apex of the boil may be tried if the formation is more advanced. If
suppuration is fully established, evacuation of the contents, followed
by antiseptic applications, constitutes the best method.
A saturated solution of boric acid or a lotion of corrosive sublimate
(one to three grains to the ounce) applied to the immediate neighborhood
of the boil or boils tends to prevent the formation of new lesions.
Frequent washing of the parts with soap and water or tincture of green
soap and water is also a preventive measure of value. In repeatedly
infected areas, mild exposures to _x_-rays, at intervals of a few days,
will often prove of curative value.
#Carbunculus.#
(_Synonyms:_ Anthrax; Carbuncle.)
#What is carbuncle?#
A carbuncle is an acute, usually egg to palm-sized, circumscribed,
phlegmonous inflammation of the skin and subcutaneous structures,
terminating in a slough.
#At what age and upon what parts is carbuncle usually observed?#
In middle and advanced life, and more commonly in men.
It is seen most frequently at the nape of the neck and upon the upper
part of the back.
#What are the symptoms and course of carbuncle?#
There is rarely more than one lesion present. It begins, usually with
preceding and accompanying malaise, chilliness and febrile disturbance,
as a firm, flat, inflammatory infiltration in the deeper skin and
subcutaneous tissue, spreading laterally and finally involving an area
of one to several inches in diameter. The infiltration and swelling
increase, the skin becomes of dark red color, and sooner or later,
usually at the end of ten days or two weeks, softening and suppuration
begin to take place, the skin finally giving away at several points,
through which sanious pus exudes; the whole mass finally sloughs away
either in portions or in its entirety, resulting in a deep ulcer, which
slowly heals and leaves a permanent cicatrix.
In some cases, especially in old people, constitutional disturbance of a
grave character is noted, septicaemia is developed, and a fatal result
may ensue.
#What is the cause of carbuncle?#
The same causes are considered to be operative in carbunculus as in
furuncle; general debility and depression, from whatever cause,
predisposing to its formation, and the introduction of a microbe,
probably the same as in furunculus, being at present looked upon as the
exciting factor.
#What is the pathology?#
The inflammation starts simultaneously from numerous points, from the
hair-follicles, sweat-glands or sebaceous glands. The inflammatory
centres break down, and the pus finds its way to the surface; finally
the process ends in gangrene of the whole area.
#How would you distinguish carbuncle from a boil?#
By its flat character, greater size, and multiple points of suppuration.
#What is the prognosis of carbuncle?#
Occurring in those greatly debilitated or in late life, and in those
cases in which two or more lesions exist, or when seated about the head,
the prognosis is always to be guarded, as a fatal result is not
uncommon. In fact, in every instance the disease is to be considered of
possible serious import.
#What constitutional treatment is usually employed in carbuncle?#
A full nutritious diet, the use of such remedies as iron, quinia, nux
vomica, with malt and stimulants, if indicated. Calx sulphurata,
one-tenth to one-fourth grain every two or three hours, appears, in some
instances, to have a beneficial effect. If the pain is severe, morphia
or chloral should be given.
#What external measures are employed?#
In the early part of the formation, injection of a five or ten per cent.
carbolic acid solution, or covering the whole area with a twenty-five
per cent. ichthyol ointment, may be employed. When it has broken down
the pus may be drawn out with a cupping-glass, and carbolized glycerine
or carbolized water introduced into each opening, and the ichthyol
ointment superimposed. If the whole part has sloughed, it should be
removed as rapidly as possible, and antiseptic dressings used. Or, if
its progress is slow, and grave systemic disturbance be present, the
whole part may be incised and curetted, and then treated antiseptically.
Mild exposure to the _x_-rays is also to be commended.
#Pustula Maligna.#
(_Synonyms:_ Anthrax; Malignant Pustule.)
#What is malignant pustule?#
Malignant pustule is a furuncle- or carbuncle-like lesion resulting from
inoculation of the virus generated in animals suffering from splenic
fever, or "charbon," and is accompanied by constitutional symptoms of
more or less gravity. A fatal termination is not unusual.
#What is the cause of pustula maligna?#
The disease is due to the presence of the bacillus anthracis.
#What is the treatment of malignant pustule?#
Early excision or destruction with caustic potash, with subsequent
antiseptic dressings; and internally the free use of stimulants and
tonics.
#Post-mortem Pustule.#
(_Synonym:_ Dissection Wound.)
#Describe post-mortem pustule.#
Post-mortem pustule develops at the point of inoculation, beginning as
an itchy red spot, becoming vesico-pustular, and later pustular, with
usually a broad inflammatory base, and accompanied with more or less
pain and redness and not infrequently lymphangitis, erysipelatous
swelling, and slight or severe sympathetic constitutional disturbance.
#What is the treatment of post-mortem pustule?#
Treatment consists in opening the pustule and thorough cauterization,
and the subsequent use of antiseptic applications or dressings.
_Internally_ quinia and stimulants if indicated.
#Framb[oe]sia.#
(_Synonyms:_ Yaws; Pian.)
#Describe framb[oe]sia.#
Framb[oe]sia is an endemic, contagious disease met with in tropical
countries, characterized by the appearance of variously-sized papules,
tubercles, and tumors, which, when developed, resemble currants and
small raspberries, and finally break down and ulcerate. It is
accompanied by constitutional symptoms of variable severity.
Hygienic measures, good food, tonics, and antiseptic and stimulating
applications are curative.
#Verruga Peruana.#
(_Synonyms:_ Peruvian Warts; Carrion's Disease; Oroya Fever.)
#Describe verruga peruana.#
A specific inoculable affection endemic in some valleys of the Western
Andes, in Peru, and characterized by a prodromal febrile period and
subsequent outbreak of peculiar pin-head- to pea-sized, or larger,
bright reddish, rounded, wart-like elevations. The prodromal symptoms,
of an irregular malarial or typhoid type, with associated rheumatic and
muscular pains, may last for weeks or several months, usually abating
when eruption presents. The lesions may be crowded together in great
bunches. The face and limbs are favorite localities. The disease is
inoculable and thought to be due to a bacillus.
The fatality varies between 10 and 20 per cent. Tonics and stimulants
are prescribed.
#Equinia.#
(_Synonyms:_ Farcy; Glanders.)
#What is equinia, or glanders?#
A rare contagious specific disease of a malignant type, derived from the
horse, and characterized by grave constitutional symptoms, inflammation
of the nasal and respiratory passages, and a deep-seated
papulo-pustular, or tubercular, nodular (_farcy buds_), ulcerative
eruption. A fatal issue is not uncommon. It is due to a micro-organism.
Treatment, both local and constitutional, is based upon general
principles.
#Miliaria.#
(_Synonyms:_ Prickly Heat; Heat Rash; Lichen Tropicus; Red Gum;
Strophulus.)
#What do you understand by miliaria?#
An acute mildly inflammatory disorder of the sweat-glands, characterized
by the appearance of minute, discrete but closely crowded papules,
vesico-papules, and vesicles.
#Describe the symptoms of miliaria.#
The eruption, consisting of pin-point to millet-seed-sized papules,
vesico-papules, vesicles, or a mixture of these lesions, discrete but
usually numerous and closely crowded, appears suddenly, occurring upon a
limited portion of the surface, or, as commonly observed, involving a
greater part or the whole integument. The trunk is a favorite locality.
The papular lesions are pinkish or reddish, and the vesicles whitish or
yellowish, surrounded by inflammatory areola, thus giving the whole
eruption a bright red appearance--_miliaria rubra_. Later, the areolae
fade, the transparent contents of the vesicles become somewhat opaque
and yellowish-white, and the eruption has a whitish or yellowish
cast--_miliaria alba_. In long-continued cases, especially in children,
boils and cutaneous abscesses sometimes develop; and it may also develop
into a true eczema.
Itching, or a feeling of burning, slight or intense, is usually present.
#What is the course of the eruption?#
The vesicles show no disposition to rupture, but dry up in a few days or
a week, disappearing by absorption and with slight subsequent
desquamation; the papular lesions gradually fade away, and the
affection, if the exciting cause has ceased to act, terminates.
#What is the cause of miliaria?#
Excessive heat. Debilitated individuals, especially children, are more
prone to an attack. Being too warmly clad is often causative.
#What is the nature of the disease?#
The affection is considered to be due to sweat-obstruction, with mild
inflammatory symptoms as a cause or consequence, congestion and
exudation taking place about the ducts, giving rise to papules or
vesicles, according to the intensity of the process.
#How would you distinguish miliaria from papular and vesicular eczema,
and from sudamen?#
The papules of eczema are larger, more elevated, firmer, slower in their
evolution, of longer duration, and are markedly itchy.
The vesicles of eczema are usually larger, tend to become confluent, and
also to rupture and become crusted; there is marked itchiness, and the
inflammatory action is usually severe and persistent.
In sudamen there is absence of inflammatory symptoms.
#What is the prognosis of miliaria?#
The affection, under favorable circumstances, disappears in a few days
or weeks. If the cause persists, as for instance, in infants or young
children too warmly clad, it may result in eczema.
#What is the treatment of miliaria?#
Removal of the cause, and in debilitated subjects the administration of
tonics; together with the application of cooling and astringent lotions,
as the following:--
[Rx] Aeidi carbolici, ..................... [dram]ss-[dram]j
Acidi borici, ........................ [dram]iv
Glycerinae, ........................... f[dram]j
Alcoholis, ........................... f[Oz]ij
Aquae, ................................ [Oz]xiv. M.
This is sometimes more efficient if zinc oxide, six to eight drachms, is
added.
Lotions of alcohol and water or vinegar and water, and also the various
lotions used in acute eczema, are often employed with relief.
Dusting-powders of starch, boric acid, lycopodium, talc, and zinc oxide
are also valuable; the following combination is satisfactory:--
[Rx] Pulv. acidi borici,
Pulv. talci veneti,
Pulv. zinci oxidi,
Pulv. amyli, .............[=a][=a].....[dram]ij. M.
Probably the best plan is to use a lotion and a dusting-powder
conjointly; dabbing on the wash freely, allowing it to dry, and then
dusting over with the powder.
#Pompholyx.#
(_Synonyms:_ Dysidrosis; Cheiro-pompholyx.)
#What is pompholyx?#
Pompholyx is a rare disease of the skin of a vesicular and bullous
character, and limited to the hands and feet.
#Describe the symptoms of pompholyx.#
In most instances the hands only are affected. It begins usually with a
feeling of burning, tingling or tenderness of the parts, followed
rapidly by the appearance of deeply-seated vesicles, especially between
the fingers and on the palmar aspect. These beginning lesions look not
unlike sago grains imbedded in the skin. In some instances the disease
does not extend beyond this stage, the vesicles disappearing after a few
days or weeks by absorption, and usually without desquamation.
Ordinarily, however, the lesions increase in size, new ones arise,
become confluent, and blebs result, the skin in places appearing as if
undermined with serous exudation. The 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
declines, recovery gradually taking place.
There are no constitutional symptoms, although it is usually noticed
that the general health is below par.
#What is the character of the subjective symptoms in pompholyx?#
The subjective symptoms consist of a feeling of tension, burning and
tenderness, and sometimes itching. Not infrequently, also there is
neuralgic pain.
#What is the cause of pompholyx?#
The eruption is thought to be due to a depressed state of the nervous
system. It is more common in women, and is met with chiefly in adult and
middle life.
#What is the pathology?#
Opinion is divided; some considering it a disease of the sweat-glands
and others an inflammatory disease independent of these structures.
#State the diagnostic features of pompholyx.#
The distribution and the peculiar characters and course of the eruption.
It is to be differentiated from eczema.
#What is the prognosis?#
For the immediate attack, favorable, recovery taking place in several
weeks or a few months. Recurrences at irregular intervals are not
uncommon.
#What is the treatment of pompholyx?#
The general health is to be looked after, and the patient placed under
good hygienic conditions. Remedies of a tonic nature, directed
especially toward improving the state of the nervous system, are to be
prescribed. _Locally_, soothing and anodyne applications, such as
lead-water and laudanum, boric-acid lotion, oxide-of-zinc, boric-acid
and diachylon ointments, are most suitable; or the parts may be
enveloped with the following:--
[Rx] Pulv. ac. salicylici, ................ gr. x
Pulv. ac. borici,
Pulv. amyli, .......... [=a][=a] ..... [dram]ij
Petrolati, ........................... [dram]iv. M.
In fact, the external treatment is similar to that employed in acute
eczema.
#Herpes Simplex.#
(_Synonym:_ Fever Blisters.)
#What is herpes simplex?#
An acute inflammatory disease, characterized by the formation of
pin-head to pea-sized vesicles, arranged in groups, and occurring for
the most part about the face and genitalia.
#Describe the symptoms of herpes simplex.#
In severe cases, malaise and pyrexia may precede the eruption, but
usually it appears without any precursory or constitutional symptoms. A
feeling of heat and burning in the parts is often complained of. The
vesicles, which are commonly pin-head in size, are usually upon a
hyperaemic or inflammatory base, and tend to occur in groups or clusters.
Their contents are usually clear, subsequently becoming more or less
milky or puriform. There is no tendency to spontaneous rupture, but
should they be broken a superficial excoriation results. In a short time
they dry to crusts which soon fall off, leaving no permanent trace.
#Is the eruption in herpes simplex abundant?#
No. As a rule not more than one or two clusters or groups are observed.
#Upon what parts does the eruption occur?#
Usually about the face (_herpes facialis_), and most frequently about
the lips (_herpes labialis_); on the genitalia (_herpes progenitalis_),
the lesions are commonly found on the prepuce (_herpes praeputialis_) in
the male, and on the labia minora and labia majora in the female.
#State the causes of herpes simplex.#
Herpes facialis is often observed in association with colds and febrile
and lung diseases. Malaria, digestive disturbance, and nervous disorders
are not infrequently predisposing factors. Herpes progenitalis is said
to occur more frequently in those who have previously had some venereal
disease, especially gonorrh[oe]a, 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
characteristic. The same holds true ordinarily when the eruption is seen
on the prepuce or other parts of the genitalia; it is only when the
vesicles become rubbed or abraded and irritated that it might be
mistaken for a venereal sore, but the history, course and duration will
usually serve to differentiate.
#Give the prognosis.#
The eruption will usually disappear in several days or one or two weeks
without treatment. Remedial applications, however, exert a favorable
influence. Herpes progenitalis exhibits a strong disposition to
recurrence.
#What is the treatment of herpes facialis?#
Anointing the parts with camphorated cold cream, with spirits of camphor
or similar evaporating and stimulating applications will at times afford
relief to the burning, and shorten the course.
#What is the treatment of herpes progenitalis?#
In herpes about the genitalia cleanliness is of first importance. A
saturated solution of boric acid, a dusting-powder of calomel or oxide
of zinc, and the following lotion, containing calamine and oxide of
zinc, are valuable:--
[Rx] Zinci oxidi,
Calaminae, .......... [=a][=a] ........ gr. v
Glycerinae,
Alcoholis, ......... [=a][=a] ........ [minim]vj
Aquae, ................................ [Oz]j M.
In obstinate recurrent cases, frequent applications of a mild galvanic
current will have a favorable influence.
#Hydroa Vacciniforme.#
(_Synonyms:_ Recurrent Summer Eruption; Hydroa Puerorum; Hydroa
Aestivale.)
#Describe hydroa vacciniforme.#
It is a rare vesicular disease usually seen in boys (only two or three
exceptions), occurring upon uncovered parts, especially the nose,
cheeks, and ears. The lesions begin as red spots, discrete or in groups,
rapidly exhibit vesiculation, and later umbilication; the contents
become milky, dry to crusts, which fall off and leave small pit-like
scars. Fresh outbreaks may take place almost continuously, and the
process go on indefinitely, at least up to youth or manhood, when the
tendency subsides. Its activity is usually limited to the warm season.
Arthritic symptoms and general disturbance are sometimes noted in severe
cases.
It is doubtless a vasomotor neurosis. Exposure to sun and wind is an
important, if not essential, etiological factor. Primarily the lesion
begins in the rete middle layers, and is purely vesicular in character;
later, necrosis of the rete and extending deep in the corium is
observed.
Treatment so far has only been palliative, consisting of the
applications employed in similar conditions. Constitutional medication
is based upon general principles. The patient should avoid exposure to
the sun, strong wind and excessive artificial heat.
#Epidermolysis Bullosa.#
#Describe epidermolysis bullosa.#
This is a rare, usually hereditary, disease or condition, characterized
by the formation of vesicles and blebs on any part subjected to slight
rubbing or irritation. No scarring is left, and no pigmentation noted.
The predisposition to these lesions persists indefinitely. The general
health is not involved. The nature of the disease is obscure.
Treatment has no influence in modifying or lessening this tendency. The
vulnerable parts should so far as possible be protected from knocks and
undue friction.
#Dermatitis Repens.#
#What do you understand by dermatitis repens?#
It is a rare spreading dermatitis starting from an injury, extending by
a serous undermining of the epidermis, and usually occurring upon the
upper extremities.
It usually begins shortly after an injury, and, as a rule, presents
itself by redness and serous exudation. The overlying epidermis breaks,
and the area of disease gradually progresses by an extension of the
serous undermining process, the denuded part looking red and raw, with
usually an oozing surface. As the disease spreads the oldest part
becomes dry and heals, the new epidermal covering being thin and
atrophic in appearance. Its most usual beginning is on some part of the
hand, and from here it may spread up the arm and involve considerable
area.
The injury from which it starts may be extremely insignificant,
apparently affording an opening for the introduction of the causative
factor, doubtless parasitic. Beyond a feeling of soreness there seem to
be no special subjective symptoms.
#Give the prognosis and treatment.#
The malady shows but little tendency to spontaneous cure. The frequent
or constant application of a mild antiseptic lotion, such as boric acid
and resorcin, or of a mild parasiticide ointment will generally bring
the disease gradually to an end.
#Herpes Zoster.#
(_Synonyms:_ Zoster; Zona; Shingles.)
#Give a definition of herpes zoster.#
Herpes zoster is an acute, self-limited, inflammatory disease,
characterized by groups of vesicles upon inflammatory bases, situated
over or along a nerve tract.
#Upon what parts of the body may the eruption appear?#
It may appear upon any part, following the course of a nerve; it is
therefore always limited in extent, and confined to one side of the
body. It is probably most common about the intercostal, lumbar and
supra-orbital regions. In rare instances the eruption has been observed
to be bilateral.
#Are there any subjective or constitutional symptoms?#
Yes; there is, as a rule, neuralgic pain preceding, during and following
the eruption; and in some cases, also, there may be in the beginning
mild febrile disturbance. There is also a variable degree of tenderness
and pain.
#What are the characters of the eruption?#
Several or more hyperaemic or inflammatory patches over a nerve course
appear, upon which are seated vesico-papules irregularly grouped; these
vesico-papules become distinct vesicles, of size from a pin-head to a
pea, and soon dry and give rise to thin, yellowish or brownish crusts,
which drop off, leaving in most instances no permanent trace, in others
more or less scarring. In some cases the lesions may become pustular
and, on the other hand, the eruption may be abortive, stopping short of
full vesiculation.
#What is known in regard to the nature of the disease?#
An inflamed and irritable state of the spinal ganglia, nerve tract, or
peripheral branches is directly responsible for the eruption, and this
state may be due to atmospheric changes, cold, nerve-injuries and
similar influences. The view has also been advanced that the disease is
of specific and infectious character.
#Give the chief diagnostic features of herpes zoster.#
The prodromic neuralgic pain, the appearance of grouped vesicles upon
inflammatory bases following the course of a nerve tract, and the
limitation of the eruption to one side of the body.
#What is the prognosis?#
Favorable; the symptoms usually disappearing in two to four weeks. In
some instances, however, the neuralgic pains may be persistent, and in
zoster of the supra-orbital region the eye may suffer permanent damage.
#How would you treat herpes zoster?#