The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1).

Date:
1845
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Licence: Public Domain Mark

Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 1). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    alimentary canal, but more often co-exists with an atonic state of the digestive organs. But what- ever may be the pathological condition of the body upon which it depends, the cause which has un- questionably the leading influence upon this com- plaint is hereditary predisposition. Sedentary ha- bits, an indolent manner of living, extremes of diet, spare as well as rich, and anxiety of mind, tend to confirm this predisposition ; and wherever it exists, trifling causes are sufficient to excite the disease. Amongst these may be mentioned errors of diet; excesses at table ; violent exercise in hot weather, or in heated rooms, especially when fol- lowed by cold drinks ; eating cold raw vegetables, as cucumbers, turnips, melons, when the body is much heated ; exposure to the heat of the sun or of the fire ; the application of irritating cosmet- ics ; vexation of mind, bursts of passion, or any strong mental emotion. It would be difficult to mistake the eruption of acne simplex, in its pure state, for any other cuta- neous affection. Ecthyma is the disease which, in appearance, it most resembles ; but the vari of acne may easily be distinguished from the phlyza- cious pustule of that disease by their smaller size, by their slower progress, and by their base contin- uing indurated after suppuration : whilst the pus- tules of ecthyma are large and superficial, never accompanied with chronic indurations, and form thick scabs more or less prominent. When the eruption of acne simplex has frequently recurred in the same part, as on the nose or forehead, the skin takes on a general appearance, which, by an inexperienced observer, might be mistaken for a pustular or the small tubercular syphilitic erup- tion ; but the particular red copper-coloured areola, and the disposition of the syphilitic tubercles to ulcerate upon their summits, will easily distinguish them ; whilst the concomitant constitutional symp- toms clear up all doubts which might arise. Bateman has undoubtedly been guilty of an oversight in considering the acne simplex as a local disease, and leaving it to be treated chiefly by external applications. But in this opinion he is, indeed, almost solitary ; for the united experi- ence of the best observers is against him. Like almost every affection of the skin, when long seat- ed in any part, it may persist as a local disease ; but in its origin it is strictly symptomatic, and is invariably aggravated by any disorder of the func- tions of those organs in which it has its source. When the pustules of acne simplex are few in number, they scarcely deserve any attention, ex- cept as symptoms of some constitutional derange- ment ; but when they are considerable, they re- quire the use of different medical measures, as well general as local, on their own account. When the disease appears to be connected with an unsat- isfactory discharge of the uterine functions, the treatment must be directed to this object. In young persons of a strong and plethoric constitution, and particularly if about the first appearance of the catamenia, a small bloodletting will afford the most immediate relief; or, if there is pain of the back or loins, a few leeches may be applied to each groin, the feet may be immersed in a warm salt- water pediluvium, and the bowels preserved in an open state by some cooling saline aperient, as the sulphate of magnesia dissolved in infusion of roses, and acidulated with diluted sulphuric acid, or the sal polychrest in combination with very small doses of rhubarb. When the patient is more deli- cate, the sulphur lotuni in combination with mag- nesia and rhubarb affords a very safe and satisfac- tory remedy. It is conveniently administered a3 follows: —R Sulphur, loti, magnesix aa ^i.; Pulv. rkei. J)i.; Fulv. rod. glycyrrhiz. ^ss. Fiant pulveres sex, quorum unus bis terve die sumendus. To this may be added the use of five grains of the pil. aloes cum myrrha at bed-time; or, if the patient is pale, and the circulation lan- guid, small doses of the sulphas ferri may be com- bined with the aloetic pill. If the eruption is ex- tensive or obstinate, five grains of the pil. submu- riat.hydrargyr. comp. may be taken at bed-time, instead of the aloetic pill. The diet should be light, cooling, and easy of digestion ; and wine and all heating drinks should be abstained from. The same general treatment is applicable to young male subjects ; a small venesection, cool- ing saline aperients, the powder of sulphur, mag- nesia, and rhubarb, and, if necessary, a few grains of Pluminer's pill, and a course of decoction of taraxacum, with a little sulphate of potass. In both cases, after the aperient and alterative reme- dies, the diluted mineral acids are useful reme- dies. The best local application to the eruption in the early stage is decoction of bran, decoction of the seeds of cucumbers or melons, or the emul- sion of bitter almonds. It is not until the erup- tion has declined and become chronic, that gently stimulating applications are required, and they are then of much use. The effect of any irritating lotion used in the early state of the eruption, is to multiply the pustules; but after suppuration, when proportioned to the sensibility of the local affection, they are often of the greatest use. Nor in this period of the disease need there be any ap- prehension of producing internal disorder by the sudden repulsion of these cutaneous eruptions; it is only in the early and active state of the dis- ease that headache and disorders of the digestive organs have sometimes been thus produced. The milder, but sometimes not the less efficacious, lotions for this purpose are sulphurous mineral waters, a weak solution of sulphuret of potass, (R Potassii sulphureti gi.; Aquae f.Oi.) or the lotion which is made by pouring a quart of boiling wa- ter upon an ounce of sulphur, and allowing it to infuse twelve or fourteen hours. When the erup- tion is extensive, the same preparations may be used in general baths at 96°, (R Potassii sulphu- reti giy.; Aq. c. c. fat balneum.) Lotions, containing alcohol, afford very satisfactory appli- cations^) this eruption. (R Aqux rosx Oss.; Alco- hol. 1.3 ii.; fat lotio.) The proportion of spirit must be diminished or increased according to the excitability of the skin ; but it must not be for- gotten, that a slight increase of inflammation is often advantageously excited by the first applica- tion of a moderate stimulus; that this transient irritation is overcome by persevering in it; and that, in this way, the skin acquires the power of bearing an increased degree of stimulus. The efficiency of alcoholic lotions is sometimes in- creased, by the addition of a little of the liquor ammonia? acetatus, or acetous acid, or subcarbo- nate of ammonia. The muriate of ammonia, in lotion, is sometimes very useful in chronic cases of acne simplex. (R Aqux rosx Oss.; Alumi- nis 3iii.; Ammonix muriatis ^i.; Potassii sulr