George Henry Fox

“ In the treatment of lichen planus arsenic is often of service, but in this, as in many other affections, it may do harm as well as good; and when there is much irritability of the skin alkaline remedies will be found to be of much greater service. Of the various local remedies which have been highly recommended no one seems to have any special value in all cases. A mild carbolic or salicylic acid lotion may be advantageously used in acute cases, and the same increased in strength when the patches have assumed a chronic character. ”

“ In the treatment of smallpox the therapeutic measures employed must necessarily vary with the severity of the disease and the condition of the patient in its successive stages. No remedy or plan of treatment will apply to all cases and at all times. As in the other exanthemata, there are cases of variola in which the disease runs so mild a course that a little nursing or simple attention to the personal comfort of the patient is all that is absolutely necessary. ”

“ Upon the scalp the lesions of contagious impetigo are frequently found, and usually appear as small, isolated, circular crusts. These frequently occasion temporary areas of partial baldness, and when the disease is of long standing and there is very much suppuration a permanent loss of some hair may result. The affection is often associated with pediculosis capitis, and in such a case the frequent scratching of the head is very apt to multiply the lesions, and often the diagnosis is obscured by the development of eczema upon the scalp and back of the neck. ”

“ The very decided tendency to grouping of lesions upon the face and about the wrists so characteristic of smallpox does not occur in varicella, in which the vesicles may appear even more extensively on the trunk than upon the face. In varicella the palms and the soles, except in infants, are almost never affected; while in smallpox these regions are practically never exempt. It is true that in the extraordinarily mild cases of smallpox, such as have constituted the majority of cases during the past two years throughout the West, lesions may or may not be present on the palms and soles ”

“ In an advanced stage the nodules and patches of lupus become somewhat scaly and not infrequently soften and ulcerate. In chronic cases seen in adult life the disease is often found to have spread over the greater portion of the face, producing a marked ectropion and a partial disappearance of the nose and ears. Such an extensive development of the disease is rarely if ever observed in childhood. Although the face is the most common site of lupus, the trunk and extremities may also be affected, either independently or with the face. ”

“ Humanized virus was, however, open to the objection that it could communicate disease if the child were not perfectly healthy, and as a matter of fact it did communicate syphilis in a certain number of instances. The possibility of this infection was so serious an objection to the use of virus from this source that in the last quarter of the century calf virus, recommended and used in Italy many years before, was gradually substituted for human virus, and at the present time the use of animal virus is general in Europe and in the United States. ”

“ The main object in treating these tumors is to destroy them completely and to excite as little inflammation as possible in so doing. When even a large molluscum is removed by means of the curette no scar or trace of the growth is usually left, since the tumor is an outgrowth of the epidermis and does not involve the true skin. But when an inflamed molluscum is scratched or irritated to the extent of inducing a purulent secretion, a slight pit may be expected to result. ”

“ Period of Invasion.—The disease is usually ushered in by fever, with a distinct chill or chilly sensations, headache, neuralgia, and a general malaise. Frequently the first symptom is a distressing backache. This is located in the lumbar region, but it may be as high up as the lower angle of the scapula, or it may be sacral and extend down into the thighs. The backache is an important symptom when present, but it is not always on hand to help one out in the diagnosis. The backache of smallpox is not peculiar or distinctive, but it is its severity which attracts attention. ”

“ The slight growth of hair which persisted after the affected skin had become smooth and comparatively normal in color was destroyed by the introduction of the electrolytic needle into each separate follicle, according to the method employed in the treatment of superfluous hair. The young man now presents not the slightest deformity of the eyelid, and scarcely a trace, upon close inspection, of the dark, warty, and hairy growth which formerly attracted attention wherever he went and was the source of great mortification. ”

“ Period of Incubation.—During this period, which extends from the date of infection to the appearance of the earliest symptoms of the disease, treatment is rarely demanded, since in the great majority of cases the outbreak of the disease is a surprise, and in no case can it be positively known that a patient has smallpox until the initial symptoms appear, and often not until the characteristic eruption has developed. In many instances, however, it is quite certain that an individual has been exposed to the contagion of variola ”

“ The affection of the skin to which attention is now briefly called under the name of linear papilloma is somewhat rare and is described in the text books of dermatology under a variety of titles. It is frequently congenital, often develops in childhood, but may first appear in later life. ”

“ In the mild confluent form the disease is similar to the discrete form only that several lesions coalesce. In the severe confluent form the coalescence is extensive and large blisters are formed. The swelling about them is intense, and with the extensive sepsis the patient rarely survives. The swelling of the face and extremities is sometimes enormous, and the suffering is so severe as to make death a welcome visitor.
Confluent smallpox runs a course similar to that of the other forms, except that it is not as rapid as the third and is usually more severe than the first. ”

“ In most cases it is readily recognized by the characteristic location of the excoriated papules which mainly constitute the eruption. The disease, as is well known, is due to the burrowing of the acarus or itch-mite in the soft skin between the fingers and elsewhere, and is usually communicated by sleeping with, or in a bed which has been occupied by, a person affected with the disease. The mature, impregnated female alone makes the burrow in which the eggs are deposited, and dies after performing this function. ”

“ As it is well known that a secondary vaccination runs its course more rapidly than a primary one, it is evident that if an exposed patient has been already vaccinated a secondary vaccination is more apt to exert a protective influence. Since vaccination with humanized virus is more speedy in its effect than when bovine lymph is used, it is advisable to employ the former when readily obtainable and to make several insertions in order to increase the probability of success. ”

“ Another tuberculide, or affection in which the bacillus tuberculosis is invariably present, is often met with in childhood as well as in adult life, and is known as tuberculosis verrucosa or lupus verrucosus. This consists of dry, warty, or papillomatous patches (Fig. 40) , which may develop upon the back of the hand, especially over the knuckles, the wrist, the popliteal spaces, and other portions of the body, and is commonly regarded as the result of local infection. The development of the disease is slow. ”

“ For a day or two at the time when the inflammation is at its height it may be well again to guard by a shield against injury from a blow or push, but the shield should always be regarded as itself a danger. If by any accident the vaccine pustule becomes infected, it should be treated like any other infected wound,—the crust removed, the ulcer cleansed with antiseptics and dressed surgically. The immunity given by the pock is not at all lessened by this treatment. ”

“ For the lumbar pain, of which the patient often complains, a hot application will usually feel more grateful. The custom of applying mustard-plasters to the lower part of the back is not to be recommended, since the irritation of the skin which is caused thereby is liable to increase the eruption in that region and add to the subsequent discomfort of the patient. The theory that the eruption can be lessened upon the face by increasing the number of lesions upon some other part of the body has never proved successful in practice. ”

“ The location of the eruption in this disease depends, to a great extent upon the character of the clothing which the patient wears, and differs in the case of men, women, and children. The excoriations about the breasts of women and upon the genitals of men and boys are due to the ease with which these parts can be scratched at night, while in young children who wear long, close-fitting night dresses the wrists and ankles are most likely to be the seat of the eruption. ”