Dermatology

“ The 'Atlas' forms a complete and systematic pictorial guide to dermatology, each disease being represented by coloured plates of actual cases, which were accompanied by a short and clear descriptive text. ”

“ The addition of two more registries was reported in 1937— a Tumor Registry sponsored by the American Society of Clinical Pathologists, and one in Dermal Pathology sponsored by the American Dermatological Association and now under the sponsorship of the American Academy of Dermatology and Syphilology. ”

“ 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 143many 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. ”

“ There are at times in some of these cases, aggregations of small flattened papules which may be considered as links connecting it with the second variety.
(6) There is no infiltration of the integument appreciable to the eye or touch.
(7) The face is rarely affected, and there is the same extremely slow evolution, great resistance to local treatment, and few or no subjective symptoms.
Referring to the whole group, he says: “We know nothing very definite about the etiology or pathology of these affections. They may appear at any age, but seem more frequent in youths or adults. ”

“ The only female case, a lady aged 47 years, resembled the other cases in its gradual evolution, long duration, absence of itching, in the persistence of the old patches with continual evolution of new ones, in its limitation to the covered parts, and in the general good health of the patient. ”

“ Generally, the patches come out very gradually and in small numbers and, in the main, symmetrically, but as the older patches never go away spontaneously, while fresh ones are continually evoluting at short or long 120intervals, large areas are involved, and in the course of years (in one case, months) the whole trunk and limbs are crowded with lesions, though there are always spaces of normal skin intervening, or sometimes completely enclosed by the diseased process, where the original patches have coalesced. ”

“ Diseases of the skin tend to manifest themselves in certain parts of the body; i.e. certain diseases exert a selective influence on the sites of their eruption. Symmetry is characteristic of eczema, psoriasis, drug rashes and the eruptions of specific fevers, while others, such as herpes zoster, ring-worm, tertiary syphilis and new growths, tend to be asymmetrical. Eczema selects the flexor aspect of the limbs and the neighbourhood of folds of skin and opposed surfaces, while psoriasis favours the extensor surfaces and the outer side of the elbows and knees. ”

“ The skin, being exposed to all external influences, discloses the symptoms of all forms of skin disease, the names of which are legion.
The skin specialist termed "dermatologist" is another production which flourishes—more or less—upon the ignorance of the public. The patient, alas, is less fortunate. He tries one after another until disgusted he sometimes resorts to special diet. Sometimes this may help, if he choose a certain kind of vegetable diet, and especially if the vegetables are such as contain a great deal of silica; for silica is the mineral basis of skin tissue. ”

“ SYMPTOMS.—Eczema, known popularly as tetter, is the most important and the commonest of the diseases of the skin. It may be defined as an inflammatory, non-contagious disease of the skin, characterized in the beginning by erythema, papules, vesicles or pustules, or a combination of these lesions, pursuing an acute or chronic course, accompanied by infiltration and itching, terminating either in discharge with the formation of crusts, in absorption, or in desquamation. The disease is multiform in character, and is capable of manifesting itself in a great variety of forms ”

“ Skin, Care of.—Among the vast majority of people air and water far too seldom touch the skin. Want of water makes it unclean, and want of water and air make it slow in reaction. Now, a healthy skin is of the utmost value when one is attacked by disease. It can regulate the temperature of the various organs, and the application of heat or cold to it will cause a reaction at once. Much of our treatment as given in this book is directed towards stimulating the action of the skin. It is obvious that in health as in disease the skin can and does so act on the internal organs. ”

“ Such errors, it has been often averred, would be almost as apt to happen in the hands of the truly medical, as of the non-medical examiners, in consequence of the knowledge and distinction of cutaneous diseases being exceedingly imperfect at these early periods of medical history. And it is certainly true that, in the writings of the older Arabian, Continental, and English physicians, we find almost all the different species of chronic cutaneous disease mixed up and described together under a few general heads and designations, as Lentigo, Impetigo, Morphea, Albaras, Gutta Rosea, etc. ”

“ In the pustular and bullous varieties there may be mild or grave systemic symptoms, but even in these types the constitutional involvement is, in most instances, slight in comparison to the intensity of the cutaneous disturbance.
What is the course of dermatitis herpetiformis?
Extremely chronic, in most instances lasting, with remissions, indefinitely. The skin is rarely entirely free. From time to time the type of the disease may undergo change. From the continued irritation and scratching more or less pigmentation results. ”

“ Describe the bullous type of dermatitis herpetiformis.
The bullous expression of the disease is usually of a markedly inflammatory nature, often innumerable blebs, small and large, appearing almost continuously, and in some instances involving the greater part of the surface. The lesions arise from erythematous skin, from preëxisting vesicles or vesicular groups, or from apparently normal integument. There is a marked disposition to appear in clusters. A change of type to the erythematous or vesicular varieties is not unusual. ”

“ Dermatitis herpetiformis is a somewhat rare inflammatory disease, characterized by an eruption of an erythematous, papular, vesicular, pustular, bullous or mixed type, with a decided disposition toward grouping, accompanied by itching and burning sensations, with, as a rule, more or less consequent pigmentation, and pursuing usually a chronic course with remissions. ”

“ The progress of dermatological science, in both its physiological and pathological aspects, has been very rapid in recent years, which makes indispensable the frequent revision of works on skin-diseases. ”

“ TREATMENT.—There is no other disease of the skin which requires so thorough a knowledge of general medicine for its successful management as does eczema. The exciting cause of the affection is to be ascertained and to be properly treated. It is the specialist who has as the groundwork a comprehensive knowledge of general medicine who is best able to cope successfully with the disease under consideration. In the management of eczema both constitutional and local treatment will be necessary. ”

“ If your skin be red, or itchy, or scaly, or out of condition in any way, go to a doctor and get the appropriate treatment for that particular disease, instead of smearing on the surface of your body some drug of which you know nothing, in the hope of its being the proper thing for the little patch of diseased skin. ”

“ A few months ago I saw the patient again, and I feel sure that the disease is eradicated.
Miss W., 42 years old, passed her childhood in the West Indies, and brought from there a peculiar skin disease. When I saw her for the first time her features looked old for her age, skin gray and sallow, hair gray, rough, full of dandruff, and moisture oozing from the ears and forehead. The scalp feels hard and thickened. The cervical glands are indurated all around the neck. On the left chest an herpetic eruption of the size of a dollar, and on the mamma a hard tumor of the size of a fist. ”

“ Treatment of Liver Spots, Sallow Complexion, Pimples, Acne, and Eczema.—First, the general treatment. While every case of skin disease must be treated according to the peculiarities of that patient’s case, still, there are general rules which should be followed in the treatment of all cases, and first in importance comes attention to the bowels. There must be procured, by some means or other, a free daily evacuation. A hard, constipated movement is not sufficient. ”

“ The space allotted to each disease has been based upon relative importance. As to treatment, the best and approved methods only—those which are founded upon the aggregate experience of dermatologists—are referred to. ”

“ The prevailing opinion among medical men is, that the latter is by far the more efficacious in most disorders, and more conducive to health than the former; because, where a person continues immersed in saline water for some time, it enters into the pores of the skin, and by that means is more likely to be of benefit in cutaneous or other disorders for which it is usually recommended. ”

“ Having observed, as in the year 1802, a spontaneous moisture on the skin on the first day of the disease, in several cases, I was led to assist this disposition in nature to be relieved by the pores, by means of sweating remedies, but in no instance did I follow it, without previous evacuations from the blood-vessels or bowels; for, however useful the intimations of nature may be in acute diseases, her efforts should never be trusted to alone, inasmuch as they are in most cases too feeble to do service, or so violent as to do mischief. ”

“ Disease germs in the skin.—Disease germs may often be found in sores and pimples on the skin, but they will not leave anybody's flesh and blood through sound and healthy skin. If our skin is smooth and fair, there will be few disease germs on it unless we rub against something dirty. A dirty skin nearly always contains disease germs. Washing and bathing our body will take disease germs from our skin and help us to keep well. ”

“ In doubtful cases, an observation of several weeks will always suffice to distinguish it from eczema, erythema multiforme, herpes iris and pemphigus, diseases to which it at times bears strong resemblance.
Give the prognosis of dermatitis herpetiformis.
An opinion as to the outcome of the disease should be guarded. It is exceedingly rebellious to treatment, and relapses are the rule. Exceptionally the bullous and pustular varieties prove eventually fatal. The erythematous and vesicular varieties are the most favorable. ”

“ Der′mal, Der′mic, Dermat′ic, pertaining to the skin: consisting of skin.—n. Dermatog′raphy, anatomical description of the skin—also Dermog′raphy.—adjs. Der′matoid, of the form of skin: skin-like; Dermatolog′ical.—ns. Dermatol′ogist; Dermatol′ogy, the branch of physiology which treats of the skin; Der′matophyte, a parasitic fungus on the skin; Der′matoskel′eton, the bony integument of many reptiles, insects, and crustaceans—also Dermoskel′eton.—adj. Dermogas′tric, connecting the skin and the stomach. [Gr. derma, dermatos, the skin—derein, to flay.] ”

“ A careful examination of the parts, in the earlier stages of the disease, will, in most cases, lead to the detection of small and deep-seated collections of matter, which, upon being let out with a needle, or the point of a lancet, will cause the swelling and redness of the skin to disappear; and, if the fomentations of warm water, and frictions with mild soap and a soft brush be persevered in, along with plain diet, and abstinence from high-seasoned dishes, pickles, cayenne, mustard, and strong liquors, a cure may, in time, be effected. ”

“ Pimples on the face are usually due to obstruction of the sebaceous glands; sometimes the obstruction leads to inflammation around the sebaceous gland (acne) which often permanently injures the skin.
2. Accumulation of effete matter on the skin occurs, unless frequent ablutions are performed. The epidermis is constantly shedding its older and more superficial parts, in the form of minute scales or “scurf.” In the absence of frequent washing, the scales of epithelium tend to accumulate, the sebaceous secretion matting the scales together, and rendering them more adhesive. ”

“ In psoriasis the epidermis separates in flakes at various spots which have not been subjected to pressure, and to cure it ointment Inflammation.containing tar or other products of the dry distillation of wood is employed. When the true skin is inflamed various appearances may arise, according to the intensity and extent of the inflammation, and the eruption may be papular, vesicular, pustular, tubercular, bulbous or ulcerative. To lessen irritation the skin is protected by dusting powders, such as oxide of zinc, starch, fuller’s earth, &c., or by ointments. ”

“ Affections of the Skin.—Although all types of skin affection are met with in the inherited disease, the most important is a papular eruption, the papules being of large size, with a smooth shining top and of a reddish-brown colour. It affects chiefly the buttocks and thighs, the genitals, and other parts which are constantly moist. It is necessary to distinguish this specific eruption from a form of eczema which occurs in these situations in non-syphilitic children, the points that characterise the syphilitic condition being the infiltration of the skin and the coppery colour of the eruption. ”

“ Eczematous symptoms may be superadded. In severe cases the entire extensor surfaces of the legs and arms, and in some instances the trunk also, are invaded. It is worse in the winter season. [Pg 119]
What is known in regard to etiology and pathology?
It is a disease of the ill-fed and neglected, usually developing in early childhood, and persisting throughout life. It is extremely rare, even in its milder types, in this country. Clinically and pathologically it bears some resemblance to papular eczema.
Give the prognosis and treatment of prurigo. ”