'TRAITE PRATIQUE DES MALADIES DE LA PEAU; DIAGNOSTIC ET TRAITEMENT.'
Par M. Le Docteur E. Guibot, Medecin De L' Hopital Saint Louis,
Paris, etc.
This, the fourth work which the author has written on dermatology, is
intended to present, in a clear and concise way, a resumé of the more
voluminous books which have preceded it. Unfortunately the dermatology
of to-day, as it appears in the English language, is drawn largely from
the precepts of the Vienna school. In fact, since the little volume of
Robert Liveing, which appeared in London about eight years ago, there
has been no truly English or American treatise on the subject; although
books on diseases of the skin have appeared in quick succession, they
have been vague echoes from the _Krankenhaus in Wien._ Do not think from
this that I undervalue the original work done by the great teachers of
local dermatology, for they have taken vast strides in the advancement
of the science, but other lines of thought and investigation are needed
to broaden the scope of the earnest student. The work before me, as its
name implies, is a practical treatise on diseases of the skin, of about
four hundred pages, with especial attention to diagnosis and treatment.
To facilitate the former, the author has grouped cutaneous maladies
which are alike in nature into what he calls _Diatheses_, of which the
syphilitic, scrofulous, herpetic, cancerous and the congestive are dwelt
upon. In differentiating the scrofulous from the syphilitic diatheses,
the author says: “In the third stage of syphilis, as we have said, the
work of destruction starts from within, attacking first the deeper
structures, as the periostium cartilage and bone, whereas scrofula
pursues the same destructive course inversely; that is to say, from the
superficial to the deep parts. This consideration, upon which we cannot
insist too strongly, is of the greatest importance in diagnosis. For
example, if syphilis attacks the nose, the part first involved is the
mucous membrane of the nasal fosæ, then the nasal bones and cartilages,
which may become completely destroyed before the process subsides,
leaving the nose flattened but the skin intact. In scrofula the work of
disorganization begins in the superficial parts—the skin—and not until
the part involved is completely destroyed does it proceed to those which
are deeper, viz., the cartilage and bone. Again, it may be seen that the
destruction is more complete in scrofula than in syphilis. This is
especially true of the skin, for syphilis has at least a respect for
this organ, which scrofula has not.”
After establishing, as he says, “the principles upon which the
scrofulous diathesis is founded,” he proceeds to enumerate the different
_scrofulides_ of the skin as follows: 1, Erythematous; 2, Phlegmonous;
3, Pustulo-crustaciæ; 4, Tuburcular; 5, Rupiform; 6, Ulcero-gumatous.
THE HERPETIC DIATHESES.—“The distinctive feature of prime import in
herpetic lesions (_herpidites_) is their duration. In the two diathesis
we have just considered we have said that the _scrofulides_ are
continuous in their duration; they present no interruption, no
intermittance; whereas the _syphilides_ are essentially intermittent;
they disappear spontaneously, or under the influence of treatment, and
reappear without regularity or periodicity. Their intervals of latency
are variable, often regulated by the change of season, especially liable
to reappear in the springtime, and sometimes after many years of
complete immunity.
“The _herpidites_ combine in their evolution the two characters of
intermittency and chronicity. At their commencement they are
intermittent; in the second stage, which occurs after a certain though
variable period, they assume the character of chronicity.” The author
further divides the _herpidites_ into benign and malignant. Under the
former are included herpes, impetigo, lichen, eczema and psoriasis; the
latter includes pemphigus, cachectic rupia and prurigo senilis
formicans. The cancerous and the congestive diatheses follow, after
which the exanthemata and the cachectic diseases of the skin.
SYMPTOMATIC AFFECTIONS OF THE SKIN, arising from pathological,
physiological and psychological disturbances are probably of more
interest than any other group, because here one finds so many things not
even mentioned in most works on dermatology, and because this class of
affections seems destined more and more to be a common inherent of
American life.
“These diseases, which are called diseases of the skin, are not so in
reality. They belong more or less to the entire organism, revealing
themselves upon the external integument with visible and palpable
peculiarities which enable us to form an opinion as to their true
nature. Considering the subject from this point of view, dermatology is
therefore one of the most important branches of pathology; it is the
torch which throws light on many morbid conditions which otherwise would
remain obscure, vague and unsettled. But dermatology is more than this;
it is the index, the external manifestation of disturbances which may be
physiological or pathological, superficially or deeply seated. It is
still more, for it is the visible expression of certain psychological
emotions and moral states which are reflected upon the skin, there to be
interpreted by the observing student.” This part of the work ends with a
chapter on dermatoses of local origin, which includes parasitic
affections.
The book concludes by taking up the treatment of the different diseases
one by one. In the treatment of syphilis the author says: “The
preparation of mercury to which we give the preference is the proto
iodide. It is less dangerous, more soluable in the stomach and more
easily assimilated. It should never be given to exceed three
centigrammes a day.”
Time forbids further details. I will simply say the book is a good one,
and will well repay careful study. Arrangements have been made with the
author and his publishers to translate the work into English.