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fulness of humours, (in which cases the disease is salutary, and its quick suppression may cause dangerous symptoms,) bad state of the chyle, teething, and scrofulous disposition.
Crusta serpiginosa is always consequent on a complication of Crusta lactea, with a syphilitic or herpetic disposition inherited from the parents, or imbibed by the child from its nurse. It is always a serious disease, may endure long, and produce dangerous symptoms.
AUTENRIETH, thinks that the itch lies at the bottom of the Crusta serpiginosa, and that the latter is an itch of sucking children. This opinion is, in general, unfounded; for itch in its perfect form is often found in sucking children, without Crusta serpiginosa, and the latter again may be found without any cansal relation with itch.
801. The treatment of milk crust is local and general, and must be guided according to the cause. The food of the child must be changed, the state of the nurse's health improved by suitable remedies, another nurse obtained, or the child weaned if the latter be not possible.
If there be acidity in the prime vie, magnesia is to be given ; and in scrofulous diseases the remedies antidotal to it. In slight cases this treatment often effects the cure; but if it be insufficient, pansy is to be given, either as decoction of half a drachm of the fresh plant, with milk, morning and evening ; or half a drachm of the dried plant in powder, with milk, or mixed with pap. In obstinate cases, or in Crusta serpiginosa, the preparations of antimony, of sulphur, or mercury, may be used, cautiously, according to the age and constitution of the patient ; as well also as other remedies which purify the skin. In the local treatment care is always necessary, in order not to suppress the secretion too quickly; but after long continuance it must be specially attended to. For loosening the scabs, cream, mild salves, oil, softening decoctions are to be used, and then washing with sublimate water. In great sensibility of the skin and spreading of the ulcers, an ointment composed of flowers of zinc, white precipitate, with olive oil and lime water, a solution of liver of sulphur, and the like. Sulphur baths, also, in these cases do good service.
VON WEDEKIND (a) thinks the use of the herba jacea inefficient. Dabbing the sore twice a-day with sublimate water will always effect a cure, at the utmost in four weeks, without injuring the health. If swelling of the glands, and sores in the neck, remain after the eruption is completely gone, these parts must be carefully washed with sublimate water; but rarely is æthiops antimonialis necessary.
D.—OF THE ITCH. WICHMANN, J. E., Aëtiologie der Krätze. Hannover, 1791. 8vo. Second Edit; with one copper plate.
GULDENER VON LOBES, E. V., Beobachtungen über die Krätze; gesammelt im Arbeitshause zu Prag. Prag., 1795. 8vo. Second Edit.
HILDEBRAND, Bemerkungen über den Krätzauschlag. Hannover, 1797. 8vo. Galès, Essai sur le diagnostic de la Gale, sur ses causes, &c. Paris, 1812. 4to.
DE CARRO, J., Observations pratiques sur les Fumigations sulphurenses. Vienne, 1819. 8vo.
Galès, J. C., Mémoire, Rapports et Observations sur les Fumigations salphureuses. Second Edit. Paris, 1824. 8vo.
(a) HUTELAND's Journal, 1822, August, p. 27.
WENZEL, K., Die wahre Krätze, mit besonderer Beruchsichtigung ihrer unrichtigen und unheilstiftenden Behandlungsarten als eine Quelle zahlloser fürchtbarer Nachkrankheiten. Bamberg, 1825. 8vo.
CAZENAVE, A. et SCHEDEL, H. E., Abrégé pratique des Maladies de la Peau, d'après les auteurs les plus estimés et surtout d'après les documens puisés dans la Clinique de M. le Dr. BIETT. Paris, 1828. 8vo.
ACKERMANN, J. C. G., Bemerkungen über die Kenntniss und Kur einiger Krankheiten, part v.
VEZIN, Ueber die Krätze und ihre Behandlung. Osnabrüch, 1843. Second Edit.
802. The Itch (Scabies, Psora, Lat. ; Krätze, Germ.; Gale, Fr.) consists in an eruption of vesicles which, sometimes small and millet-shaped, are filled with transparent fluid, sometimes are larger and filled with thick pus-like matter, somewhat inflamed at their circumference, and mostly at first occurring between the fingers, on the wrists, and on the joints ; gradually they spread over the whole body, and burn and smart severely after the person is heated, or during the night. The vesicles either dry up and crust, (Dry Itch, Scabies sicca,) or they burn and pour out an acrid fluid which corrodes the parts (Moist Itch, Scabies humida.)
If the itch be neglected or suppressed, many vesicles often arise at one part, run together, burst and discharge an acrid ichor, which seizing on the neighbouring parts, considerable ulcers are often in consequence produced, which are covered with scabs ; between these the acrid Auid penetrates; their edge is thick, and their circumference covered with itchpustules (Itch Ulcers, Ulcera scabiosa.) The appearance of these ulcers, the previous existence of the itch, which has been quickly suppressed, or the still existing eruption, render the diagnosis easy.
(KRAUSE (a) states that itch may exist in persons who wash themselves often, or who have very tough skins, without any eruption; the itching and the power of communication may be present, but no visible sign of the disorder may exist, except the burrows of the insect.]
803. The cause of itch is a contagious matter which can only produce the disease by immediate and somewhat long-continued contact of a person affected with the itch, or by substances, as clothes, bedding, and the like, infected with the contagion. The susceptibility for this contagion varies, but it is favoured by uncleanliness, living in bad air, bad food, and the like ; from which circumstances itch is very common in workhouses, among the poor, in dirty hospitals, in certain businesses, and so on. As to the itch-mite found in the pus of the itch-pustule, and which some consider as the cause of the disease, others as secondarily developed in the itch-pustule, opinions are not yet alike, even after the careful inquiries of late made.
The so-called False Itch (Scabies spuria, symptomatica) indeed resembles the true disease in its appearance; it does not, however, usually first show itself between the fingers, does not smart so much in warmth, is not contagious, but may be so, and under certain circumstances runs into true itch. In most cases it seems to be a kind of herpes, arises particularly in great uncleanliness, in bad feeding, in living in bad air, after the suppression of the usual discharges in persons who have been subject from early years to stoppage in the bowels, scrofula, or gout, in spring time, and during recovery from inflammatory diseases. On the outbreak of itch other diseases often disappear (Scabies critica.) (a) CASPER's Wochenschrift, July, 1810.--Forbes's British and Foreign Medical Review, vol. x. p. 564.
The itch-mite, (Acarus scarabæi,) which, described formerly (1), and particularly by WICHMANN (a), could not be found by others, (BATEMAN, BAKER, Caxtox,) or has not been considered as the cause of itch, has, by the dispute between ALIBERT and LUGOL, by RENUCCI's observations (6) confirming its existence, by the ingenious colonizing experiments which ALBIN GRAS (c) instituted, and by the careful inquiries of EBLE (d) and others, of late become of considerable importance, as thereby the earlier contradictory statements are put to rights. From EBLE's observations especially, it results that the itch-mite is to be found neither in the lymph nor in the pus of an itch patient, and just as little within the vesicles or pustules; also never in Scabies pustulosa, but always in Scabies vesicularis alone, and even at that time only just prior to the formation of the vesicle and its being filled with serum. EBLE in vain employed himself to find them elsewhere than between the fingers and on the wrist; they may, however, occur on other parts of the body. In perfectly round, well-defined and isolated vesicles the mite is sought in vain; but, on the contrary, it is seen in vesicles farther advanced, which are only well-rounded and defined on one side, but on the other side have a distinct, dark, grayish, yellow canal, from three-fourths to one line longer, perhaps one-fifth of a line wider, also filled with a little serum, at the opposite blind end of which is found a little wee body, somewhat darker than the rest of the cuticle. If this canal be slit up with a cataract-knife without injuring the dusky body, the mite. a drop of pale serum, usually escapes, and if the back of the cataract-knife be attempted to be brought under the mite, it may be raised and put upon a glass, where it may be ascertained with a simple but strongly magnifying lens, whether you have before you the mite or a piece of epidermis, or dried lymph; for it shows the trunk and very hairy feet which are usually in motion. Under the microscope may be examined all the peculiarities shown by the mite, as WICHMANN had already given them, and the accurate engravings are only to be ascribed to the best microscopes (e).
The number of itch-mites has no direct proportion to the intensity of the disease; generally there are but few itch-mites on a person affected with the itch; a hundred may, however, exist on the hands of a patient who has but few vesicles (f ).
Itch is produced only by the mite and not by the fluid of the pustule, and persons inoculated with pus from such pustules do not have the disease in consequence (EMERY) (9). The itch-mite belongs to nocturnal animals, as it only wanders about at night, so contagion appears almost alone to be effected by sleeping with an itch patient (AUBE) (h).
It is important as regards determining the inoculation of itch by transplanting the mite, that the mite can only be found in the itch which has not been treated with external remedies, although the itch continues; also that single itch-mites may be transferred, but no itch produced, whilst it appears after the translation of a large number (GRAS.) The number of mites has also no proportion to the number of pustules; they are not found in the pustular form, although that is as contagious as the vesicular ().
[(1) Our countryman, THOMAS MOUFFET, the author and editor of the Theatres Insectorum, London, 1634, fol., says that ABINZOAR or AVENZOAR, a Spanish-Arabian Physician of Seville, who lived in the twelfth century, was the first who described the itch-mites as acari, little lice that creep under the skin of the hands, legs and feet, causing pustules full of fluid. He also quotes JOUBERT, who called them sirones, or mites concealed under the cuticle, beneath which they creep like moles, gnawing and causing a troblesome itching. But MOUFFET himself saw them, and remarks that their habitation is not in the pustule, but near it; which statement was subsequently proved by LINNÆUS and Dr. ADAMS. And he also observes, that they cannot be lice as they live under the cuticle, which lice do not (j). HYACINTA CESTONI, at the latter end of the seventeenth century, made a careful examination of the itch-mite; an account of which is given by Bonomo in a letter to the celebrated entomologist, REDI (k).
(a) Aëtiologie der Krätze. Hannov., 1791. Second (5) Gras; in Annales des Sciences Naturelles, Edit.
vol. vi, p. 122. (6) Gazette des Hôpitaux, Paris, 1834. Gazette (9) BEUREND', Allgem. Répertor der aus. Joar. Médicale. Paris, 1834.
naliste, Jan. 1835.-KÖALER in Med. Vereins (c) Recherches sur l'Acarns ou Sarcopte de la zeitung für Preussen. 1836. No. 9, 41. Gale de l'homme. Paris, 1834.
(1) Considérations générales sur la Gale et Ile(d) Ueber die existenz der Krätzmilbe; in Jahrb. sect qui la produit. Paris, 1836. des östr. Staates. Neueste Folg, vol. ix. p. 3.
(i) PENTZLIN, upon Scabies vera: in von Gashi (e) RASPAIL, Mémoire comparatif sur l'Histoire und WALTHER's Journal, vol. xxiv. p. 176. Naturelle de l'Insecte de la Gale. Paris, 1834, 8vo.
) KIRBY and SPENCE, Introduction to Enton FRORIEP'Atlas zu Hautkrankheiten, book v. logy, vol. i. p. 92. pt. ii. Weimar, 1837.-HEILAND, Dissert. de Acaro (k) Observations sur les Cirons ou Inevetes de la humans. Berol., 1836. 8vo.
Peau des Galeux ; in Collect. Académ. Etrangère de
(2) It must not be overlooked that, in 1812, Galès, Apothecary to the Hôpital St. Louis (a), made some very extensive inquiries on the subject of itch, and examined with the microscope more than three hundred of these animals, taken from the itch vesicles, which were always of the same form, but had sometimes six, sometimes eight legs, depending, as he believed, on variety of development. He confined one of these mites with a watch-glass upon his hand, and observed it penetrating the cuticle; a few hours after which three vesicles appeared, and the intense itching left no doubt of the
804. The itch is sometimes more easy, sometimes more difficult to cure, but never dangerous under proper treatment. If it be neglected, especially with continued uncleanliness, it often changes its form considerably, so that there are fewer pustules than thick scurf, and various degenerations of the skin, often resembling Lepra squamosa, with considerable thickening of the skin and cellular tissue, and extensive ulceration, and as in protracted ulcers, (par. 749,) with the symptoms of long-continued general ailing, to wit, loss of appetite, weakness, hectic fever, swelling of the glands, and costiveness. If it be connected with other diseases, as scrofula, syphilis, scurvy, gout, rheumatism, and catarrh, it is always more obstinate and ill-conditioned. If suppressed quickly, asthma, inflammation of the lungs, consumption, dropsy, convulsions, blindness, diseases of the joints, and the like, may ensue.
805. In the treatment of itch, a simple and complicated form are distinguished. In simple itch, when in an otherwise healthy person it has existed for a longer or shorter time, it is always to be considered as a purely local complaint, and to be cured merely by local means. Complicated itch being in relation with the above-described general diseased conditions and dyscrasies, their treatment must be attended to.
806. Simple itch is cured by any remedy which destroys the itch-pustule and produces such inflammation in the skin that the cuticle mortifies and is thrown off. On this circumstance may be explained the great number of remedies and modes of treatment recommended for the itch, which only operates when in their composition they have such substances as bring about the above-mentioned effects, or are so energetically rubbed in that the rubbing itself produces the same result. Externally, frequent washing with soap and water is recommended, soap baths, frequent change of the washes, and the greatest cleanliness, flowers of sulphur with soap and water, or as a salve with fat, alone or in connexion with precipitate of mercury, white vitriol, extract of lead, with laurel berries, with muriate of ammonia, and the like. Also ointments of manganese, of white and black hellebore, ung. oxygenatum, washes of solutions of sublimate, of white vitriol and liver of sulphur, the sulphur fumigation highly valued by Galès and DE CARRO; the English mode of cure, in which the patient lies naked between blankets and has his whole body rubbed thrice a-day with an ounce of ointment of hog's lard, soap, sulphur, nitre, and hellebore, and is put into a lukewarm bath only at the beginning and end of the cure; and, lastly, the rubbing in of black or green soap.
807. Friction, however, with Horn's liniment and black soap is far preferable to all other modes of treatment. Both remedies are simple in their application, and cheap, and cleanliness can be easily preserved.
Greasy salves are of all the remedies against the itch the most filthy, partly because, especially if they have been long kept in store in the apothecaries' shops, they quickly dry up the itch and metastasis is produced; partly because their use is accompanied
(u) Quoted at the head of the Article.
with much disagreeableness, and the observance of due cleanliness is scarcely possible. The wards of itch patients in hospitals where this mode of treatment is employed, give sufficient proof of this assertion.
808. The liniment recommended by HORN (a), composed of one part of flowers of sulphur, two parts of black soap, and as much water as necessary to make a liniment, is to be rubbed in four times a day to the amount of four to six drachms, on all parts affected with the itch and so smartly that the patient may feel a burning sensation and the diseased skin may spring off ; at the same time, also, warm baths and the greatest cleanliness possible.
The strenuous rubbing-in of this liniment, so that the above-mentioned symptoms may be excited, is in no case to be neglected, and therefore also in hospitals the friction is not to be left to the will of the patient, but is to be made under the observation of trustworthy attendants. I have, by attending to this circumstance, perfectly cured in a short time cases of inveterate itch which have withstood various kinds of treatment.
809. FISCHER (6) has proposed the application of smear soap (black or green soap, sapo viridis) in the following way:-The patient, quite naked, smears his whole body, in the morning, with from two and a half to three ounces of green soap, then puts on a clean fresh shirt and goes to bed from which he is not to get up till the cure is completed, except to eat and to go to the night-stool ; in the evening the same quantity of ointment is to be rubbed in as in the morning. On the second and third days two complete rubbings, each of two ounces, of the whole body are to be made, as well where the pock and smarting are, as where they are not. On the fourth day or after the sixth rubbing, the friction is to be continued morning and evening but only on those parts where the eruption and smarting exist ; the same also on the fifth and sixth days; and from the fourth to the sixth day no more than four ounces are to be used. On the seventh day, when no more of the eruption and itching are observable, the morning rubbing is to be carefully used, but in the afternoon a general soap bath (of smear soap and warm water) is to be resorted to, which concludes the cure and the patient is to be provided with clean linen and clothes. If after the soap baths a few pocks of itch still show themselves here and there, they must be anointed a day or two longer and the patient must then bathe again. In summer he may be at once set at liberty, but in winter requires a day or two's rest. During the cure no internal treatment is needed, his food must be simple, soup, pulse and meat; his drink water; the temperature of his room at all times of the year should be from 18° to 21° RÉAUMUR [about 72° to 81° Fair.)
810. The symptoms which occur during this treatment are the follow. ing. Some hours after the first rubbing there is tension of the skin with slight burning ; gradually the burning becomes more severe and at the third or fourth rubbing so great, that the irritable patient declares he feels as if he lay in the fire. The third day is usually the most painful ; the skin is then not merely red and inflamed but elevated into little closeset watery blisters with which the itch pustules become confluent. On the fourth the redness for the most part still remains, the little vesicles become here and there larger, in many parts crack and the skin turns off in plates as in true smooth scarlet fever. The patient suffers in the night only a little smarting. Merely on those parts where the rubbing has been less severe and the inflammation of the skin together with the watery
(@) Oeffentliche Rechenschaft über meine zwölf (6) Grar; in Heidelberger klinisch. Annales, jahrige Dienstführung, u. s. w. Berlin, 1818, p. 164. vol. vii. p. 554.