A manual of the practice of medicine / by Frederick Taylor.

  • Taylor, Frederick, Sir.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: A manual of the practice of medicine / by Frederick Taylor. Source: Wellcome Collection.

    911/966 (page 891)
    addition to these lesions, patches of eczema, impetiginous crusts, and urticarious wheals are often present. There is, thus, very great variety in the lesions in different cases. In some cases the burrows are numerous, with few inflammatory lesions ; in others, vesicles and pustules are abundant, and burrows are with difficulty found. In some cases there are more papules, in others more pustules. The parts of the body especially liable to the attacks of the acarus are the skin between the fingers, the front or inner sid-e of the wrist, the front of the forearm, the ankle and foot, the axilla, the groin and the genitals, the inner side of the thigh and the nates ; and the eruption spreads beyond these parts, on to the abdomen from the groin, or along the inner side of the leg or thigh. The back, shoulders, and chest are but little affected; and the face, neck, ears, and scalp nearly always escape. The occupation of the patient may have influence upon the localization. Ilebra was in the habit of recognizing the occupation of a cobbler by tlie predominance of itch-lesions on the buttock. On the other hand, occupations involving the immersion of the hands in materials (oily or otherwise) anta- gonistic to the acarus would prevent their presence in this typical situation. In children, the lesions are more widespread, the feet and ankles are commonly affected, and pustules are frequently present. Diagnosis.—The localization of the lesions is an important guide to diagnosis. An itching eruption of mixed papules, vesicles, and pustules, occurring mainly about the fingers and wrists, and also in the other situations mentioned, should lead to a careful search. If a burrow can be found, the minute white elevation at the cleaner end should be looked for, and its epidermis care- fully scratched through with the point of a needle; the acarus may then be picked out, as it readily adheres to the surface of the needle. If this cannot be done it is best to snip off the whole burrow, and to examine for ova or fragments of the acarus under the microscope. Finally, where there has been much inflamma- tion, so that burrows cannot be found, the crusts may be removed, boiled in solution of potash or soda, the fluid allowed to settle in a conical glass, and the sediment examined for fragments of acarus. Treatment.—-Itch is generally quickly cured by the free inunction of sulphur ointment. This should be done at night, and the ointment should be left on, covered by suitable clothing, until the morning, when it may be washed off in a hot bath. The same process may be repeated on two successive nights. The disagreeable odour of suli)hur ointment may be lessened by the addition of balsam of Peru. For some skins, sulphur ointment is too irritating, and requires dilution. An ointment of styrax (prepared storax 145 grains, sp. vini rect. lard 1 ounce, Guy's Hosp. Pharm.) is also a more pleasant, less irritating, and yet effectual preparation. Vlemingkx' solution may also be used, ur