Essentials of Diseases of the Skin Part 57

What applications are usually advised in the late, or localized, syphilodermata?

Ointment of ammoniated mercury, twenty to sixty grains to the ounce; oleate of mercury, five to ten per cent. strength; mercurial plaster, full strength or weakened with lard or petrolatum; a two to twenty per cent. ointment of iodol; resorcin, twenty to sixty grains to the ounce of ointment base; and lotions of corrosive sublimate, one-half to three grains to the ounce.

The following is valuable in offensive and obstinate ulcerations:--

[Rx] Hydrarg. chlorid. corros., ........... gr. iv-gr. viij Ac. carbolici, ....................... gr. x-xx Alcoholis, ........................... f[dram]iv Glycerinae, ........................... f[dram]j Aquae, ............ q.s. ad ........... [Oz]iv. M.

Ointments are to be rubbed in or applied as a plaster; lotions, employed chiefly in ulcers and ulcerations, are to be thoroughly dabbed on, and usually supplemented by the application of an ointment. Iodol may also be applied to ulcers as a dusting-powder, usually mixed with one to several parts of zinc oxide or boric acid.

Give the treatment of hereditary infantile syphilis.

It is essentially the same (but much smaller dosage) as employed in acquired syphilis. Attention to proper feeding and hygiene is of first importance.

Mercury may be given by the mouth, as mercury with chalk (gr. ss-gr. ij, t.d.); as calomel (gr. 1/20-gr. 1/6, t.d.); and as a solution of corrosive sublimate (gr. ss-[Oz]vj, [dram]j, t.d.). If mercury is not well borne by the stomach, it may be administered by inunction; for this purpose, blue ointment is mixed with one or two parts of lard and spread (about a drachm) upon an abdominal bandage and applied, being renewed daily. Treatment by means of baths (gr. x-x.x.x to the bath) of corrosive sublimate is, at times, a serviceable method.

Pota.s.sium iodide, if exceptionally deemed preferable, may be given in the dose of a fractional part of a grain to two or three grains three times daily.

What local measures are to be advised in cutaneous syphilis of the newborn?

If demanded, applications similar to those employed in eruptions of acquired syphilis, but not more than one-third to one-half the strength.

Lepra.

(_Synonyms:_ Leprosy; Elephantiasis Graecorum.)

What do you understand by leprosy?

Lepra, or leprosy, is an endemic, chronic, malignant const.i.tutional disease, characterized by alterations in the cutaneous, nerve, and bone structures; varying in its morbid manifestations according to whether the skin, nerves or other tissues are predominantly involved.

What is the nature of the premonitory symptoms of leprosy?

In some instances the active manifestations appear without premonition, but in the majority of cases symptoms, slight or severe in character, pointing toward profound const.i.tutional disturbance, such as mental depression, malaise, chills, febrile attacks, digestive derangements and bone pains, are noticed for weeks, months, or several years preceding the outbreak.

What several varieties of leprosy are observed?

Two definite forms are usually described--the tubercular and the anaesthetic. A sharp division-line cannot, however, always be drawn; not infrequently the manifestations are of a mixed type, or one form may pa.s.s into or gradually present symptoms of the other.

[Ill.u.s.tration: Fig. 62. Tubercular Leprosy. (_After Stoddard._)]

Describe the symptoms of tubercular leprosy.

The formation of tubercles and tubercular ma.s.ses of infiltration, usually of a yellowish-brown color, with subsequent ulceration, const.i.tute the important cutaneous symptoms. Along with, or preceding these characteristic lesions, blebs and more or less infiltrated, hyperaesthetic or anaesthetic, pinkish, reddish or pale-yellowish macules make their appearance from time to time; subsequently fading away or remaining permanently (_lepra maculosa_).

When well advanced, the tubercular or nodular ma.s.ses give rise to great deformity; the face, a favorite locality, becomes more or less leonine in appearance (_leontiasis_). The tubercles persist almost indefinitely without material change, or undergo absorption or ulceration; this last takes place most commonly about the fingers and toes. The mucous membrane of the mouth, pharynx and other parts may also become involved.

[Ill.u.s.tration: Fig. 63. Anaesthetic Leprosy.]

Describe the symptoms of anaesthetic leprosy.

Following or along with precursory symptoms denoting general systemic disturbance, or independently of any prodromal indications, a hyperaesthetic condition, in localized areas or more or less general, is observed. Lancinating pains along the nerves and an irregular pemphigoid eruption are also commonly noted. There soon follows the special eruption, coming out from time to time, and consisting of several or more, usually non-elevated, well-defined, pale-yellowish patches, one or two inches in diameter. As a rule, they are at first neither hyperaesthetic nor anaesthetic, but may be the seat of slight burning or itching. They spread peripherally, and tend to clear in the centre. The patches eventually become markedly anaesthetic, and the overlying skin, and the skin on other parts as well, becomes atrophic and of a brownish or yellowish color. The subcutaneous tissues, muscle, hair and nails undergo atrophic or degenerative changes, and these changes are especially noted about the hands and feet. These parts become crooked, the bone tissues are involved, the phalanges dropping off or disappearing by disintegration or absorption (_lepra mutilans_). Sooner or later various paralytic symptoms, showing more active involvement of the nerve trunks, present themselves.

State the cause of leprosy.

Present knowledge points to a peculiar bacillus as the active factor, while climate, soil, heredity, food and habits exert a predisposing influence.

Is leprosy contagious?

The consensus of opinion points to the acceptance of the possible contagiousness of leprosy; probably by inoculation, but only under certain unknown favoring conditions.

What are the pathological changes?

The lesions consist essentially of a new growth, made up of numerous small, more or less aggregated round cells, beginning in the walls of the bloodvessels. In this way the tubercular ma.s.ses and various other lesions are formed. As yet, positive involvement ot the central nervous system has not been shown, but some of the nerve trunks are found to be inflamed and swollen, with a tendency toward hardening.

What several diseases are to be eliminated in the diagnosis of leprosy?

Syphilis, morph[oe]a, vitiligo, lupus, and syringomyelia.

When well advanced, the aggregate symptoms of leprosy form a picture which can scarcely be confused with that of any other disease. In doubtful cases microscopical examinations of the involved tissues, for the bacilli, should be made.

State the prognosis of leprosy.

Unfavorable; a fatal termination is the rule, but may not be reached for a number of years. The tubercular form is the most grave, the mixed variety next, and the anaesthetic the least. Patients are not infrequently carried off by intercurrent disease. Proper management will often delay the fatal ending, and exceptionally, in the anaesthetic variety, stay the progress of the disease.

What is the treatment of leprosy?

Hygienic measures are important. Chaulmoogra oil and gurjun oil internally and externally are in some instances of service. Strychnia alone, or with either of these oils, is ofttimes beneficial. Ichthyol internally, and external applications of the same drug, and of resorcin, chrysarobin, and pyrogallic acid, have been extolled. Change of climate, especially to a region where the disease does not prevail, is often of great advantage.

Pellagra.

(_Synonym:_ Lombardian Leprosy.)

Describe pellagra.