhaped, not infrequently aligbtly raised, maeulcB. When
Wfll established thej do not entirely disappear under preasare. At
first a pale-pink or dull, violaceous red, they later become yellowish
or coppery. The eruption is generally profuse ; the face, backs of the
hands and feet may escape. It persiBta several weeks or one or two
months \ as a rule, it is rapidly responsive to treatment.

How would yon digtingulBh the maoolar syphiloderm from
measles, rdtheln and tinea versicolor ?

Mca.'iU'S is to b(! diffcninti^itod by its catiirrlutl symptoms, fever,
form and situation uf the eruption ; rotheln, by its small, roundish,
confiuent pinkish or reddish patches, its precursory pyrexic symp-
toms, its epidemic nature, and short duration ; tinea versicolor by
its Hualiness, peripheral growth, distribution uud history.

And, finally, by the absence or presence of other symptoms of
syphilis.

What several varieties of the papnlar emption of Byphilis are
met with %

There are two forms of the papular eruption — the small and large ;
thoso of the latter type may undergo various modifications.

Sesoribe the small-papnlar eruption of Byphilis,

The tmaU-pajudar sj/phihderni (jnilinry ynpidar sypJiSoderm)
usually shows itself in the third or foorth month of the disease, and
stsof a more or less generalized eruption of disseminated or
grouped, firm, rounded or acuminated pin-head to millet-seed-ai»ed
papules, with smooth or slightly scaly sunimits, and in some lesions
showing pointed pustulation. Scattered minute pustules and some
large papnl»« are usually present. The eruption is profiiso, most abun-
dant uiKiu the trunk and hmbs ; and in the early part of the out-
break is of a bright- or dull-rod color, later assuming a violaceous or

0>iiii(ti>it tmu lit L'lilaoMiaa ^iitAu if l — i a g wmIj- ■■ the fint
•t^ Mr niiflu iu(i|i(Im>, awl nunwrti cf » mtn <r ii» fti«» iKw. i erap-

|i>iii iif |H!4- t« tliiiio-kiEucl or brger; la^ kvhM w mal, fiimly^
ItJUtcU, luitn: i>r|twti rnJM'il, (luR-redp^idM; viikM itsiaamooth

furfiuu, wliicLi \nU:f iiHimlly luxtuines corend vilh > filn of exfbliai-
tiliK i^iiiiluriiiiiL 'fll" I'Uliltluo, m a rule, derrkf ^lovijr. i«iaaio sta-
^iinury wiVi'iul Wtn!^ iir u Tuw itinntha, and ibco )ia^ ttway by
Hbetiriiliiiii, luuviiig alitilil |ii^iiimiUliiin, which gradiMlly Ikdes; or
tlicj limy uiulurgu mrUilli luiitliliiiHtliiiw. Id mast uascs it responds
ruiiiilly U) iruauiktiiith

Vliat modifications do the papules of tlie large-papular sypM-

loderm sometimes undergo?

They may uliauge into llu; minst ])apule and s(|iiaiuou.s papiilii.
Describe the moist papule of syphilis.

The change into the niuist papnle (aJso called mvcoiit pattA, Jlat
condylmna) is not uiiLonimon whire uppoamg Buri'cices and natural
folds of skm are snb)ected to mjre or less contact, ns about the
uiiteB, the Hcriito femoraJ regions umbiUcu'f asillse and beneath the
aiammse. The drj flit papules graloallv beeonii: nioiat and cov-
ered with a grayiah BticLy mucoid Betretion aeveml may uoalesce
aiid form large flat patches. They may bo remain, or they may
become hypertrophic warty or papillomatous with more or less crust
formation {veQelntmg nyphdodemi)

Sjvhilodorai {AfUT Eega '_

Sesoribe the sqnamoas papule of syphilis.

Thia tendency of the large-papular eruption to become scaly, when
exhibited, is more or less conunun to all papules, and constitutes the
fqiiamout or papulo-sqiiamoiis typhiloderm (improperly called jwo-
rinsit syphilitica). The papules become somewhat flattened and are
covered with diy, grayish or dirty-gray, somewhat adherent scales.
The scaling, as compared to that of psoriafiis, i^, as a rule, relatively
slight. The eruption may be general, as usually the case in the
earlier mouths of the disease, or it may appear as a relapse or a
I later manifestation, and be limited iu extent.

As a limited eraptiou it is most frequently seen on the palms and

200

DISEASES OF THE S

browiiiah tint. It. runs a elimnn; (wurKe, ia somewhat rebellioi

treatment, and displays a. tc'iideni^y to n>liiji!-L'.

How would 7011 distinipiiBh the small-papular syphiloderm

from keratosis pilaris, psoriasis ptmctata, papnlar ec- _

zema, and liolieii rabei 1
The distrihutioD and estjsut of the eruption, the color
ing, with usually the presence of pustules and large papules s
other eonoomitant symptoms of syphilis, are points of difierenoe
Postvdes never occur in the ai

Deioribe the large-papular emptioii of syphilis.

The laTge-pnpiihir xyphiloderm (or lenticular syph
common form of cutaneous sj'philis, appearing usually in the fint
six or eight months, and consista of a more or less generalized erup-
tion of pea- to dime-sized or larger, flat, rounded or oval, firmly-
seated, more or less raised, dull-red papules ; with at first a. smooth
suriace, whieh later usually becomes covered with a film of exfoUa- j
ting epidermis. The papules, as a rule, develop slowly, remain bI
tionaiy several weeks or a few months, and then pass away hy {
absorption, leaving slight pigmentation, which gradually fades ;
they may undergo certain modifications. In most cases it responds 1
lapid^ to treatment.

I lie

ofk-i

ivWIIous t<i t

"■ ^j/phSmierm. Ofcurring c
(-■atiueiit.

How are yon to disting^nish the papnlo-squamouB syphilodei
from psoriasis?
In psoria'us the eruptioii ia more iuflammatory, aad usually bright
red; thescaleswhitiBhorpearl-coloredand aaarule, abandant, Itis
generally seen in greater pnifuaon upon certain parts, as, for instaoce,
the esteDsur surfaces, especully uf the elbows and knees. Xt i|
not infrequently itchy, and, moreover, presents a different histoi;,. ]

In the syphilitic truption some of the papules almost inTBriaUrJ
remain perfectly iiee fnim any t<'ndene\ to stale formation ; there bJ
distinct deposit or infiltration, and the lesions are of a dark, slu|
red or ham tint ; and, moreover, concomitant symptoma of sy
are usually present.
Describe the annular eraption of gyphilis,

The annular injphUmierm (circmale Kj/philidfmi) is ohser^-ed usr
ally in association with the large-papular eniptton, and consists o

NEW mlOWTHS. 203

several or moreTttriously-BJKed, ring-like leaiona, witli u distinctly
elevated Bulid riJge or wall peripherally and a more or leas flattened
centre. It ia commonly seen about the mouth, forehead and neck.
The lesion appears to have ita origin from an ordinary, usually eoale-
lesa or slightly scaly, large papule, the central portion uf which has
been incompletely formed or has become sunken and flattened. The
manifestation ia rare, and is seen moat frequently ia the negro.

What several varieties of tbe pustular Byphiloderm are met
with?
Thcsiuatl a(juiuiriiitod-pustuLiray|iliiliideriu, thckrgcaeuiuinated-
pustulikr syjihilodenn, the small flat-pu;^tular s,v|ihilo<lerm, and the
large flat-pustukr sypliiloderm.

Describe the small acnmiiiated-paBtnlar eruption of syphilia.

The sntali aaimmatcd-puxtular iyphtlnderm {ftiiliary pustular
^/phUoderm) is an early or late secondary eruption, commonly en-
countered in the first six or eight months of the disease. It ooa-
mts of a more or leaa generaliaed, disseminated or grouped, millet-
seed-HiKed, acuminated pustules, nguidly seated upon dull-red,
papular elevations. The eruption is, as n rule, profuse, and usu-
ally involves the hair-follicles. The pustules dry to crusts, which
fall ofl" and are often followed by a (Jight, fringe-like exfoliation
around the base, constituting a grayish ring or collar. Minute pin-
point atrophic depresMons or stwns are left, which gradually become
less distinct. Scattered large pustules, and sometimes papules, are
not infror|uently i.ircacnt.

Describe the large acnmlnated-pustular eruption of syphiliB.

The large ncuminnled-piatiilar stjphiloilenn (fume-fomi lOfphUo-
derm, varwUi-firrm in/philoderm) is a more or less generalized erap-
tion, occurring nenolly in tlie &st six or eight months of the diseaae.
It consiste of smalt or large pea-sized, disseminated or grouped,
acuminated or rounded pustules, resembling the lesions of acne and
variola. They develop slowly or rapidly, and at first may appear
more or less papular. They dry to somewhat thick crusts, and are
seated upon superficially ulcerated bases.

It pursues, as a rule, a comparatively rapid and benign course.
In relapses the eruption is usually more or lees localiuMl.

204 DISKASES liF THE SKIN.

How would yon distingnish the large acununated-pustiili
Byphilodenn from acne and variola }

In acne the usual limitation nf the lesions to the face or face and
shoulders, the origin, more nipid formation and evolution of the
individual Icaons, uad the chrouic character of the disease, b^h
usuully distinctive points. ^M

lu variola, the intensit; of the general ^mptoms, the shot-l^H
beginning of the let^ona, their uooiee, the umbilication, and ^^M
definite duration, are to be wnsidered. ^M

The presence or absence of other symptoms of syphilis has, ifl
obscure cases, an important diagnostic bearing. fl

Describe tbe small flat-piuttilftr eraption of sypbilifl. fl

The siuaU Jlat-piisiiilar siff)li3adenn {impcligo-form, stfpJulodenn^
consists of Oi more uT less gene nilizeti, [lea-sized, fiatorraised, discrelaH
irregularly-grouped, or in places confluent, pnstales, appearing usuaMH
in the first year of the disease. The imatnlea dry rapidly to yelIoi^|
greenish-yellow, or brownish, more or less adherent, thick, iineTariH
somewhat granular crusts, beneath which there may be aaperficial ^H
deep ulceration ; where the lesions arc confluent a continuoua sha^H
of crusting forms. The erupljoa is often scanty. It ts most £i^H
quentJy observed about the nose, mouth, hairy parts of the &ce aD^|
scalp, and about the genitalia, fret^uently in ussociatiou with papukaB
on other parts. S

Are you likely to mistake the small flat-pustular gypMtflM
derm fbr any other eruption } ^|

Scarcely ; but when upou the scalp, it may hear rough resei^H
bknce to pustular eczema, but the erosion or ulceration will serre t^|
differentiate. Moreover, concomitant sym]itoni.s of syphilis are t|H
he looke<l for. H

Describe the large flat-pustnlar eruption of syphilis. 9

The large Jlat-pvMul(ir syphilodcrm (fcdiyma-forni syphihdtnig^k
conusts of a more or less generalized, scattered eruption, of Ui|d^|
pea- or dime-Mzed, flat pustules. They dry rapidly to crasts, T^^|
bases of the lesions are a deop-red or copper color. Two types li^H
the eruption are met with. ^H

In one type — the superficial variety— the cnwt is flat, rounded <]^|
ovalisb, of a yellowish -brown or dark-browQ color, and seated npg|^|

a, Bnpeificiftl ertiaon or ulcer. The Icalons are usually n

and most abnndiiiit on the bock, shuulders and extremities. It

appears, as a rule, withia the first year, and generally rami a benign

In the other type— the deep variety— the crusfc is greenish or
blackish, is raised and more bulky, oA«n conicul and stratified, like
an oyster shell — riipia; beneath the crusts may he seen rounded
or irregular-shaped ulcers, having a greenish -yellow, puriform secre-
tion. It is usually a late and malignant manifestation.

BnpU. {AJIer Tatury Ita. )

fowwould yon differentiate the large flat-pnstnlar syphilo-
denn fiom ecthyma!

syphilitic lesions are more numerous, are Bta-ttcred, are

attended with Kniiurficia! or duep nlceratimi, and followed by more
scar-formation. Moreover, the histoty, and presence or
of other symptoms of syphilis have an important diagnostic

nlue.

Seaoribe the bulloiu eruption of syphilis.

Tlio hiilhiiis infpltil'idfrm (iif ai*|uired syphilis) is a rare and

mtftUy Ute eruption, itppearing in the fonu of discrete, disseminated,

206 DISF.ASES OF TRK SKIN.

rounded or oralish, pea- to walnat'Sized, putial^ or fall; distonded,
blebs. The seroua eontente soon become doody and pnriform. In
some cases the lesions are distinctly pustular ftom the beginning.
The crust, which Boon fonns, is of a yellowish-brown or dark green
color, and may be thick and stratified {rttpii), ae in the deep variety
of the large flat-pustalar syphiloderm. The erosions or ulL-ata be-
neath the crusts secrete a greenish-yellow fluid. Itis a malignant
type of eruption, and is uauitlly seen in broken-down subjects. J

It is not an uncommon manifestation of hereditary G3q)hilis (q. tvjl
in the newborn. ^

How is the bnlloua sypMloderm to be differentiated from

other pemphigoid emptionB 1
By the griivity of tho iJlsea-so, the accompanying ulccnitioii, the
course anil history ; and by other evidentes, [iList or present, of
syphilis.

Describe the tnberciilar eiuption of syphilis.

The tuhfTCular syphilnderm (sypkiloderma tiibcrculosttm) may a
ceptionally uumr within the first year as a more or less gene
ernption. As a rule, however, it is a late manifestation, at t
appearing many years afler the initial lesion; is limited ii
and shows a decided tendency to occur in groups, often forming s(
ments of circles.

It consists (as a late, limited manifestation) of several or i
firm, rarcumscribed, deeply-sealed, smooth, glistening c
scaly elevations ; rounded or acuminated in shape, of a yeliowidi'4<
brownish-red or coppery color and usually of the mze of B
large peas. Several groups may coalesce, and a serpif^noa
result (ncrpifflnoaa tuhnreiil'ir syphiloderm). The lemons d
slowly, and are sluggish in their conree, remaining, at times, t<x Ti
or months, with but little change. As a rule, however, they t^
nate sooner or later, cither by absorption, leaving n
permanent pigment stain with or without sligbtatropby (im
ting tubercular nyjihlnderm), or by ulceration (vkeraling tvie
lar ej/phikiderm).

Describe the ulceratini^ tubercular syphilodemi.
Tile nlceruliun may be nuiwrficia] ur deep in cliar^icttr

^.^

NEW GBOITTHS. 207

weral ov all of the leaons forming the group. The patch mi^
^' ODuaist, therefore, of small, discrete, punched-out ulcers, or of one
a continuous ulcers, segmental, creaeentic or serpiginous in
I'fihape. ITiey are covered with a gummy, grayish -yellow deposit or
I tiiey may be crusted. As the ulcerative changes take place, now
i, especially about the periphery of the group or patch, may
I Appear from time to time.

instanoes, more especially about the scalp, the surface of
I the ulcerations becomes papillary or ■wart-like, with an offensive, ycl-
k-lowish, puriforui secretion {gjfftkHit cutanea papiBomatosa).

■jphiloA^rlb. (AJtpr Kr^ya.)

I I^m what diseases is the tubercular sypMloderm to be
differentiated T
■'mm tubercular k^pposy. e|)itlii:liijma and lupus nilgiiris, i'Si)etiaJly
tlie last-nanied.
What are the chief diagnostic characters of the tubercolai

Isyphilodemi 1
The tendency to form sogments, crescents and drdea, the color,
the pigmentation and uWnition, the history, and not infiequently
Biarka or scare of former eruptions.

208 DISIiHSES op TIIE SKIN.

SeBcribe the panuiiatoiis eruption of syphilis.

The guminatmui si/philo<Jerm (sjpAifoderma gummatosuTn, gvfn- 1
via, gypliUoaui) is usuallj a late uanifestation, showing itself af
several or more painless (ir slightly painful, ronnded or flat, mc
less circumscribed tumors ; they are slightly rMsed, moderately firm,
and have their seat in the subcutaneous tissue. They t«nd to break
down and ulcerate.

The lesion begins usually as a pea-aized deposit or intiltratioi
grows slowly or rapidly ; when fiilly developed it may be the size of |

Oummau. {AfUr Jullfen.)

a walnut, or even larger. . The overlying skin becomes gradnally
reddish. At first firm, it is later soft and doughy. It may, even
when well advanced, disappear by absorption, but usually t«nds to
break down, termiii;itiiig in a small or large, deep, punchiKl-uut uloer.

Does the gammatooa syphiloderm invariably appear a« a
roimded well-defined tumor !

No. Eiceptionally, instead of a well-defioed tumor, it may ap-
pear as a more or less diffused pat4!h of infiltration, leading eventa-
ally to extensive Buperficial or deep ukeratJoa.

7 GEIOWTHS.

209

From what formations is the giimmatonB syphiloderm to be
differentiated ?
From fiirunele, abacess, and aebaceoup, fatty and fibroid tiimorB.
Attention to the origin, cijurse, and beliavior of tlie lesion, to-
gether with a lii.4or.v, must all bf tou.sidiTed in Joiibtftil cases.
What is to be said in regard to the character and time of
appearance of the cutaneous manifestations of heredi-
tary syphilis T
In B. groat nieasnre tbp cutaneous manifestations of hereditary
syphilis are essentially the same as observed in acquired syphilis.
They are usually noted to occur within the iist three months of
eitra-uteriiie life. The macular, papular, and bullous eruptions

Sescrlbe these several cutaneoas manifestations of hereditary
syphilis.

The macid'ir (erythemat*>us) eruption begins as large or small,
blights or dark-red macules, later presenting a. ham or caf£-au-lait
appearance. At first they disappear upon preamirc The lesions are
more or less numerous, usually become confluent, especially about
the folds of the neck, about the genitalia aud buttocks ; in these
regions resembling somewhat erythema intertrigo.

The papular eruption is observed in conjunction with the eiythe-
matous manifestation, or it occurs alona The lesions are but slightly
elevated, and seem to partake of the nature of both macules and
papules. They are usually discrete, and rarely abundant ; they may
become decked with a film-like scale, and at the various points of
junction of skin and mucous membrane, aud in the folds, they
become abraded and macerated, developing into moist papula.

The buBiiwi eruption consista of variously-sized, more or less puru-
lent blebs, and is usually met with at or immediatuly following
birth. It is most abundant about the hands and feet Macules and
[lapules are oftun interspersed. There may bo superficial or deep
ulceration underlying the bullaj.

What other symptoms in addition to the cntaneoas manifest
tations are noted in hereditary syphilis in the new-
bom 1

Mucous patches, and sometimes ulcers, in the mouth and throat ;
14

hoarseness, aa shown by the pficnliar try, and iudlcnting iDTolve-
ment of the laryni ; i^nuffles, u shIIuw and illrty appearance of the
Bkin, los) uf flesh and often a afariveled or Bcnile luuk.

What ii the pathology of cataneoos syphilis ?

The syphilitic deposit consists of round-cell infiltrati
mucous layer, the corium, and in the deep lesions the subcutaneous
ooDiiecliTe tissues also, are inyolyed in the pnx'css. The iufiltration

difiappears by absorptiun or uloenition.
Give the prog^iosis of CDtaneons sypMllE.

In acquired gyiihUa, f'avoruble ; sooult or later, unless the whole
gystem is so profoundly affected by the ^qthilitic poison that a &tal
ending ensues, the cutaneous manifestations disappear, either spon-
taneously or as the result of treatment. The earlier eruptions wiH
often pass away without luedicutioD, but treatment is of material
aid in moderating their severity and hastening their disapijearance,
and is to be looked upon as essential ; in the late syjibilodeimata
treatment is indispensable. In the large pustular, the tubercotar
and gummatous lesions, considerable destraetion of tissue may take
place, aud in consequence scarring result 111 health &om any eaase
predisposes to a relapse.

In hereditary iafanlile siipkilis, the prognosis is always nocertaln :
the more distant from the time of birth the manifestations appear
the more favorable usually is the outcome.
How IB cutaneous aypMliB to be treated 7

Always with constitutional remedies ; and in 1
and espttially in those more or les
also.

What constitutional and local remedies are commonly em-
ployed in cutaneous syphilis ?

Ci'iiftitiilMiKil RKmi-iliis. — Miiri'ury ;md potii.ssimu iodide; tonics
and nutrients are necessary io some eases.

Load Remtdies. — Mensurial ointments, lotions and hiths, and
iodol in ointment or io (and also calomel) powder form.
Give the constitutional treatment of the earlier, or secondary,
eruptions of syphilis.

In setoudary or early L'lTiptious mereury alone in almost every

n the graver emptioaa,
., with local applieatioDS

NEW UROnTIIS. 211

ease ; with tonics, if nailed fi>r. If mercury is coutraiudirated
(extremely rare), potassium iodide may be substituteil.

How is mercnry aBUail^ adminlBtered in the eruptions of sec-
oodary syphilis ?

By the mouth, chiefly sh the protiodide, calomel aud blue maas,

ID dosage just short of mild physiological action ; by inunction, in

the form of blue ointment; by hj/podermic injrctiim, usually as

B Bublimate Bulutiun ; and hy Jkm^ation, with calomel aod

. the bisalphuret.

The method by the mouth ia the common one, and it is only in
rare instances that any other method is necessary or adyisahle.

What local applications are usually advised in the emptionB
of secondary syphilis?
If the eruption is extensive, und more e«4pecially in the pnstukc
I types, baths of corrosive sublimate (3ii-3iv to Cong, xsi) may be
L used ; and ointment of ammoniated mercury, twenty t« aixty grains
I to the ounce, blue ointment, and the t«n per cent uleate of mercury
I alone or with an equal quantity of any ointment base.

The same applications or a dusting powder of calomel may also be
used on moist papules.

How long is mercury to be actively continued in cases of
early (secondary) syphilis 1

Until one or two months after all manifeatationa (cutaneous or
other) have disaitpeared, and then, as a general rule, continued, as
a small daily dose, for one to two years — unless there should be some
oon tmindication.

(Almost all authorities arc agreed as to the importance of pro-
longed treatment, but differ somewhat on the question of intermittent
or unintermpted administration. )

(Jive the oonstitational treatment of the late, or localized,

Byphilodermata.
Mercury always, usually in small or moderate ilocjige, as the binio-
I dide or corrosive chloride, and potassium iodide ; the latttr in dose
I varying from two grains to two drachms or more, L d., depending
r UpuD its action and the urgenqy of the case.

aia PISKASKS OK TllK aKI.N. I

Bow long is constitutional treatment to be contlnoed in cam 1
of th« late sjrphUodennata ? i

Ailii-1'l.v tor wvimil w.fks nftcr l!ie diuappearauce of aJl symptama, I
ttiiil tlioii (t-siHviiilh' t lie uien-ury) oiiiitinueJ iii siuailer dosage (about J
...1,. tliinll i;.r on,' o.- in,, months limgor, I

What applirations are usually advised in the late, or localized, I
•yphilodermata t J

OitiUiu'iil i»f ■uiiiioiiiiitiHl uit'niiry, twenty tn mxty grains to thel
HHtiiv ; <i\^K« of niowuij. five to ten per cent, strength ; niercuridj
liliuaiT, 1\ill »tn>tkgth or weskeoed with lard or petroktunt ; a two tofl
Iwvuly |M'r tviit. uiiitinoiit of iudul ; resorcin, twenty to eisty graioKl
|« till' oum* of raiilUH'iit hase ; aiid-lotioDS of corrosive sublimate, ■
tuw-hxlf to lliiw iir^ta to the ounw. I

11w fiiUiiwitgi iii VNhuthlu hi uHen^ye aud obstinate ulcerationa : — I

H. Hjilmn. phlortd, corpos., gr. iv-gr. riy I

Kw wrUilii-S gr. x-xx I

AI«.tK>H>i. fgiv I

(Jljfoi'din' rgj I

Aini» ij. s. nd 5 iv, M. I

OtiitliioUiN (U1I t<> Ui rulibtxl ill or applied an a plaster ; lotions, ein-
IJuj^hI t<llil^HJ- in iilww niid ulwnitiona, are to be thoroughly dabbed
lilt, nm) UMIMlly MupplonnMitiyl by the application of an ointment.
IimIiiI limy nki Ui iijiplii'd to uWta im a ilustiug-powder, osually
Uiiicoil wllli I'll" to wvi'iiil )Hirlt< of vine oxiilc or lK>ric acid.
Qiv« the treatment of her«ditat7 infantile syphilis.

It In iiiMoutiu11,v ihti Hunu' (Uit miu'h siuiiUer dosage) as emploTed J
III iKHiulrud Nyphilk Alt«'iilioii to pro|«r feeding and hygiene is of J
flwt ImiHirtjiiicv.

Mercury may bo giwn by the mouth, na mcrcuiy with cl
(ill'. M-iti'' li< t. d.); HHnitiiniel {gr. ^<|-gr. i, t.d.); and asasdutiMi I
of wirrodive fluMinial<j Ot"'' «s-SvJi 3j, l.d.). If mercury is not irdl 1
borne Uy Ihn Hlnmach, it may be adiiiinist«rod by inunction ; for Hiifi 2
puriniNc, bhie olntuicnt ia mixed witli one or two parts of lard and J
spread (about a dnkehm) n[ton an abdominal bandage and applied, i
bding roncwed daily. Treatment by means of hatha (gr. x-ssz to J
the bath) of corroslvu sublimate is, at times, a serrioeable method.

NEW llRnwTHS. 213

ilide, if eiteptioniUly deemed preferable, may be gii
in the doBO of a frftctiotml part uf u grain to two or three grains three
times dally.

What local measures are to be advised in cutaneous syphilis
of tlie newborn^
H' demuiided, appliPul.ionH siuiilar tn thnsi- enipilnyi'd in emptiaiis
of aci|Qired syphilis, hut not more than uiie-third tu one-half the
Htrength.

Lepra.

(S^no^jw. : Leprosy i Elcphantmds OrlBeonim.)

Wliat do you imderstajid by lepiosy ?

Lepra, or leprosy, ig tin endemic, chninii;, malignant constitutional
disease, characterized by alterations in the cutaneous, neire, s
bone stmctares ; varying in its morbid manifestutiunH according to
whether the skin, nerves or other tissues are predominantly involTed.
What is the nature of the premonitory eyutptomB of leprosy!

Ill some iiiiitances the active nianifestjitions appear without pre-
monition, hut iu the m^ori^ of eases symptoms, slight or severe
in character, pointing toward profouud constitutional disturbance,
such as mental depression, malaise, cbills, febrile attacks, digestive
derangements and bone pains, are noticed for weeks, months, or
several years preceding the outbreak.
What several varieties of leprosy are observed t

Two definite forma ai'c usually described — tlie tubercular iind tbe
anesthetic. A sharp division-line cannot, however, always lie
drawn ; not infrequently the manifestations are of a mixed type,
or one form may puss into or gradually present sympUims of the

Describe the symptoms of tubercular leprosy.

The foi'matioii of tubercles and (ubereukr masses of iiifiltratinn,
usually of a yellowish -brown color, with subso(|uent ulceration,
constitute the imjiortant cutaneous symptoms. Along witli, or pre-
ceding these characteiistio lemons, blebs and more or less infiltrated,
hyi>erffisthetic or anesthetic, pinkish, reddish or pale-yellovish

^^^ uauaij.

^^L cunstil

^^m oedine

^^H hyi>en

TUbttnilw Ui-nar. t^In- .Inf.font.

DsRoribe the sjmptoma of aniMthetio leprosy.

Ki'lliiwiiiK iir iiliiim willi (iftviirwiry fympttJins denoting general
iyateRiic ilisturbuiuw, ur M»lo|it<Liiifiilly »f uny iirodrumol indications,
a hyi>enefltUetic oondiliuii, in Uxiilixuil urmui or nior« or \sm geueni, i
iiobAorr^HJ. Limrinating puinH ulnng llie nerves aitd &d iiregnlar
peraphijj;Did t^niption iire alao common]; noted. There soon folluwa I
tilt! Hiiuuial entiitiiJti, eorolDg out Irom time to time, and coneisting
of wvciul or more, nsaiiilj' uou-elevatod, wcU-definod. pale-yclWieh
patches, one or two inches in diumeter. As a rule, they are &t fi

NEW OROn-THS.

215

nather hypenesthetic Dor amesthetic, but raay be the seat of slight
bumiDg or itching. Thej spread peripherally, and tcud to clear in
the »«ntre. The jwtohes eventually become markedly anajsthelie,
and tile overlyiog akin, and the skin on other paits as well, becomes
atrophic and of a browniali or yellowish color. The Hubcutaneous
tissues, muHcle, hair and nails undergo atrophic or degenerative

kdianges, and these changes are especially noted about the hands and
These pait« become crooked, the bone tissues are involved,

*- the phalangea droppiDjE off or disappearing, by disintegration or
ab»)Tption (Itjira miililnns). Sooner or later various paralytic
qrniptoms, showing more a^-tive involvement of the nerve tranks,
preaeut tbeuselves.

I state the cause of leprosy,

Prestiut kiiuwledge points to a peculiar bacillus aa the active factor,
I vbile uliniatt', soil, heredity, food and habits exert a. predisposinK
iDfluence.

Is leprosy contagions?

It in pnibuiiiy ciiiitagionH in the senBii that sjphilia is — by iDucala-

What are the pathological changes f

Tlie lesions consist essentially of a new growth, made op of
nunierous small, more or less aggregated round cellu, beg-jiiDiag ia
the wiiUa of the bloodvessels. In this way the tubercular viaSBa
anU Vftrioua other lesions are formed. As yet, positive iuvolvement
of the central ncrvoua syat«ni has not been shown, but some. of the
nerve trunks are found to bn iaflauied and swollen, with a, tendency
toward hardcuing.

What several diseases are to be eliminated in the diagnosis
of leprosy?

Syphilis, morphoea, vitiligo and lupus. {

Wheu well advanced, the aggregate symptoms of leprosy form * <
picture which can scarcely be confused with that of any other dis-
ease- In doubtful cases microscopical examinations of the involved
tissues, for the bacilli, should be made.

State the prognosis of leprosy.

Unfavorable; a fatal termination is almost invariable, but may not
be reached for a number of years. The tubercular form is the most
grave, the mixed variety next, and the anit'stlietic the least Pa-
tients are not iufronuciitly ctiiTiwl off by intt^rcurrent disease. Proper
treatment will often delay the fatal ending.

What is the treatment of leprosy ?

Hygienic measures are impoitant. Chaulmoo^.i oil and gurjan
oil internally and eitemally, are in some instances of service.
Strychnia alone, or with either of these oils, is ofttimes bcneliuBl.
lubtbyot internally, and external apphcation of the same drugv
and of resordn, chrysarobin, and pyrogallio acid have been extolled.

NEW GEOWTHS. S

Pellagra.

{Ss»o")m ; Luuibardiaii Lpproay.)

Describe pellagra.

Pellafn'^ ^ "■ ^1"" '>"'' usually pragreseive disease occurring cliie%
ta lUily, iluv, it ia thought, to the continued ingestion of decom-
posed or fermented maize. It is characteriaed by cutaneoua symp-
toms, at first upon exposed parts, of an eiTthemiitoua, desquamative,
veaiimlar and bulloOB character, and by general constitutional dis-
turbance of a markedly neurotic type. A fatal ending, if the dis-
ease ia at all severe or advanced, is to be espccted.

Treatment is based upon general principlea.

Epithelioma.

{f!g«onif^i. .■ Skin Cancel ; Epilhclial Cancer; CBrcinoma Epilhelialo.)

What several varieties of epithelioma are met with?

—tilt; hu[)erUeial, tliu Juop-soati?d, ami tlif pLijiillumMttnLS.

Describe the clinical appearances and course of the superficial
variety of epithelioma.

Till) Buperficial, or fiat variety (ruiitnt vlcer), begins, usually on
the face, as a minute, firm, reddish or yellowish tubercle, as an
aggregation of such, as a warty excreacenec, or as a localized degen-
!- erative soboti'hffiic pat^^h. Sooner or later, commonly atWr montha
I or sevcnil years, the surface becoiuea slightly excoriated, and an iu-
it, yellowish or brownish crust is formed. The excoriation
gradually develops into Bupeificia! ulceration, and the diseased area
becomes slowly larger aud larger. New lesions may cmtinue, from
time to time, to appear about the edges aud go through the same
changes.

Tlie ulcer haa usually an uneven surface, Booretes a thin, scanty,
viscid fluid, which dries to a firm, adherent crust It is usually
iM defined against the healthy skin by u slightly devutcd, hard, roll-like,
K wosy-louking border. In rare instaoccs there is a dispomtiun, at
^^ points, ti) BpoDtaneous ioTolution aud scar formation ; as a rule,
^A however, the ulcerative action slowly progresses.

:;iS DISEASES OF THE SKIN.

Tlio ei'K'i^ iitjJlh i8 uuimpair«l, the Dei^hboring lyinplu^ '
sImmIs are uiA involved, and the local condition, bt«foR<] tbe disEi- I
utvuiviit, (livis rise to little trouble, unless, as occasionally Imjipe*
it p*i«« iiitii tlnj iuoTC lUiiligiiiiiit, deep-seated variety.

Desoribe tbe clinical sppesrances and coorHe of the deep-
seated variety of epithelioma.

TlnM!i4..!>-H'ul.iiv:irii-ly>1;irU from the superficial fomi, <ir ttlipgins
Ml n luU'n'lo ,ir ikuliiW ill tlio Kkiii, Whon typiaiUy developed.

Gpltlidloiiift. (jjWaXfvii.)

a rcddisli, shining tubercle or noJulc, or iirei of infiltration, form* '
in tbo Hkin or Milieutonceua ti^iic. In the ceurse of weeks or
niontbti HUiHirAuiol or dtHip-aeated ulueratioa toketi place ; the aleer
haviug hardened, and, aa a rule, everted edgea. The suHaee is red-
disb and granular, nnd Becrutes an iehorous discharge. The i
tration epreads, the uleor enUrgea both peripherally and in depl
mUDolc, cartilage and bone ofk'n becuming inviided. The neighbo

g lyiophatio gloads arc finally implicated, pains of a bnniing or
milgic type ure especieiipeil, and fmm septiwetoia, marasmus or
nvolvement of yilal parts, death cveutually eusuea.

Describe the clinical appearances and conrse of the papillo-

matons variety of epithelioma.

The pa]iilliiiuut«iLS ty\i<i usu;illy arises fi'oiu Ihe superficial or
deep-f«at«d varietj, or it may begin a-s a papillaiy or warty growth.
When fiiUy developed, it presents an uleerattid, fissured and papillo-
matoua surface, with an ichorous di^harge which dries to crusts.
It is slowly progressive, and Booner or later may derelop a malignant
tendency.
TTpon what parts is epithelioma commonly observed?

AkiUt tlie face, es|)ei:ially the nose, eyelids and lips ; and also
about the genitalia. It may involve any part.

At what age is epithelioma usually noted?

It is csMcutially a diswLse of middle and lale life, although it is
exception ally met with in the young.

What is the cause of epithelioma T

The etiology is obscure. It is not, as a rule, inherited. Any
locally irritated tissue may be the starting point of the disease.

State the pathology.

The process consists in the proliferation of epithelial cells from
the mucons layer ; the cell-growth takes place downward, iu the
form of fiuger-Iike prolongations or columns, or it may spread
out laterally, so as to form rounded masses, the centres of which
usually undergo buniy transformation, resulting in the formation
of onion-like bodies, the so-called cell-nesbi or globes. The rapid
cell-growth requires increased nutriment, and hence the bloodvessels
become enlarged ; moreover, the pressure of the cell-masses gives
rise to irritation and iiiflaiomation, with corresponding serous and
round-cell infill rati on.

How wonld you distinguish epithelioma from syphilitic
ulceration, wart, and lupus vulgaris 1

From syphilis it is to be difTerentiated by the history, duration,
character of the base and edges, its comparative slow progress, its

220 DISEASES OF THE SKIN.

usually slight, viscid discharge, often streaked with blood, and, if
nei»ossary, by the therapeutic test

Wart or warty growtlis are to be differentiated by attention to tiidr
history and course. Long-continued observation may be neoessaiy
before a jx>sitive opinion is warrantable. The appearance of any
ti*ndency to crusting, to break down or ulcerate is significant of ejH-
tholiouiatous degeneration.

In lupus vulgaris the deposits are peculiar and multiple, the
ulcerations are of different character, the tendency to scar-:formation
oonstiuit ; and, with few exceptions, it has, moreover, its beginning
in childhoiMl or early adult life.

What fiioton are to be considered in giving a prognosiB in
epithelioma?

Tlio variety, extent, and rapidity of the process. The superficial
form may exist for years, and give rise to no alarm ; whereas the
doepor-sinitod varieties are always to be viewed as serious, and are,
indeed, often fatal. Involving the genitalia, its course is oftien
strikingly rapid. Relapses, after removal, are not uncommon.

What is the special object in view in the treatment of epi-
thelioma?

Thorough destruction or removal of the epitheliomatous tissue.

How is the destruction or removal of the epitheliomatons
tissue effected ?

By the use of such cuustics as caustic potash, pyrogallic acid,
arsiMiie, and the galvano-wiutery; and by operative measures, such
as i»xeision and erasion with the dermal curette. (See treatment of
lupus vulgaris.)

Of these several methods, that with the curette and that by exci-
mon iu|4uit4»bleciwe8, are the most convenient and satisfactory.

NEW GROWTHS.

Faget'B Disease of the Nipple.

{S^'"

iligniiHt Papillurj Den

; Piigefa Disc

WlLatd

yon n&derstaad by Faget's disease of the nipple t

Paget's diBeise is a rare, iaflanimatory-lookirig, niiilignaQt diaeose
of the nipple a,iiJ areola in women, eventually knuiiiating in can-
cerous involvement of the entire gland.
Describe the BymptomB of P&get'a diaeaae.

The first eyniptonis, which usually last fiir months or years, are
apparently edematous, aecompaniml with mure or less burning,
itehing und tingling. Gradually, the diseased area, which is sharpty-
defitied, and feela like a thin kyer of indurated tissue, presents a
florid, intensely rod, very finely-granular, raw Burfa(M, attended with
a more or less copious viscid exudation. Sooner or later retraction
and destruction of the nipple, followed by gradual aoirthous involve-
ment of the whole breast, takes place.
What is the pathology of Faget's disease T

It is thuught, on the one hand, to be a cancerous disease results
ing fnim a continued euKematoua infiiimmatiun of the parts, and by
others it ia considered (« he of a caneergus nature from the very
iK'ginning. It is usually met with in womeu between the ages of
iul^J and ^ixty.
State the diagnostic featnren of Faget's disease.

Tlie age of the piitieiit ; the sharp limitation ; the well-defined,
indurated film of infiltmtion ; the peculiar, red, raw, granulating
appearance ; and, later, the retractitm of the nipple ; and, finally,
the involvomcut of the deeper parta.
What is the prognosis f

If the <lisi'iiso is recognized early, and properly treated, a com-
plete cure may Ije atiticipati'd ; later the outlook ia the same as that
uf scirrhusv:if the breast.
What is the treatment of Faget's disease ?

Thorough cauterization by means of caustic pot4ish or the galvano-
cautery ; or, iu estirpiitiou by means of the curette or excision.

Until the diagnosis is thoroughly established, soothing applicatioDB,
Hooh as are employed ia acute eczema, are to he advised.

DISEASES f>P THE BKIN,

(Ajjiniiym. ; FB™lnl^C^li^; Siirocina of tho Bkin.)

Describe the several varieties of sarcoma.

Sarcoma of the akin ia a more or less mtili^oaDt new growtli, rf
mpiil or alow- progress, characterized by tho appearance of m^
or multiple, variously-ahaijed, Jiscrete, non-pigmeoted or pigmaniei

tabeicles or lumora, of size Viiryiug from that of a shot to a hazel-
nut or larger. As a rule the growths are smooth, firm and elastic,
somewhat piLiufiil upon pressure, and exhibit a tendeocy to ulcerate.
Tlie ovorlyiDg skin is at first Dormal and somewhat movable, but aa
the growths approach tho surfacu it becomes reddened and adherent;
or, if the disease is of the pigmented vanety, it acquires a tduish-
black color.

NEW GROWTHS. 223

The multiple pigmented sarcoma {mdano'sarcoma) appears fii-st
usually on the soles and dorsal surfaces of the feet, and later, on the
hands. There is more or less diffuse thickening of the integument.
The lesions themselves manifest a disposition to bleed.

A rare form of sarcoma (more recently viewed as a granuloma) is
that described under the name of mycosis fungoides (also called in-
Jiammatory fungoid neoplasm). It is characterized usually by
symptoms of an eczematous and erysipelatous nature, and by the
sudden or gradual appearance of pinkish or reddish, tubercular, no-
dular, lobulated or ftirrowed tumors or flat infiltrations, which may
disappear by involution or be followed by ulceration. The lesions,
especially in their early stages, are, as a rule, accompanied with more
or less burning and itching.

State the prognosis of sarcoma.

The disease is always more or less maUgnant, and, as a rule,
sooner or later, a fatal termination takes place. It is usually slow
in its course.

What is the treatment of sarcoma?

Treatment is palliative. Surgical interference may be of service
in particular situations. A favorable influence has been noted, in a
few instances, to follow hypodermic iigections of Fowler's solution
in increasing dosage.

DISEASES OP THE SKIN.

CLASS Vn.— NEUROSES.

Hyperaesthesia.

Wlat is hyperffisthesia ?

By hypcricsthcsia is mtiant incxeased cutaneous sensibility. It -
usually more or less localizoti, and is met with aa a symptom in fiuc-
doDal and organic nervous diseases.

Dermatal^a.

(Synons"" • Ncurslgia uf the Skin ; rihramWisq, of the Skin

Wliat do yoa andentand by dermatalgia ?

By dermatulgia is meant a tender or painfiil condition of the skin
unattended by structurid change. It is commonly limited to a small
area, and is usually symptomatic of fiinctional or organic nervoiLS
disease. As an idiopathic affection it is looked upon as of & rheu-
mulic origin.

Treatment depends upon the cause.

AnEBBtheBia.
What ii BUEBstliesia !

AinBNthesia ts a diminution, comparativeorcomplete, of cutaneous
Bciisibility. It is usually localized, and ia met with in the coui^
of certain nervous affections. It is also encountered in leprosy,
tnorphcea and like diseases.

Pruritus.
Whftt do yon nndergtand by pmritnu ?

i'l'iinliiB id a fiirictioujil disi'ii.se of the skin, the sole symptom of
Wliii'li Ih ili'liitiif, tlirrii Ixliig rni Rtruotural cbunge.

Xlt>«orlbe the lymptomi of pruritus.

II' mill' mill I'MM'iitiiil nympt^im is itchiuess, usuully mun.' or leas

7. Itfe

ie skio I
a small I

WMroxfBnta], and worse at night. There are no prunaiy structural
HeBiona, but in eevere and persistent cases the purta become so iiri-
Hated hj continued scratehiog that secondary lesions, such as papules
^amd slight tlaukeuing aod infiltration, may result It is much more
Bbimiiuon in advanced life — -pruntta tenUU. In such cases, aa well as
Wia those cases in younger and middle-aged individuals in which the
[itchiness develops at the approach of cold weather and disappears
upon the coming of the warm season (pnin'tiii hihtnlis), the pru-
ritus is usually more or leas generalized, although not infrequently
in the latter the legs are specially involved.
Ib pruritus always more or less ^neralized ?

No ; not inlrenuently the itehing is hmited to the genital region
{pruritus ecroti, pruritus vuIvcf) or to t!ie anus (.j/run'tue uni).
To what may pruritus oftea be ascrifaed 1

To digestive and intestinal derangements, hepatic disorders, the
uric acid diathesis, gestation, diabetes mellitus, and a depraved state
of the nervous Bystew.

Pruritus vulvie is at times due to irritating discharges, and pruritus
ani occasionally to seat worms.

Is tliere any difflcnlty in the diagnosis of pmritos !

No. The subjective symptom of itching without the presence
of structural lesions is diagnostic. In those severe and [lersislent
I in which cscoriations and papules have resulted from the
EKnttfhing, the history of the case, together with its course, must
reconsidered. Care should be taken not to confound it with pedicu-
In this latter the excoriations usually have a somewhat pecu-
liar distribution, being most abundant on those parts of the body
Bvith which the clothing hes closely in contact. (See pediculosis

s.)
'' Wliat prognosis would you give in pruritus ?

In the wnjority of cases the condition responds to proper treat-
ment, hut in others it proves rebellious. The prognosis depends, in
fact, upon the removability of the cause. Temporary relief may
always be given by esternaJ applications.
Hov would you treat pruritus?

With ^steiuic remedies directed toward a removal or modilicatioa

226 DISEASES OF THE SKIN.

of the etiological factors, and, for the temporary relief of the it
iDg, suitable antipruritic applications. In obscure cases, quin
belladonna, nux vomica, arsenic, pilocarpine and general galyami
tion may be variously tried.

Exceptionally, the relief furnished by external treatment is more
or less permanent

Name the important antipruritic applications.

Alkaline baths ; lotions of carbolic acid (Sj-Siy to Oj), of thymol
(gr. xviij-gr. xxxij to Oj alcohol and water), of resorcin (3j-5iv to
Oj), of liquor carbonis detergens (Jj- J iv to Oj), and liquor picis alka-
Unus (3j-3iv to Oj) used cautiously. One or several ounces of
alcohol and one or two drachms of glycerine in each pint of these
lotions will often be of advantage, as the following : —

R. Ac. carbolici, Sj-^iij

Gylcerinse, f^y

Alcobolis, fjij

AqusB, q. 8. ad Oj. M.

The various dusting powders, alone or used in com'unction with the
lotions.

And in some cases, especially those in which the skin is unnatur-
ally dry, ointments may be used, such as equal parts of lard, lanolin,
and petrolatum ; to the ounce of which may be added five to thirty
grains of carbolic acid, three to twenty grains of thymol or ten to
thirty minims of chloroform.

What external applications are to be used in the local varie-
ties of praritus ?

In pruritus ani and pruritus vulvoe^ in addition to the various ap-
plications above, a cocaine ointment, one to ten grains to the ounce,
a strong solution of the same (gr. v-xx to Sj), and an ointment
containing ten to thirty minims of the oil of peppermint to the
ounce ; sponging with hot water, often affords temporary reUef.

In pruritus vulva?, moreover, astringent applications and injections
of zinc sulphate, alum, tannic or acetic acid, in the strength com-
monly employed for vaginal injections, are at times curative.

PABASmC AFFECTIONS. 227

CLASS vm— PABAsrric affections.

Tinea Favosa.

(Synonym : Favus.)

What is tinea favosa?

Tinea favosa, or favus, is a contagious vegetable-parasitic disease
of the skin, characterized by pin-head to pea-sized, friable, umbili-
cated, cup-shaped yellow crusts, each usually perforated by a hair.

Upon what parts and at what age is favns observed ?

It is usually met with upon the scalp, but it may occur upon any
part of the integument. Occasionally the nails are invaded.
It is seen at all ages, but is much more common in children.

Describe the symptoms of favus of the scalp.

The disease begins as a superficial inflammation or hyperaemic
spot, more or less circumscribed, slightly scaly, and which is soon fol-
lowed by the formation of yellowish points about the hair follicles,
surrounding the hair shaft. These yellowish points or crusts increase
in size, become usually as large as small peas, are cup-shaped, with
the convex side pressing down upon the papillary layer, and the con-
cave side raised several lines above the level of the skin ; they arc
umbilicated, friable, sulphur-colored, and usually each cuj) or disc is
perforated by a hair. Upon removal or detachment, the underlying
surface is found to be somewhat excavated, reddened, atrophied and
sometimes suppurating. As the disease progresses the crusting be-
comes more or less confluent, forming irregular masses of thick,
yellowish, mortar-like crusts or accumulations, having a i)eculiar,
characteristic odor — ^that of mice, or stale, damp straw. The hairs
are involved early in the disease, become brittle, lustreless, break off
and fall out In some instances, especially near the border of the
crusts, are seen pustules or suppurating points. Atrophy and more
or less actual scarring are sooner or later noted.

Itching, variable as to degree, is always present.

What is the conrse of favus of the scalp ?
Persistent and slowly progressive.

if fkTVs vlMn seated b

' Bo Utoae n|ioti 1
IS by tba MBMwtBl dSKreaoas i>f the [J

wfe ami •v«f» tliaai fmitu iMjnmnH. twtvivl

i fractures, espod J

«{Uilt'niiul iHTtiun, by the vt^lable )iarasit«, the achnrum SrJuH
Iriuii. U id MuitH^uQ^ It bi A M>iui>aratively t»i« disewie m th
TOUiitrj', and is observed almoist exclusively amuog tbu poor. Tl:
nitilti lire rarely nlTovtod |iriniurilj"-

Ii i« uki iiit't with ill tlie lower itniiuiils I'roni wliicb it i& douliUe^
nut iiit'niiui-iitl.v i
What are the diag^nostio features of favtu ?

Tli« yellow, and o^n cuii-sha|.nl, crusts, briltlon
hair, alropiiy, and tlie history.

PARASITIC AFFECTIONS.

229

r would you distingmsh favns from eczema and ring-
worm?

la by tlie condition uf the afft'Ctiiii hair, tlie atrupliic
reiis, the odor, and thu history. From ringworm hy
the crostiiig and the atrophy. In this latter disease there is usually
but slight aealinesB, and rarely any scarring.

Finally, if necessary, a njicroBcopic examination of the crusts may
be made.
State tlie method of examination for tangxis.

A portion of the mist is moistened with liquor potaasse and exam-
ioed with a power of three to five hundred diameters. The fungus,
(achorion Schonlcioii), conaisting of mycelium and spores, is luxuriant
and is readily detected.
State the prognosis of favus.

Upon tlie sciilp, favus is extremely chronic and rebellious tii treat-

Epilating ForeEju.

ment, and a cure iu three to twelve months may be conadcred
satisfactory; in neglected cases permanent baldness, atrophy and
scarring sooner or later result Upon the general surface it usually
responds readily — escepting favus of the nails, which is always
obstinate.

How is farus of the scalp treated!
Treatment is entirely local and consists in keeping the parts free
Lfrom crusts, in epilation and applications of a parasiticide.

B crusts are removed by oily applications and soap-aud-water

The hiiir on and around the diseased parts ia to be kept

f cut, and when practicable epilation, or extraction of the

1 hairs, is to be advised; tbia latter is of material md in

r the cure. Kemedial applications — tho so-called panisiti-

:, aa a rule, to be made twice daily, If an ointment »

230 DISEASES OF THB SKIN.

usihI, it is to be thoroughly rubbed in ; if a lotion, it is to be dabbei
oil tor H.*venil uiiimtes and allowed to soak in.

Name the most important paraiitioides.

Comksivc sublimate, oue to four grains to an ounce of alcohol and
water ; earbork* acid, oue part to three or more parts of glycerine;
a ton percent, oleate of mercury; ointments of ammoniated mer-
ciiiy, sulphur and tar; and sulphurous acid, pure or diluted Hie

following Ls valuable : —

R. Sulphur, prsecip., ^^

Saponis yiridis,

01. cadini, aa g:j

Adipis, ^88. M.

Chrysarobin is a valuable remedy, but must be used with cautioD;
it may ])e employed as an ointment, five to ten per cent, strength,
as a rubber phister, or as a paint, a drachm to an ounce of gutti-
percha solution.

How is favns upon the general surface to be treated f

In the same general manner as favus of the scalp, but the
remedies emi)loyed should be somewhat weaker. In &vris of the
nail fre(iuent and close paring of the affected part and the appli-
cation, twice daily, of oue of the milder parasiticides, will eyentaal)y
lead to a good result.

Is constitutional treatment of any value in favns !

It is (luestionable, but in debilitated subjects tonics, especialty ood-
liver oil, may be prescribed with the hope of aiding the external
applic4itions.

Tinea Trichophytina.

{Si/nont/m : Ringworm.)

What is tinea trichophytina?

Tin(»a trichophytina, or ringwonu, is a contagious, vegetable-para-
si tic disease due to the invasion of the cutaneous structures by the
vegetable parasite, the trichophyton.

PARASITIC AFFECTIONS. 231

o the clinioal cbaracters of ringworm vary according to tlLo

part affected !
Yes, ulVen coii!?iJerably ; thus upnc tlie siailp, upon the gi^neni!
■isurfapj.', anil U}Mju tlie bt'iirdi.il regioD, the disouso usually prescuts
BtotiiUy different appcaranuee.
Describe, the symptoms of ring^worm as it occurs upon non-
hairy portions of the body.
Hmgworm of the general Burfiice {tinea truJtophi/tiaa corporu,
tea circinata) appea,ra as one or more Bmall, slighUy-cleyat«d,
Bharply-liniited, somewhat Bealy, hypersBmic spots, with, rarely,
minute papules, vesico-papules, or vcmcleB, especially at the circum-
fereDoe. The patch spreads in a uniform manner peripherally, is
slightly scaly, and tends to clear in the centre, assuming a ring-like
appearance. When coming under observation, the patches are
usually Jrom one-half to one inch in diameter, the centml portion
pale or pale red, and the outer portion more or less elevatecl,
hyperjcmio and somewhat scaly. Aa commonly iwted one, several
patches are present. After reaehing a. certain size they may
Kmmn stationary, or in exceptional cases may tend to spontaneous
disappearance. At times when close together, several may merge
anil furm a liirge, irregular, gyrate patch.

Iti'hiii^', ii.-;ii:illy slight, may or may nut be present.
Describe the symptoms of ringworm when occurring about
the thighs and scrotum.
In adults, more especially males, the inner portion of the upper
of the thighs and scrotum {tinea tridwphytina crurix, so-called
ISetcnut i»ur|7ina^Kni)may be attacked, and here the afiection, favored
^ heat and moisture, develops rapidly and may soon lose its ordi-
nary cUnical appearances, the inflammatory ^^uptoms becoming
eeperaally prominent. The whole of this region may become in-
volved, presenting all the symptoma of a true eczema ; the border,
however, is sharply defined, and usually one or more outlying patches
of the ordinary clinical type of the disease may be seen.
Deiorlbe the symptoms of ringworm when involTing the
nails.
In ringwoi-m of the nails [tinea tricbophylina luiguium) these
Btmcturcs become soft or brittle, yellowish, opaiiue and thickened

"-r^ji^:

""*»«

««*««i,;

IMtoio

PARASITIC AFFECTlflNS. 233

; the follicles are Bumewhut promineDt ; there is more or liss
kipecia, with here and there broken, giiawcd-off-looking hairs, some
€ which may be broken off just at the outlet of the follicles and
i^pcar as bliiek epeckf.

>oee ringworm of the scalp always present typical appear-

ncesl

irariably. In some cuses the patch or patehes may become
most completely bald, a[id in others a teudeni^ to the formation
I pustules, with more or less crust-formation, may be seen. The
iffection raayalso appear as small, scattered spots or points.

What is tinea kerionT

Tinea kerion {/■ej-[bn)iBamarkedly inflammatory type of ringworm
of the sculp involving the deeper tissues, appearing as a more or
less bald, rounded, inflammatory, cedematflus, boggy, honeycombed
tumor, discharging from the follicular openings a mucoid secretion.

Does rinfworm of the scalp ever occur in adults?
Nu. (ExtrL.liL,:ly rare exo.pt ion..)

Bescribe thesjrmptoms of ringworm of the bearded region.

Ringworm of the bearded regiou {(iiie/i trtdwphytiaa barbte, tinea
m/coeix, paraiitio tycmu, harbcr'ii itch) begins usually in the same
manner as ringworm on other parts, as one or more rounded, slightly
Bcaty, hyi)eraemio pat«hea. In rare instances the disease muy peiv
sist as such, with very little tendency to involve the hairs and follicles ;
but, aa a rule, the hairy structures are soon invaded, many of the
hairs breaking off, and many falling out. From involvement of the
follicles, more or less subcutaneous swelling ensues, the parts assum-
ing a diatinotly lumpt/ and nodtilar condition. The skin is usually
oonsder»bIy reddened, often having a glossy appearance, and
studded with few or numerous pustules. The nodules tend, ordi-
narily, to break down and discharge, at one or more of the follicular
openings, a glairy, glutinous, purulent material, which may dry to
thick, adherent crusts.

The disease may l>e limited to one patch, or a large area, even to
the extent of the whole bearded region, becomes involved. The
upper lip is rarely invaded.

»^c

, w., ,.;,,r '";" -f'^..! to„ ,t'°°*»«, .«i J' „"'^'™'»

How do yon examine for tlie fongna 1

The acrapiDgs or hiiir ehuulil bo maisteneii with, liquor potassse,
and exaiuiuoil wltli n jiiiwer frum three liundred diaiueters upward.

How is ringwomi of the general surface to be distinguished

from eczema, pcoriasis and sebonhceal
B.T tlio triDwth iiiid chiiriietors oi' thi! pnttli, the tthglit scalineas.

yellow, cup-sliiiped cmstw, uikI the ijreseu<«! of the atrophic areas in
thut di»eiise itre ]iiithogDouiuiiie.

Sow is ring^oim of the bearded region to be diBtingiUBbed
from eczema and non-paraBitie sycosis l

By the peculiar luraiiiiiess of the jiarts, the hrittleness of tho hair,
DHjni or IcMs hair-!om, the hiatury, mid finally, in douLtful cases,
by rai;;r(iw'upical esamination.
Wbat is the prognosis of ringwonn of these several parts ?

AVIlijii upon the general surface, the dL^easo usually responds rap-
idly la therapeutical applicatioDB ; upon the eca!p it u always a stub-
bom affection, and, as a rule, re([uirea at least several months of
energetic treatment to effect a euro. In tbk latter region the disease
will disappear spontaneously as the age of Sneen or sixteen is
reached. Tinea Hjuosia yields in moat inatanees in the uourso of
several weeks or a few months.

Is ringworm of these several parts treated with the same
lemedies !

As a rale, yes ; but the strength must be modified. The scalp
will fitand strong applieatioiis, us will likewise the bearded region ;
upon iion-huiry portions the remedies should be used somewhat
weaker. They should he applitMl twice daily ; ointments, if used,
being well rubbed in, and lotions thoroughly dabbed on.

How would yon treat ringworm of the general snr&ce ?

By applications of the milder parasiticides, snch as a ten to fifteen
per cent SJjIution of sodium hyposulphite ; carbolic acid, five to
thirty grain.s to the ounce of water, or lard ; a saturated solution of
boric acid ; ointnicnt.9 of tar, sulphur and mercury, offieinal strength
or wenkoned with lard.

Wlieo occurring upon the upper and inner part of the thighs
(so-called eczema marginatum), the same remedies are to be em-
ployed, but usually stronger. Deserving of s]jecial mention is a lotion
of eotTOsive sublimate, oue to fimr grains to the ounce ; or the same
remedy, in the same pro|)ortion, may be used in tincture of myrrh or
betiKoin, ami pairiti.'d ou the parts.
How would yon treat ringworm of the scalp?

By occasional soap-and-hot-water washing ; by extraction of the

-> DISILVSES OF THE SKIN.

iiiv..lvtil h:iii>, wlii-ii itractkxible ; by carbolic acid orb
ii.i the whiilo >4-ali». so ai to limit, aa luueh as puss^ible
tlu- ili-«:L-«- : and by daily (or twice daily) applicatium
ail- 1 iiiv..l\\-4l arvas of a {lara^iiticide. The following
Vidua) If : tli«* nl«aie nf nieivuiy, with lanl or lane
-tniijth, tn-in five to tweuty tK.T cent. ; carbolic aci
tlirt-o t-r ui'-re jiarts of glywrine or oil; corroeivc
S'lutii'!! ill akiihid and water, one to four crains
<u!i-hur uintuunt: and citrine ointment, with one oi
larl. C'lin--;iP..biu is a valuable remedy, but is to be
v-arc : it may W prvsoriU*d a:? a rubber plaster or in
gutta-i.^'i\-ha. vT as an niutmont. ten to fifteen per cen
And als*.» : —

R . Hydran:. olt-at. ''20 "^^ ^z:

Ao. <.'arlx>Iii.i ^j

Louoliu =~

In that fonu kiK-wu as tiiua kt-rion. mild applica
maudt"*! at first : laror the s;imo trc-atment as in the onj

How is ringworm of the bearded region to be tre

On the simo conond j-Ian a:. I with the same reuiedii
ohT^-SiiTX'bin^ as in r::i.:w..r*.u -. :' the 2^-ih». Epilation is
tis*\l as an oscknuial pan -T'tho trxatiut-nt. Special mei
mavio of an ointuuut k-f vlv.ito i-t' uicaury, sulphur
lotivni of Sixiium li\'i\vsulrh".to ".o.'-j.*^ •i^'-^ * lotion of ci
limato (}:r. j-iv to X.^V

How is the certainty of an apparent cnre in xii
the scalp or bearded region to be determined

By micr.xsivpik'-al cx.a:u:n.i:: 'U v^:' tho noWim»wiusr haii

to time tW several w^vks art or vl'.><i»;it::iua:KV of tzvatmc

Cu!\^ v»f rinjwv»rm v^f ilio cx'neral surtavv ts usuid^ sjoll

Is constitntional treatment of any aid toward il

ringworm f

It is d'.'ukt'ul. aithouch 'v\ vi;:uli\u in a depraved stat

the di-*ase is often m»tt^l t*» Iv ojHviV.'^^- >iubU*TO. ai

cuii-livcr uil and similar r.*mi\Ues may At tiwct^ i^vav of 1

Tinea VerBicolor.

(ijnoiij,™. .■ I'itytiaaij ViiMicuIot; ChromopLytoaia.)

t is tinea versicolor?

I versicolor in a vegetable-parasitia disease of tlio skin,
actcrized by Ta,rioufly-siKed and shaped, slightly swily, macular
patches of a ycUuwiah-fawn eubr, and occurriug for the most part
npoQ thu tnink.

' Describe the symptoma of tinea Teiaicolor.

The disease beginii as one or more yellowish maxnilar points ; these,
iu the course of weeks or months, gradually cstend, and, together
with other piitclies that arise, may form a more or less uontiiiuoua
sheet of eruption. There is slight scaliness, always insignificant and
iurfiiraccous in character, and at times, except upon close inspection,
scarcely perceptible. The color of the patches is pale or brownish-
yellow ; in rare Instaucea, in those of delicate skin, there may be
more or less hypersemia, and in eunaequenee the eruption is of a
reddish tinge. The number of patches varies ; there may be hut a.
few, or, on the other hand, a profusion. Shght itching, especially
when the p.irt^ are wanii, is uiiuiilly present.

Does the eruption of tinea versicolor show predilection for
any special region?
Yes; the upper part of the trunk, especially anteriorly, is the
usual Bea.t of the eruption, hut in exceptional iustanoes the neck,
axilke, the arms, the whole trunk, and the inner Bnrfaces of the
thighs may become invaded.

What course does tinea versicolor pnrsne t

Persistent, hiil sunivwhrtt variable ; aa a rule, however, slowly pro-
gresBive and last! i if; lor yeui-s.

To what is tinea versioolor doe ?
^_ To a vegetable fuiigmt^the micrmpi'fiinfitrfiir.
^^^^he affection is tolerably common, and occurs in all parts of the
^^Bjddi With rare exceptions, it is a disea:^ of adults, and while
^^Hnd upon as oontajnous, mast be eo to an extremely slight degree

"fill. J ,'"? i..,,,

°'*"-~»f„

PARASITIC AJ'FECTIONS. 241

oFa lotion of — sulphite or hyposulpliite of sodiuiu, a dmchiu to the
ounce ; eulphuroua acid, pure or diluted ; carbolic ocid, or resorciD,
tea to twenty graina to the ouuce of water and alcohol ; or corroave
euhliniate, one to three grains to the ounce of water. Sulphur and
ammoniated-mercury ointments arc also scrviceahle. The following
used alone, simply aa a Boap, or in oonj unction with a lotion, is often
f special value : —

R. Sulphnr. prtecip., 3vj

Saponia viridis, gx. M.

After the disease is apparently cured, an occasional remedial ap-
plication should be made for a few weoks or a mouth. In order to
guard against the possibility of a relapse.

Erytbrasma.

Describe erytbrasma.
Erythraama ia an extremely rare disease, due to the presence and

- »^

■1 *^ -^ -.

-- ^ ^:

**:c«,

»Ji

•I--..:.

PARASITIC Ai'FtlCTIO.VB.

matouH symptoms are superadded ; iu luiig-persistent coses, indeed,
the burrows and other consequent lesions may be more or less com-
pletely marked fay the eczcmatous iuflammation, and the true uatuie
of the disease be greatly obscured.
Wliat do you me&n by bnrrowB t
BuiTowM, or cum'cidi, are tortuous, straight or zigzag, dotted,
, slightly elevatiil, dark-gray or blackisb thread-like linear fonnationa,
k Tarying in length from an eighth to a half an inch.

\Stiw is a burrow formed T

By the impregnated female parasite, which penetrates the epi-
s obliquely to the rete, depositing as it goes along ten or
¥H, forming a minute passage or burrow.
' ITpon what parts are borrows moat oommonly to be foimdT

In the iiiterdigital spaffl't;, on the flexor surtat'e of the mriste,
about the uiammro in the fumale, and on the shaft of the peiiia in
the male.

Are burrows usually present in nnmbera T

No. Several may be found iu a single case, but they are rarely
s the irritation caused by the penetration of the para-
la either to violent scratching and their destruction, or gives
i to the formation of veacleB and pustules, and oonseqaeatly
tr fbnuatjon is preveoted.

yri»t oonne doei aeabiei pnrsue i

Uisa|,ji(.„ra„„e. *^ tendeo.

To what is soabiea due ?
To Ih, i„,.,i„„ „f ,,,, „^„„^ «™„i^, ._ . .

» th. ,Hn .ri .pp.„.,, .^^ J„ ^^t^"^"" " "

of the ajTuptoms. "part i

Th,' ,\f--r:,->' ix wntngims to a marked decree, and is most

1 Ii ...lii 1.1. (I'll liyBlyoiiinjr with those affected, orbyooenpyi

inil 111 will. Ii rill iiffwitiil iicrwjri hiw slept. It oocurB, for obi
miMdiw, iiHMiill.v iiiiiinifT llio JXMF, although it is oucaaiooally
with uiiionB till' Ix'lli'i' oinwm

State the diR^oitic l^atnrei of loabias.

Tlic hiimiws. t.!n> |Mviilinr liistrihution ami the multiformrf.
lhi> i-nnitiiiii, the piMgvwih'e devrlopineiil, and usuallyu hialoiy

PAKASmC AFFECTIONS. 245

E How do Tesicolar and piutiilar eczema differ from scabies 1

Eczema is usually limited in extent or irregularly distributed, is

I distijictly pateliy, with ufteu the formatiou of large diffused areas ;

iriable in ita clinical behayior, better and worse from time to

time, aud differs, moreover, in the absence of burrows and of a

hiiitury of coDtagion.

How does pedionlosis corporie differ from scabies 1

In the distribution ol' the eruption. The pedicuU live in the
olothiug aud go to the skin solely for nourish mcnt, and hence the
eruption iu that conditiun is upon covered piirts, especially those
parts with which the clothing lies cloitely iu coutuct, os around the
neck, across the upper part of tlie back, about the vaiet and down
the outside of the thighs ; the hands are free.

State the prognosis of scabiea.

It is favorable. The dtsea^' is readily cured, and, as soon as the
parasites and their ova are destroyed, the itching and the secoiidaiy
symptoma, as a rule, rapidly disappear.

How is scabies treated?

Treatment is entirely external, and consisla of a preliminary soap-
and-hot-watcr bath, an application, twii^e daily for three days, of a
remedy destructive to the parasites and ova, and finally another bath.

Vliat remedial applioations are commonly employed in

I scabies 1
Sulphur, balsam of Peru, atyrax, and ,3-naphthol, singly or severally
Bombined. In uhildren, or in those of sensitive skin, the following : —
B- Sulphur, pnecip giv
Balsam. Pemv., 3 iv
Adipia,
Petrolati, ai gias. M.
And iu adults, or those of non-irritable skiu :—
B. Sulphur. prtBcip., 3J
Balaam. Pewv., gsa
/i-Naphthol 3ij
I Adipis,
I Petrolati, . . . aS . . q. a. ad . . . |iv. M.
K-^ :

IJISEASES OF THE S

ly employed
three |i;irta of laid.

f treatment Bufficient to bring- about a

1 always present in

lu ployed in i

' 346

Styrar ia a remeJyof value and
ointmeut in the struugth of one part
Is one such course
onref

Yes, in ordiuary caaea, if the applicatinna have l>een careMl?
and thoruughlj made ; exceptiouully, however, some parasites and
ova escupe destruction, and consequently itching will again begin W
show itself at the end of a week or ten days, and a repetition of tlie
treatment become necessaty.
Does tbe secondary dermatitia which
severe cases require treatment ?

Only when it ia unnsually persistent or severe ;
Tarious soothing applieatious, lotions oroiutmeuts
©ozema are to be proscribed.
Is a dermatitis due to too active and prolonged treatment
ever mistaken for persistence of the scabies?

Yes.

PediculoBis.

{Sy,-<f>!,'i> : Plithdriiiais; Lousineaa.)

Define pediculosis.

Pediculosis is a term applied to that condition of local or general
cutaneous irritation due to the presence of the animal parasite, the
pediculus, or louse.
Name the several varieties met with.

Three varieties are presented, named according to the parts involved,
pedicidoais capitis, pediculosis corporis, and pediculosis pubis ; the
parasite in each being a distinct species of pediuulmi.

Pediculosis Capitis.
Describe the symptoms of pediculosis capitis.

Pediculosis capitis (ptidifulosit ct^ to the iirch«!ncc

Ui cbildren thaa

PABASmC APPBCnONS, 247

in adults. It is cWactemed hj marked itchiog, and the fonnatioii
of various inflammatory lesions, such as papules, pustules and cxcori-
atbns— resulting from the irritation produced by the panisitea ami
from the scratching to which the intense pruritus gives liiK. lu
lact, an eczematous emption of the pustular type soon results,
att«nded with more or less crust formation. In consiiiuenoe of the
cutaneous irritation the neighboring lymphatic glands miiybucume
inflamed and swollen, and in rare cases suppurate. The occipital
re^oa is the part which ia usually most profusely infested. In
those of delicat« skin, especially in children, scattered papules.

veaco-papoles, pustules and excoriatiuns may oficn be seen upion
the forehead and neck.

In addition to the pediculi, which, as a rule, may be readily found,
their ova, or ntit, are always to be seen upon the shaft of the hain,
quite Ennly attached.

Decoribe the appearance of the ova.

They are dirty-wbite or grayish -looking, minute, pear-shap*^
bodies, viable to the naked eye, and fastened upon tha sluA o*
die bails with the small end toward the rout

Is there any difficulty in the diagnosis of
pedicolosis capitis ?

Nu. Tlie diiignntiis is rwiilily made, as the pedi-
culi ^ri! usually to be fuund without dlfficalty, and
even when they exist m small numbers and are not
readily diacoverod, the presence of the ova will in-
dicate the nature of the affection.

Pustular eruptiona upon the scalp, espediHy
posteriorly, should always arouse a. suspicion of
pedionlosiB. The possibility of the podicnloeis
being aecoadary to eczema must'not be forg-otten.
What is the treatment of pedtcoloHis capitis!

Treatnicut consists in the application of some
remedy destructive to the pediculi and their ovs.
Crude petroleum is effectiTe, one or two thorough
apphcationa over night being usually suffitient ; m
order to lessen its inflammability, and also to luask
its Bomewbat disagreeable odor, it may be mixed
with an equal part of olive oil and a small quantity
of hilsam of Peru added.

Tincture of cocculus indicua, pure or diluted,
may also be applied with good results.

When the parts are markedly eczematoue, an
ointment of ammoniated mercury or /^-naphthul,
thirty to siity grain;! to the ounise may be used.
How are the ova or their shells to be removed
&om the hair ?

By the frequent use of acid or alkaline lotioDfi,
such as dilute acetic acid and vinegar, or scdudoiB
of sodium carbonate and borax.

Pediculosis Corporis.

I Describe the symptoms of pediculosis corporis.

Pediculosis corporis ia deiiendciit upon the presence of the pedioa-
lUB corporis Ipalicthia vestinuTiti), a largtT variety than that infest-
ing the scalp. It is ch^racteriwd lyjtttffe o^^mjeocnil itching,

r with variuuM inflamiuatory lesions and excoriations. As

e parafiitea are to be fuuud chiefly in the fulda and aeama of the

othine. visiting the sliin for the purpose of feeding, the various

■symptoms — the minute hemorrhagic puncta showing the points at

which they have been sucking, and the consequent papules, pustules

and excoriations— are, therefore, to be found most abundantly on

those parts with which the clothing comes closely iu oontaet, as, for

State tbe diagnoatic characters of pediculosis corporis.

The presence of the mi»ut« hemorrhagie puncta, the multiform
character and peculiar distribution of the eruption. Careful scarc^h
U almost invariably disclose one or more ]>edieuli.

it is the treatment of pediculosis corporisl
{[he olotiiing and bed-covunngs are to be thorougiUy baked or

DISK A BBS OF THE SKIN.

IwiW, tlie pediculi and their ova being in t.his mat

Aa teiuporarr meaauTeij, ointmetite of solpliar and staphisa^Hi, mi

lotions of carbolic acid, may be advised.

PediculoBis Pubis.
Describe the ■ymptoms of pedlcnlosiB pnbia.

Pediculosis pubis is a cnndition due tfl the preeence of tho
pediculua pubis, or crab-louse. It ia characterized by more «
less itching about the genitalia, together with papules, eieoriadons,
and other inflanimutory lesions. The amouut of irritatioD varies;

it may be slight, or, on the other hand, severe. The poraRta,
which is the snialleHt of the three varieties, may be diacoveied
upon dose examiaation seated near the rootii of tho hmrs, clatching;
the hair, with its head downward and buried in the follicle. '^'^^
ova may be seen attached to the bair-shafts.

It iiifosta adults chiefly, being in most instances probably
tracteil through sesual int«;rcourec.
Is the pedioolns pubis found npon any other part of the bodyt

Yen, Although ita favorite habitat is the region of tlie pubea, it
may, in exceptional ioetances, also infest the axillce. the stemat
region of the male, the beard, eyebrows, and even the eyelasheB.

PARASITIC AFFECTIONS. 251

State the diagnostic characters of pediculosis pnbis.

The region involved, itching, variable amount of irritation, and,
above all, the presence of the pediculi and their ova.

Vame the several applications usnally made for the cure of
pediculosis pubis.

A lotion of corrosive sublimate, one to four grains to the ounce ;
infttsion of tobacco ; a ten to twenty per cent, ointment of oleato of
mercury ; ammoniated mercury ointment, and a five to ten per cent.
)3-naphthol ointment.

Cysticercus CellulossB.

Describe the cutaneous disturbance produced by the cysti-
cercus cellulossB.

The presence of cysticerci in the skin and subcutaneous tissue gives
rise to pea to hazelnut-sized, rounded, firm, movable tumors whidi,
when developed, may remain unchanged for months. The i)arasites
are disclosed by microscopic examination.

Most of the cases have been observed in Grermany.

Filaria Medinensis.

{Synonym : Guinea- worm.)

State the character of the lesions produced by the filaria
medinensis.

The young microscopic worm penetrates the skhi or deeper tissue,
where it grows gradually, finally reaching several inclies or more in
length and about a half-line in thickness ; inflanmiation is excited
and a tumor-like swelling makes its appearance, which, sooner or later,
breaks, disclosing the worm. It may also present a cord-like appear-
ance. It is rarely met with outside of tropical countries.

Treatment consists in gradual extraction. Asafoetida internally
has been found to be curative, the parasite being destroyed and sub-
sequently absorbed or discharged.

254 DISEASES OF THE SKIN.

Pulex Irritans.

{Sffnonym : Common Flea.)

Describe the cutaneoiu distnrbanee produced by the pnlez
irritans.

It consists of an erythematous spot with a minute central hem(X^
rhagic point In irritable skin, a wheal-Uke lesion may result

Treatment consists of applications of camphor or ammonia water.

APPENDIX.

ATLAS REFERENCES.

(Only plates giving clear and satisfactory representations are referred to.)

Aone.
G. H. Fox's Atlas, 2d Ser., Part 7 ; Morrow's Atlas, plate Lix.

Aone Bosacea.
Duhring's Atlas, plate E ; G. H. Fox's Atlas, 2d Ser., Part 8 (3
figures, showing the several grades) ; Morrow's Atlas, plate lix.

Alopecia Areata.
Duhring's Atlas, plate n ; G. H. Fox's Atlas, 2d Ser., Part 9 (3
plates) ; Taylor's Atlas, plate LVii.

Atrophia Cutis.
Taylor's Atlas, plate LViil (angioma pigmentosum et atrophicum) .

Comedo.

G. H. Fox's Atlas, 2d Ser., Part 7 ; Morrow's Atlas, plate xxxvi.

Fig. 2.

Dermatitis.

G. H. Fox's Atlas, 2d Ser., Part 2 {rhua poisoning and dermatitis

calorica) ; Morrow's Atlas, plate L, Fig. 2, and Taylor's Atlas, plate

XLEC, Fig. 2 (superficially ulcerative dermatitis^ from the bromides) ;

Morrow's Atlas, plate L, Fig. 1, and Taylor's Atlas, plate XLix, Fig.

1 {fmUous eruption from the iodides),

Demiatitis Exfoliativa.
G. H. Fox's Atlas, 2d Ser., Part 4 ; Morrow's Atlas, plate XLix,
Kg. 3.

255

25r> DISEASES OF THE SKIN.

Dermatitia HerpetUbrmls.

Morrow's Atlas, plate uii (wncuktr t$pe),

Bothsrma.

Duhriug^s Atlas, plate JJ ; Taylor's Atlas* plate XLm.

Eosema.

Duhring's Atlas, plates— A (erythematous), x {papular), t (vesteular),
Y [pustular), o, GG and HH (rvbrum), and i {aquamaus) ; G. H. PV)x'8
Atlna, '2d Ser., Parts 2 {erjfthematoua), and 3 {rubrum and squamous) ;
TViylor's Atlas, plate xxvil (pustular and nc&rum) ; Morrow's Atltf,
plates XLV, Fig. 1 (squamous), and XLVU (seborrkaieum).

Elephantiasis.
Morrow's Atlas, plate LXI.

Epithelioma.
G. II. Fox's Atlas, 2d Ser. , Part 11.

Erysipelas,
^lorrow's Atlas, plate XL, Fig. 2.

Erythema Multiforme.
Duhring's Atlas, plate cc (papular) ; G. H. Fox's Atias, 2d Ser.,
I'art 1 (bullous) ; Taylor's Atlas, plate xxxiv (annular).

Erythema Nodosum.
Duhring's Atlas, plate v ; Taylor's Atlas, plate xxv.

Fibroma.
(J. il. Fox's Atlas, 2d Ser., Part 9 ; Morrow's Atlas, plate LXiii.

Herpes Iris.
Morrow's Atlas, plate XLii, Fig. 1.

Herpes Simplex.
G. H. Fox's Atlas, 2d Ser., Part 6 (face) ; Morrow's Atlas, plate Li,
Figs. 1 and 2 (face)^ 3 and 4 (genitalia) ; Taylor's Atlas, plate VI,
Figs. 1 and 2 (genitalia).

Herpes Zoster.
G. TI. Fox's Atlas, 2d Ser., Part 6 (supra-orbital) ; Duhring's Atlas,
plat<^ R, Taylor's Atlas, plate XLV, and Morrow's Atlas, plate Lil
(intercostal).

APPENDIX. 257

Ichthyosis.

Duhring^s Atlas, plate F ; G. H. Fox^s Atlas, 2d Ser., Part 8

Ixni>etigo Contagiosa.
Buhring's Atlas, plate z.

Impetigo Herpetifonnis.
Taylor's Atlas, plate xxxvni.

Keloid.
G. H. Fox's Atlas, 2d Ser., Part 9 : Morrow's Atlas, plate LXiii.

Lepra.
G. H. Fox's Atlas, 2d Ser. Part 10, and Taylor's Atlas, piate Lil
{mcumlar and tubercular).

Lichen Ruber.
Taylor's Atlas, plates Liii {planus) and Liv {acuminatu8) ; Morrow's
Atlas, plate Lvii (planus).

Lupus Erythematosus.
Dahring's Atlas, plate c ; Taylor's Atlas, plate XLrv.

Lupus Vulgaris.
Dnhring's Atlas, plate bb, and G. H. Fox's Atlas, 2d Ser., Part 10
{non-ulcerating) ; Taylor's Atlas, plate LV {ulcerating).

Milium.
Morrow's Atlas, plate xxxvi, Fig. 3.

MoUuscum Epitheliale.
Taylor's Atlas, plate Li ; Morrow's Atlas, plate LX, Figs. 1 and .2.

Pediculosis.
G. H. Fox's Atlas, 2d Ser., Part 12 (capillitii and corporis) ; Taylor's
Atlas, plate xxxii (corporis).

Pemphigus.

Dahring's Atlas, plate ii, G. H. Fox's Atlas, 2d Ser., Part 7, and

Taylor's Atlas, plate xl (vulgaris) ; Morrow's Atlas, plate liv (vulgaris

said foliaceus).

Pityriasis Rubra.

Taylor's Atlas, plate xxxvii ; Morrow's Atlas, plate xlix, Figs.

1 and 2.

DISEASES OF T

I
I

Taylor's Atlaa, plate XLVII.

PsoriasiB.

Dnhring's Atlas, plates b and dd ; Taylor's Atlas, plate ]
G. H. Fox'a Atlas, 2d Ser., Part 5.

Purpura.
Duhring's Atlas, plate k ; Morrow's Atlas, plate LV, Fig. 1.

RMnoBcleroma.

Morrow's Allaa, plate l

G. H. Foi's Atlas, 3d Ser., Part 11.

ScableB.
Dnhring'a Atlaa, plate q ; Taylor's Atlas, plate XLVi,

Seborrhoea.

Dnhring's Atlas, plate w, and G. K Fox's Atlas, 2d Ser., Fart I
{face) ; Morrow's Atlas, plate XXXVI, Fig 1 {aetdp).

Sudamen.
Tkflor'B Atlas, plate XI.Vii ; Morrow's Atlas, plate xxsvi. Fig. i

Dahring's Atlas, plate h.

Syp bills Cutanea.
Duhrinfi'N Atlas, plate j, Taylor's AtLis, plate x. Figs. 1 and 2, tt
Morrow's Atlas, plate xlt {macalar] ; Dnbring'jj Atlas, plate L, I
Taylor'* Atlna, plate XI, Figs, land 9, and Morrow's Atlos, plate xm,'"
(imall'ptijiuliir) ; Duhring's Atlas, plate aa, and Taylor's Atlas, plate
XII (largt-papular) ; Morrow's Atlas, plate xvi {papalo-a^amoua)]
Morrow's Atlas, plate xviii (paliuar) ; G. H. Fos'a Atlas, 2d Sep.,
Port 4 (planlar) ; Morrow's Atlas, plate XV {papwla-puntular) ; Dah-
Aitif'a Atlna, plate L {tmall aeuminalrd-pimtiiliir) ; DnbrinK's Atlas,
plate IJ, Taylor's Atlas, plate xiv, Figs. 1 and 2, and Morrow's Atlas,
platn xxtll llargfamitninalfd-piisttilaT) ; Taylor's Atlas, plate XV, F
1 and 2 {omiill fial-jmiiutar) ; Duhring's Atlas, plate d, Taylor's AtlJ
plutaa XVI und XVII, aud Morion's Atlas, plate xxv {Inrge Jtal-ptUliiiiA
n(pia) I DubliDg's Atlw, plate EE, and Taylor's Atlas, plate 3

APPENDIX. 259

{non-ulcerating tubercular) ; Taylor's Atlas, plate XX, and Morrow's
Atlas, plate xxvii {ulcerating tubercular) ; Morrow's Atlas, plates
XXVIII, XXIX and xxxiii, Fig. 2 {gummatous) ; Morrow's Atlas, plates
XXXIV {bullous — hereditary) and xxxv {polymorpTtous — ^hereditary) ;
Taylor's Atlas, plate xxii {macular and papular — ^hereditary).

Tinea Favosa.
Dohring's Atlas, plate o {sccUp) ; G. H. Fox's Atlas, 2d Ser., Part
11 {scalp and general surface).

Tinea Triohophytina.

Dahring's Atlas, plates fp {scalp and general surface) and s {barbsB —

nodular) ; G. H. Fox's Atlas, 2d Ser., Part 11 {scalp and general sur-

fajce) ; Taylor's Atlas, plates xxxvi {Jcerion)^ XLI {cruri£)^ xui i)>arbs&

— superficial form).

Tinea Versicolor.

Duhring's Atlas, plate G ; G. H. Fox's Atlas, 2d Ser., Part 12 ; Tay-
lor's Atlas, plate xxxv.

Urticaria.

Taylor's Atlas, plate xxxix ; Morrow's Atlas, plate XLin, Fig. 1.

Urticaria Pigrmentosa.
G. H. Fox's Atlas, 2d Ser., Part 2 ; Morrow's Atlas, plate xmi.
Fig 2.

Verruca.

Taylor's Atlas, plate ii. Fig. 8 {acuminata) ; Morrow's Atlas, plates
XIX, Fig. 1 {acuminata)^ and LX {senilis).

VitiUgo.
Duhring's Atlas, plate M.

Xanthoma.
Monow's Atlas, plate LXiv {planum).

IIHI

UIHEASES OP THE SKIN.

JtKI-ATIVK Fl{E<iUE.VCY OF THE TASIOCS DISEASE OF

HKIN AH BUOWN BY THE STATISTICS (123.746 CASES)
OE-' TlIK AMElilCAN DERMATOLOGICAL ASSOCIATIOX
fi)U TKM YEAK8, lK7«-87.

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APPENDIX.

261

STATISTICS— ( Continued. )

Classification of
Diseases.

8. Of Connective Tissue.
Sclerema neonatorum ...

Scleroderma

MorphcBa

Elephantiasis

JRosacea :

a. erythematosa

b. hypertrophica

Framboesia

Class V. Atrophies.

1. Of Pigment.

Leucoderma.

Albinismus

Vitiligo «

Canities

2. Of Hair.

Alopecia

Alopecia furfuracea

Alopecia areata

Atrophia pilorum pro-
pria

Trichorexis nodosa

8. Op Nail

Atrophia unguis

4. Of Cutis

Atrophia senilis

Atrophia maculosa et
striata

Class VI. New Growths.

1. Of Connective Tissue.

Keloid

Cicatrix

Fibroma

Neuroma

Xanthoma

2. Of Muscular Tissue.
Myoma

8. Of Vessels.

Angioma

Angioma pigmentosum
et atrophicum

88
89
57
785
881
68
22

191

926
830
794

23
3

19
6

1
152
89
93
11
69

462

0X>30
0.081
0.046
0.684
0.808
0.047
0.018

0.062
0.008
0.155
0.035

0.749
0.670
0.641

0.019
0.002
0.021
0.015
0.005
0.013

0.019

0.0008

0.124

0.065

0.075

0.009

0.056

0.0008

0.373

13 0.010

Classification of
Diseases.

Angioma cavernosum...

Lymphangioma

4. Mycosis fongoide

Bhinoscleroma

Lupus erythematosus...

Lupus vulgaris

Scrofuloderma

Syphiloderma :

a. erythematosum

b. papulosum

c. pustulosum

d. tuberculosum

e. gummatosum

Lepra:

a. tuberosa

b. maculosa

c. ansesthetica.

Carcinoma

Sarcoma

Class VII. Neuroses.

Hypersesthesia :

a. Pruritus

b. Dermatalgia

Ansesthesia.

Class VIII.

Parasitic
Affections.

Vegetable.

Tinea favosa

Tinea trichophytina :...

a. circinata *.

b. tonsurans

e. sycosis

Tinea versicolor

2. Animal.

Scabies

Pediculosis capillitii

Pediculosis corporis

Pediculosis pubis

Total

477

536

668

13888

••••■•

1068

2716

854
2289
705
675
365
1268

8192

2579

1704

436

0.018
.012
.0008
.002
.885
.488
.536
11.22

.020
.005
.008
.004
.868
.044

.003
2.12
.009
.018

.286
1.85
.569
.545
.295
1.02

2.58
2.09
1.38
.352

123746

^^^^^^^WDE^^^^^^^B

iCABUS rDmDa1oniti<,41.
A Bcabiti, 344.

AppendU. 265. '

Area Celsi, IBS.

Achorion SubJinieilm, 228.

Argyria, l:i3.

Aone, 107-114.

Arsenic, oruplione from, S8.

arliflaialiB, lOS.

Artificial eruptions (feigned emp-

fttrophica, lOS.

tione), 60.

Oftohectieomm, 108.

indnrftta, IDS.

Atrophia cutis, 174-176.

pilorum propria, 171-172.
unguis, 178-173.

keloid, lie.

lanoes, 111.

Atrophic linoB and apoW, 174. ■
Atrophies, 30, 162-176.

papnlosii, IDS.

punctata, 108.

Atrophoderma, 174.

rosacea, Ut^llS, 18.1.

Atrophy of the hair, in.

Mbasea, 38.

Sails, 172.

tar, 108.

Bkin, 17*.

Tulgarb,107.

AddisoD'a disease, pigmcalaCiun nf

senile, 176.

tho Bkin in, 133.

Atropia, ernplions from, 68.

Amhum, 198-18T.

Albiampus, 16S.
AlbiBus, 162.
Alopecia, 1B6-1B8.
areata, IBS-lTl.

farfuracea, 187.
wnile, 187.

TJALDNBSS, 16B.

D BarbadoH leg, 1S8.

Barber's itcb, Z3.t.

Bed-bug, 253.

Belladonna, eruptions from, 6S.

Blanching of tho hair, 16B.

Blackheads, 40, 41.

Bleba, 23. "

Boil, B2.

Bot-fly, 253.

Bromides, eruptions &aai, 68.

Bromidroiis, 34-30. ^m

AnalDmy of the ekin, 17-21, U. 3B.
Angiomft, 181-1B2.

BuUk, 23. ^H
Bums, 56. ^^H

■implel, 181.
Angiomyoina, 18],

Burrows, ^H

Aaidroalii, 34.

Anthrax, 6i, 89.

pALCULI. cutaneatu, 43. ^H
V Callositaa, 13B-139. ^H

Anliprrln, eruptiona from, 68.

Callosity, 138. ^H

263 ^m

264

INDEX.

Callous. 138.

Callus/ 138.

Cancer, epithelial, 217.

skin, 217.
Canities, 166.

pnematura, 106.

senilis, 166.
Carbuncle, 64.
Carbunculus, 64-66.
Carcinoma epitheliale, 217.
Chafing, 46.
Chapping, 95,
Charbon, 66.
Cheiru-pompholyx, 69.
Cheloid, 176.
Chloasma, 182-184.

uterinum, 133.
Chloral, eruptions from, 58.
Chromidrosis, 85.
Chromophytosis, 239.
Chrysarobin, 86.

Chnrsophfinic acid (chrysarobin), 86.
Cicatrices, 24.
Cimex lectularius, 268.
Classification, 28-81.
Clavus, 189-140.
Comedo, 40-48.

extractor 42.
Condyloma, flat (or broad), 201.

pointed, 143.
Configuration, 24.
Contagious impetigo, 121.
Contagiousness, 27.
Copaiba, eruptions from, 58.
Corn, 139.
Cornu cutaneum, 141-142.

humanum, 141.
Crab-louse, 250.
Crusta lactca, 93.
Crustse, 24.
Crusts, 24.

Cubebs, eruptions from, 58.
Culex, 258.
Cuniculus, 243.
Curette, 194.
Cutaneous calculi, 43.

horn, 141.
Cutis ansorina, 135.

pendula, 161.
Cyst, sebaceous, 44.
Cysticercus cellulosa}, 251.

r\ANDRUFF, 36, 37.

*^ Defluvium cupillorum, 1G7.

Demodex foUiculorum, 41.
Depilatories, 152.
Dermalgia, 224.
Dermatalgia, 224.
Dermatitis, 55-60.

acute general, 88.

calorica, 56.

contusiformis, 50.

exfoliativa, 88-89.
general, 88.
recurrent, 88.

gangrsenosa, 60.

herpetiformis, 76-79.

medicamentosa, 57.

papillaris capillitii, 119-120.

traumatica, 55.

venenata, 56.

malignant papillary, 221.
Dermatolysis, 161.
Dermatomyoma, 181.
Dormatosclerosis, 155.
Dermatosyphilis, 198.
Digitalis, eruptions from, 59.
Disorders of the glands, 28, 81-45.
Dissection wound, 66.
Distribution and configuration,24-26.
Drug eruptions (dermatitis medica-
mentosa), 57.
Duhring's disease, 76.
Dysidrosis, 69.

ECTHYMA, 128-124.
Eczema, 92-106.
Eczema erythematosum, 92.

fissum, 95.

impetiginosum, 93.

madidans, 94.

marginatum, 231.

papulosum, 93.

pustulosum, 93.

rubrum, 94.

sclerosum, 96.

seborrhoicum, 37, 88, 96.

squamosum, 94.

verrucosum, 96.

vesiculosum, 93.
Electrolysis in removal of hair, 153
Elephant log, 158.
Elephantiasis, 158-161.

Arabum, 158.

Graecorum, 213.
Endemic verrugas, 67.
Epidermis, 18.

INDEX.

265

Epilating forceps, 229.
Epithelial cancer, 217.
Epithelioma, 217-220,

moUnscum, 135.
Eqninia, 67.
Erasion, 195.
Eruptions, feigned (artificial), 60.

medicinal (dermatitis medica-
mentosa), 57.
Eiysipehis, 61-62.

ambulans, 61.

migrans, 61.
Erythema, 45.

annulare, 48.

bullosum, 48.

caloricum, 45.

desquamative scarlatiniform, 88.

gyratum, 48.

intertrigo, 46-47.

iris, 48.

marginatum, 48.

multiforme, 47-49.

nodosum, 50-51.

recurrent exfoliative, 88.

simplex, 45-46.

solace, 45.

traumaticum, 45.

venenatum, 45.

vesioulosum, 48.
Erythrasma, 241-242.
Excessive sweating (hyperidrosis), 31.
Exooriationes, 24.
Excoriations, 24.

FARCY, 67.
Favus, 227.
Favus of general surface, 228.

of nails, 228.

of scalp, 227.
Feigned eruptions, 60.
Fever blisters, 71.
Fibroma, 177-179.

molluscum, 177.
Fibromyoma, 181.
Filaria^ 160.

medinensis, 251.
Fish-skin disease, 148.
Fissures, 24.
Flea, common, 254.

sand, 253.
Flesh- worms, 40, 41.
Folliculitis barbae, 116.
Forceps, epilating, 229.

Fragilitas crinium, 172.
Framboesia, 67.
Freckle, 131.
Frost-bite, 56.
Fungous foot of India, 197.
Furuncle, 62.
Funinculosis, 63.
Furunculus, 62-64.

GAD-fly, 253.
Galvano-cautery, 194.
Galvano-cautery battery, 193.

handle, 192.

instruments, 192.
Gangrene of the skin, (dermatitis

gaogrsBUOsa), 60.
Gelatin dressing, 105.
Gelatole plaster, 106.
Giant urticaria, 53.
Glanders, 67.
Glands, sebaceous, 36.

sweat, 31.
Glossy skin, 174.
Gnat, 253.
Goose-flesh, 135.
Grayness of the hair, 1 66.
Grutum, 43.
Guinea-worm, 251.
Gumma, 208.
Gutta-percha plaster, 106.

HAIR, 21.
atrophy of, 171.

graying of, 166.

hypertrophy of, 151.

superfluous, 151.
Hair-follicle, 21.
Hairy people, 151.
Harvest mite, 252.
Heat- rash, 67.
Hemorrhages, 29, 128-181.
Hereditary infantile syphilis, 208.

cutaneous manifestations of, 209.
Herpes, 71.

facialis, 72.

gestationis, 76.

iris, 75-76.

labialis, 72.

prseputialis, 72.

progenitalis, 72.

simplex, 71-78.

zoster, 78-75.

^P 266 ^J^^^^^^l

HirmtiM, lil.
HJTes, SI.

Enmines piloiri, 151.

Horn, CQtoncous, lil.

^^1

HjdroB, Tfl.

Leaione, 22. ^^H

UTponeelliesU, S24.
Hjijeridrosis, 31-88.

sonsetubTC, 23. ^^H

HjpertricbOEU, 161-lH.

Hjpertrophia, 2U, 131-181.
Hypertrophia Bcor, 177.

olomentary, 22. ^H
primary, S2. ^^H

Hypertrophy of tho hair, 15!.

teeminij, 93. ^^|

nail, 150.

Leai»patbia,163. ^H

Lichen pilaris, 134. ^^M

TCHTHTOSIS, 148-lSO.
1 hjitrii, 1*8.

planus, ^^^^^^M

ruber, 89-91. .^^^^^H

eehuffi, 38.

90. ^^^^H

nu,p[ex. US.

Impetigo, 180-121.

aouttgiora, 1SU1Z3.

urUcaCus, 52. ^^^^^^H

herpiitiformiB, 183.

Bimplei, 120.

Linear WHrieaalion, IM. ^^M

Liomjoma cutis, 181. ^^M

Lii^uoF catbonis detereena, IDS. ^^M

lodidee, eruptions from, 59

Itoh, 242.

Louse, body (podiDuluB corporia), SJ^^H

bwber'a. 233.

clothes [podiouliu oorpori*}, >^^H

init». 252.

^^M

iiodee, aea.

bead (pediculQs eapltii), S4S. ^H
LouBiness, ^46. ^H

Lupus. 188. ^M

TIQGEB, 2S3.

cxedeni, ISE, 1S9. ^H

T7EL0ID, 178-177.
A. nicatrieial, 176.

exfoliativa, 189. ^^B

ciBloeraag, ISB. ^^H

fBhie,17«.

hypertrophiotu, 199. ^^^H

of Addiuin, 15«.

sebaoeus, ISi. ^^M

of Alihert, 178.

ulaeralions, 1S9. ^H

spoil tftUBOUB, 176.

verrueo™8, IHB. ^H

Kertttoma, 138.

Tui^ris, I'ss-ies. ^H

plhirie. 134-13S.

tuberoBum multiplex, ISg. ^^H

Korion. 233.

Lvmphaneiectodee, 183. ^^H

T AND MurT-y, 123.
JU Lanugo, 169.

11ACUL.S, 22. ^^1
m Dt stria! atrophies, 175. ^^M

Lentigo, 131-132.

Leontiasis, 214.

Mai^ulcri. 32. ^^H

Lepra, 213-216.

Madura foot, 197. ^^M

Le|iro.y.213.

^^^^^^^^^^^^^^^^^M

^^^^^^^^^^^^^^^H

^^^^^^^^^^^^^^^H INDEIE. 26? '^^^1

Nettle-ruah, 51.

Neuralgia ,]f Ihe akin, 224.

Neuroms, 179.

Hateanik, 132.

Ncuroaes, 30, 224-228.

Merourr, eroptiona from, Sfl.

Sita, 247,

Mffinria, 87-«9.

.Ite, 88.

o-'Sss'&r'""-"'

crjsWIma, 33.

rubrs, 68.

Ointment biiaea, 2T.

Milium, 43-44.

Onychatropbia. 172.
OnyehauitB, lM-181.

nBffllle, «.

Mill! omal, 93.

OnycbomyiKais, 17S.

Mile, hurrert, 252.

fsvow, 228.

itch, iU.

Opium, eniptions from, 59.

MoiBtpapulB. 200, 201.

OsmldroBU, 34.

Ova of pediculi, 247.

epitheliale, 136-138.

fibroBum, 177.

DAPILL*,, norvona nnd Tssrular,

r 20.

sohaoBum, 135.

Horpbik, eruptions fmm, 90.

Pachydermia, 158.

Morplic™, 1S6-188.

Pngefa disease of the nipplo, 221.

Muaquito, Z&3.

Paputo, 23.

Mucous paleh, 201.

Papule, moist, 200, 201.

MyeetomE, 197.

Papulea, 23.

PuDsitio DfTections, 31, 227-SM.

Myomi, 181.

BjocaiB, 233,

cutis, 181.

tolangieotodos, 181,

Psrohmeat akin, 17*.

FaTODRihia, 150,

Patoh. mu«>ua,201.

Pedimiloaia, 248.

TtraiVUS »mnou9, 133.
il eapillaiy, ISl.

ea|>iltitii, 24fl.

e^itla. 246-248.

finuxneia, 181.

eorporis, S48-2S0,

pufis, 250-261.

Pediculua cupitia, 247.

pilcna, 147, 151.

t-jrporis, 249.

BMgnineaa, 181,

ilmplei, 181.

yeatimenti, 243.

ipilui, 147.

Pelioaia rheumatioa, 12S.

.pid*;. 183.

Pallaitra, 217.

tobaroaua, 182.

folUueua, 125.

naoai, 182.

TOlgflris, 125.

verruooBue, 14 J.

prnriginoauB, 76.

Kail, atniphy of, 172.

Perforating uloer of the toot. IST-

n'exdlc-^older fnr eiectral;ii<, 153.

IBB.

268

INDEX.

Phtheiriasis, 246.

Plan, 67.

Pityriasis maculata et circinata, 87.

pilaris, 134.

rosea, 87-88.

rubra, 89.

versicolor, 239.
Plaster-mull, 106.
Podelcoma, 197.

Poison dogwood, dermatitis from,
56.

ivy, dermatitis from, 56.

sumach, dermatitis from, 56.

vine, dermatitis from, 56.
Pomphi, 23.
Pompbolyx, 69-71.
Port-wine mark, 182.
Post-mortem pustule, 66.

tubercle, 145.

wart, 145.
Prickly beat, 67.
Primary lesions, 22-23.
Prurigo, 106-107.
Pruritus, 224-226.

ani, 225.

biemalis, 225.

scroti, 225.

senilis, 225.

vulvae, 225.
Psoriasis, 79-87.

circinata, 81.

diffusa, 81.

guttata, 81.

gyrata, 81.

inveterata, 81.

nummularis, 81.

punctata, 81.

syphilitica, 201.
Pulex irritans, 254.

penetrans, 253.
Punctate scarification, 195.
Purpura, 128-130.

hsBmorrhagica, 129.

rheumatica, 128.

simplex, 128.

scorbutica, 130.

urticans, 128.
Pustula maligna, 66.
Pustulae, 23.
Pustules, 23.

AUININE, eruptions from, 59.

RAPIDITY of cure, 27.
Relative frequency, 26.
Rhagades, 24.

Rheumatism of the skin, 224.
Rhinophyma, 114.
Rhinoscleroma, 188-184.
Rhus poisoning, 56.
Ringworm, 230.

of bearded region, 233.

of general surface, 231.

of the nails, 231.

of the scalp, 232, •

of the thighs and scrotum, 231.
Rodent ulcer, 217.
Rosacea, 183.

acne, 114.
Rubber plaster, 106.
Rupia, 205, 206.

SALICYLIC acid, eruptions from,
60.
Sand flea, 253.
Sarcoma, 222-228.

cutis, 222.
Sarcoptes scabici, 244.
Scabies; 242-246.
Scarification linear, 194.

punctate, 195.
Scales, 24.
Scarifier, single, 188.

multiple, 188.
Scars, 24.

hypertrophic, 177.
Sclerema, 155.

neonatorum, 154-155.

of the newborn, 154.
Scleriasis, 155.
Scleroderma, 155-156.

circumscribed, 156.

neonatorum, 154.
Scorbutus, 130-131.
Scrofuloderma, 195-196.
Scurvy, 130.

land, 129.

sea, 130.
Sebaceous cyst, 44.

gland, 36.

tumor, 44.
Seborrhoea, 86-40.

congestiva, 184.

oleosa, 37.

sicca, 37.
Secondary lesions, 23-24.

INDEX.

269

Shingles, 73.

Skin, anatomy of, 17.

cancer, 217.

general idiopathic atrophy of,
174.

glossy, 174.

looseness of, 161.

parchment, 174.
Spider naevos, 183.
Spots, 22.
SquamsB, 24.
Staijis, 24.
Statistics, 260-261.
Steatoma, 44-45.
Steatorrhoea, 36.
Stramonium, eruptions from, 60.
StrisB et maculse atrophicse, 175.
Strophulus alhidus, 43.
Strychnia, eruptions from, 60.
Subjective syniptoms, 22.
Sudamen, 83-o4.
Superfluous hair, 151.
Sweat glands, 31.

colored (chromidrosis), 35.

phosphorescent, 35.
Sweating, excessive, 31.
Sycosis, 116-119.

non-parasitica, 116

parasitic, 233.
Symptomatology, 22-26.
Symptoms, objective, 22.

subjective, 22.

systemic, 22.
Syphilis, hereditary, 209.

eruptions of, 209.

cutanea, 198-213.

early eruptions of, 198.
late eruptions of, 198.
papillomatosa, 207.

of the skin, 198-213.
Syphiloderm, 198, 199.

acne-form, 203.

annular, 202.

bullous, 205, 209.

circinate, 202.

ecthyma-form, 204.

erythematous, 199, 209.

gummatous, 208.

impetigo -form, 204.

large acuminated-pustular, 203.

large flat-pustular, 204.

large papular, 200.

lenticular, 200.

macular, 199, 209.

Syphiloderm, miliary papular, 199.

miliary pustular, 203.

non-ulcerating tubercular, 206.

palmar, 201, 2U2.

papular, 199, 209.

papulo-squamous, 201.

plantar, 202.

pustular, 203.

serpiginous tubercular, 206.

small acuminated-pustular, 203.

small flat-pustular, 204.

small papular, 199.

squamous, 201.

tubercular, 206.

ulcerating tubercular, 206, 207.

variola -form, 203.

vegetating, 201.
Syphiloderma, 198.
Syphiloma, 208.

TAR acne, 108.
Telangiectasis, 114, 182-183.
Tetter, 92.
Tinea circinata, 231.
cruris, 231.
favosa, 227-230.

fungus of, 228.
unguium, 228.
kerion, 233.
sycosis, 233.
tonsurans, 232.
triohophytina, 230-238.
barbae, 233.
capitis, 232.
corporis, 231.
cruris, 231.
fungus of, 234.
unguium, 231.
versicolor, 239-241.
fungus of, 240.
Traumaticin, 86.
Trichorexis nodosa, 172.
Trichophyton, 234.
Tubercle, anatomical, 145.
Tubercles, 23.
Tubercula, 23.

Tuberculosis of the skin, 188.
Tuberculosis verrucosa cutis, 1 45.
Tumor, sebaceous, 44.
Tumors, 23.

Turpentine, eruptions from, 60.
Tyloma, 138.
Tylosis, 138.

270

DIBXX.

TTLCEB, rodent, 317.
t/ Uleens 2-L
Uridrosis, 3ft.
Urtieftriay 51-^54.

ImUosa, 53.

diroiiie,52.

hsemorriiagum, 52.

papoIoBS, 52.

taberQ«^ 52.

fiant, 53.

pigmentoflBy ftft.

VK^KKEAL wart, 143.
▼ Yerroea, 143-^145.
Yonmca acnminata, 143.

digitata, 143.

ftliformis, 143.

neerogenica, 145-146.

plana, 143.

senilis, 143.

yulgaris, 143.
Yermgas, endemic, 67.
Yesides, 23.
Yesicolae, 23.
Yitiligo, 163-16S.
YitUigoidea, ISO.
YIeminckx'a solution, 116.

WAST, 143.
pointed, 143.
post-mortem, 145.
yenereal, 143.
Wen, 44.
Wheals, 23.
Wood-tick, 252.
Wound, dissection, 66.

XAyTHELASMA, ISO.
XanthelasmouiBa, 55.
Xantiioma, 180-131.
multiplex, ISO.
plannm, 130.
tobercnlatnm, ISO.
tuberosum, ISO.
Xeroderma, 14S.

pigmentoBom, 174^

AWS, 67.

rNA, 73.
Zoster, 73.

{

T74 Stelwagon, H.W. 81185
S82 Essentials of diseases
1890 of the skin.

NAUE

DATB DUB

■" "" :^

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