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ESSENTIALS OF DISEASES OF THE SKIN

Including the Syphilodermata

Arranged in the Form of Questions and Answers Prepared Especiallyfor Students of Medicine

by

HENRY W. STELWAGON, M.D., PH.D.

* * * * *

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A New and Complete Dictionary of the terms used in Medicine, Surgery,Dentistry, Pharmacy, Chemistry, and kindred branches; together with newand elaborate Tables of Arteries, Muscles, Nerves, Veins, etc.; ofBacilli, Bacteria, Micrococci, etc.; Eponymic Tables of Diseases,Operations, Signs and Symptoms, Stains, Tests, Methods of Treatment,etc. By W.A.N. Dorland, M.D., Editor of the American Pocket MedicalDictionary. Large octavo, nearly 800 pages, bound in full flexibleleather. Price, $4.50 net; with thumb index, $5.00 net.

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ESSENTIALS OF DISEASES OF THE SKIN.

Since the issue of the first volume of the #Saunders Question-Compends#,

OVER 290,000 COPIES

of these unrivalled publications have been sold. This enormous sale is indisputable evidence of the value of these self-helps to students and physicians.

Saunders’ Question-Compends. No. 11.

ESSENTIALS OF DISEASES OF THE SKIN

Including the Syphilodermata

Arranged in the Form of Questions and Answers Prepared Especiallyfor Students of Medicine

by

HENRY W. STELWAGON, M.D., PH.D.

Professor of Dermatology in the Jefferson Medical College, Philadelphia;Dermatologist to the Howard and Philadelphia Hospitals, etc.

Seventh Edition, Thoroughly Revised

Illustrated

Philadelphia and LondonW. B. Saunders Company1909

Set up, electrotyped, printed, 1890. Reprinted July, 1891.Revised, reprinted, June, 1894. Reprinted March, 1897.Revised, reprinted, August, 1899. ReprintedSeptember, 1901, May, 1902, September, 1903.Revised, reprinted January, 1905.Reprinted March, 1906. Revised,reprinted March, 1909.

Printed in America

Press ofW. B. Saunders CompanyPhiladelphia

PREFACE TO SEVENTH EDITION.

In the present–seventh–edition the subject matter, especially asregards the practical part, has been gone over carefully and thenecessary corrections and additions made. Nineteen new illustrationshave been added, a few of the old ones being eliminated. It is hoped

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Vegetarian Dishes Page 9

1 pint soaked peas. 1 ounce butter. 2 1/2 pints water. 1 stick of celery. 1 1/2 teaspoons salt. 1 large carrot. 1 large turnip. 1 large onion. 1 dozen peppercorns. 1/2 teaspoon mixed herbs.

Dissolve the butter in a saucepan, place in it the peas and one pintof water, and boil gently for half-an-hour. In the meantime prepareand slice the vegetables and add them to the peas, together with theseasonings, boil for one and a half hours, and pass through a sieve,rubbing the vegetables through with a wooden spoon.

No. 18.–Dried Green Pea Soup.

1 1/2 pints soaked green peas. 1 large onion. 1 large carrot. 1 large turnip. 2 quarts water. 1 ounce butter. 1 teaspoon salt. 1 dozen peppercorns.

Dissolve the butter in a large saucepan, place in the peas (whichmust have been carefully picked over), the vegetables sliced, and thepeppercorns. Boil gently three hours, add salt, and rub through a wiresieve with a wooden spoon. Serve with sippets of toast.

No. 19.–Fresh Green Pea Soup.

2 pints of shelled green peas. 1 ounce butter. A handful of mint. 1 cabbage lettuce. 3 pints of water. 1 1/2 teaspoons of salt. 1 onion. 1 lump of sugar.

Dissolve the butter in a large saucepan and place in the peas, the onionsliced, the lettuce and mint thoroughly washed, the water, salt, andsugar. Boil for one and a half hours, strain through a wire sieve,rubbing the peas through with a wooden spoon.

No. 20.–Potato Soup.

(Very suitable for children.)

1 1/2 pounds potatoes. 2 onions. 1 tablespoon sago. 2 pints water. 1/2 pint milk. 1 1/2 ounces butter. 1 teaspoon salt. 1/2 teaspoon pepper.

Peel and slice the potatoes and onions, and fry them for ten minutes inthe butter, but without browning them. Place them in a saucepan withthe water, salt and pepper (the latter should be omitted if for youngchildren), and boil for an hour; add sago and milk, boil for about tenminutes, stirring all the time, then rub through a wire sieve with awooden spoon, and serve.

No. 21.–Rice Soup.

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Vegetarian Dishes Page 10

(Very suitable for children.)

1/4 pint rice. 3 pints water. 1 pint milk. 1 1/2 ounces butter. 1 large turnip. 1 large onion. 1 large potato. 1 teaspoon salt.

Place the butter in a large saucepan, and let it melt so as to greasethe whole of the bottom of the pan; wash the rice and place it with thevegetables sliced in the saucepan, and boil for about three-quarters ofan hour, stirring frequently; add milk and salt, and simmer carefullyfor about a quarter of an hour, taking care that it does not burn.

No. 22.–Sea Kale Soup.

14 nice heads of kale. 1 potato. 1 onion. 1 1/2 pints water. 1/2 pint milk. 1 1/2 ounces butter. 1 lump of sugar. 1 teaspoon salt. 2 teaspoons sago.

Dissolve the butter in an enamelled saucepan, then add the kale, afterthoroughly washing and cutting it into two-inch pieces; place thesaucepan over a gentle heat, shaking it frequently. Peel and slice thepotato and onion, and place them, together with the salt, water andsugar, with the kale. Boil one hour, strain, return to the saucepan, addmilk and sago, replace over the fire and stir for ten minutes. Strainagain into a tureen, and serve with sippets of toast.

No. 23.–Semolina Soup.

3 pints water. 1 carrot. 1 turnip. 1 onion. 2 potatoes. 1 tablespoon raw semolina. 3/4 teaspoon salt. A little pepper.

Slice the vegetables and boil them in the water for about an hour, rubthrough a wire sieve, replace in the saucepan, add seasoning and shakein the semolina gradually. Boil for ten minutes, stirring all the time.

No. 24.–Brown Stock.

1 pint soaked lentils. 3 pints water. 1 carrot. 1 turnip. 1 ounce butter. 1 teaspoon of salt. 1 onion. 6 peppercorns.

Dissolve the butter in a large saucepan, place in the lentils, water,and vegetables sliced. Boil one hour, add salt, re-boil until quitedone. Strain.

No. 25.–White Stock.

1 pint soaked haricot beans.

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Essentials of Diseases of the Skin Page 2

that the continued demand for this compend means a widening interest inthe study of diseases of the skin, sufficiently keen as to lead to thedesire for a still greater knowledge.

H.W.S.

PREFACE TO FIRST EDITION.

Much of the present volume is, in a measure, the outcome of a thoroughrevision, remodelling and simplification of the various articlescontributed by the author to Pepper’s System of Medicine, Buck’sReference Handbook of the Medical Sciences, and Keating’s Cyclopaedia ofthe Diseases of Children. Moreover, in the endeavor to present thesubject as tersely and briefly as compatible with clear understanding,the several standard treatises on diseases of the skin by Tilbury Fox,Duhring, Hyde, Robinson, Anderson, and Crocker, have been freelyconsulted, that of the last-named author suggesting the pictorialpresentation of the “Anatomy of the Skin.” The space allotted to eachdisease has been based upon relative importance. As to treatment, thebest and approved methods only–those which are founded upon theaggregate experience of dermatologists–are referred to.

For general information a statistical table from the Transactions of theAmerican Dermatological Association is appended.

H.W.S.

CONTENTS.

PAGEANATOMY OF THE SKIN 17 The Epidermis 18 The Blood-vessels 19 The Nervous and Vascular Papillae 20 The Hair and Hair-follicle 21

SYMPTOMATOLOGY 22 Primary Lesions 22 Secondary Lesions 23 Distribution and Configuration 24 Relative Frequency 26 Contagiousness 27 Rapidity of Cure 27 Ointment Bases 27

CLASS I.–DISORDERS OF THE GLANDS 28 Hyperidrosis 28 Sudamen 30 Hydrocystoma 31 Anidrosis 31 Bromidrosis 32 Chromidrosis 32 Uridrosis 33 Phosphoridrosis 33 Seborrh[oe]a (Eczema Seborrhoicum) 33 Comedo 38 Milium 42 Steatoma 43

CLASS II.–INFLAMMATIONS 44 Erythema Simplex 44 Erythema Intertrigo 45 Erythema Multiforme 46 Erythema Nodosum 50 Erythema Induratum 51 Urticaria 52 Urticaria Pigmentosa 56 Dermatitis 58 Dermatitis Medicamentosa 60 X-Ray Dermatitis 63 Dermatitis Factitia 64 Dermatitis Gangraenosa 65 Erysipelas 66 Phlegmona Diffusa 68 Furunculus 68 Carbunculus 70 Pustula Maligna 72 Post-mortem Pustule 73 Framb[oe]sia 73 Verruga Peruana 73 Equinia 74 Miliaria 74 Pompholyx 76 Herpes Simplex 78 Hydroa Vacciniforme 80 Epidermolysis Bullosa 80 Dermatitis Repens 81 Herpes Zoster 81 Dermatitis Herpetiformis 83 Psoriasis 86 Pityriasis Rosea 95 Dermatitis Exfoliativa 96 Lichen Planus 98 Pityriasis Rubra Pilaris 99 Lichen Scrofulosus 100 Eczema 100 Prurigo 118 Acne 119 Acne Rosacea 126 Sycosis 130 Dermatitis Papillaris Capillitii 135 Impetigo Contagiosa 136 Impetigo Herpetiformis 138 Ecthyma 138 Pemphigus 140

CLASS III.–HEMORRHAGES 144 Purpura 144 Scorbutus 146

CLASS IV.–HYPERTROPHIES 148 Lentigo 148 Chloasma 149 Keratosis Pilaris 151 Keratosis Follicularis 153 Molluscum Epitheliale 153 Callositas 155 Clavus 156 Cornu Cutaneum 158 Verruca 160 Naevus Pigmentosus 162 Ichthyosis 165 Onychauxis 167 Hypertrichosis 168 [OE]dema Neonatorum 170 Sclerema Neonatorum 171 Scleroderma 172 Elephantiasis 174 Dermatolysis 176

CLASS V.–ATROPHIES 177 Albinismus 177 Vitiligo 178 Canities 180 Alopecia 181 Alopecia Areata 183 Atrophia Pilorum Propria 187 Atrophia Unguis 188 Atrophia Cutis 189

CLASS VI.–NEW GROWTHS 191 Keloid 191 Fibroma 192 Neuroma 194 Xanthoma 195 Myoma 196 Angioma 196 Telangiectasis 197 Lymphangioma 198 Rhinoscleroma 198 Lupus Erythematosus 199 Lupus Vulgaris 203 Tuberculosis Cutis 209 Ainhum 212 Mycetoma 212 Perforating Ulcer of the Foot 213 Syphilis Cutanea 213 Lepra 231 Pellagra 235 Epithelioma 236 Paget’s Disease of the Nipple 240 Sarcoma 241 Granuloma Fungoides 242

CLASS VII.–NEUROSES 244 Hyperaesthesia 244 Dermatalgia 244 Anaesthesia 244 Pruritus 244

CLASS VIII.–PARASITIC AFFECTIONS 247 Tinea Favosa 247 Tinea Trichophytina 251 Tinea Imbricata 261 Tinea Versicolor 262 Erythrasma 265 Actinomycosis 266 Blastomycetic Dermatitis 266 Scabies 267 Pediculosis 271 Pediculosis Capitis 272 Pediculosis Corporis 274 Pediculosis Pubis 275 Cysticercus Cellulosae 276 Filaria Medinensis 277 Ixodes 277 Leptus 277 [OE]strus 278 Pulex Penetrans 278 Cimex Lectularius 278 Culex 279 Pulex Irritans 279

TABLE showing Relative Frequency of the Various Diseases of the Skin 280

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Vegetarian Dishes Page 11

3 pints water. 1 large carrot. 1 large onion. 1 large turnip. A little celery. 1 ounce butter. 1 teaspoon salt. A very small quantity each of mixed herbs, mace and peppercorns.

Dissolve the butter in a saucepan, add the beans, vegetables sliced, theseasonings, and water; boil all together for two and a half hours.Strain.

No. 26.–Tomato Soup.

2 1/2 pounds tomatoes. 1 large carrot. 1 large turnip. 1 large onion. 1 1/2 pints water. 3 ounces butter. 1 tablespoon sago. 2 teaspoons salt. 1 dozen peppercorns.

Slice the carrot, turnip and onion, and place them with two ounces ofbutter in a good-sized saucepan and fry for a few minutes; add water,peppercorns, and one teaspoon of salt, and boil gently. Cook thetomatoes in another stewpan, according to Recipe No. 155, adding to themthe other teaspoon of salt and one ounce of butter. When quite tender,pour them into the saucepan containing the vegetables and simmeraltogether for about an hour, or until the vegetables are thoroughlytender. Strain, return to the saucepan, and when boiling stir in thesago; simmer gently for half an hour, and the soup may, if liked, beagain strained before serving.

No. 27.–Turnip Soup.

10 turnips. 2 onions. 2 potatoes. 1 small stick of celery. 1 pint milk. 3 pints water. 2 ounces butter. 2 teaspoons salt. 1 teaspoon peppercorns.

Dissolve the butter in a large saucepan, place in the vegetables sliced,salt, peppercorns, and water, and boil gently for two hours. Strain,return to the saucepan, which must be perfectly clean, add milk, simmera few minutes and serve.

Note.–A tablespoon of cream placed in the tureen, and stirred into thesoup as it is poured in, is a great improvement, or it may be thickenedwith one tablespoon sago.

No. 28.–Vegetable Soup.

1 potato. 2 onions. 2 carrots. 2 turnips. 2 sticks of celery. 3 pints water. 3 or 4 thick slices of beetroot. 1 dozen small sprigs of watercress. 1 dozen small sprigs of parsley. 1 1/2 teaspoons salt. 2 tablespoons pearl barley. 1 ounce butter.

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Essentials of Diseases of the Skin Page 3

DISEASES OF THE SKIN.

#ANATOMY OF THE SKIN.#

Fig. 1.

#The Epidermis.#

“]c_, corneous (horny) layer; _g_, granular layer; _m_, mucous layer (rete Malpighii). The stratum lucidum is the layer just above the granular layer. Nerve terminations--_n_, afferent nerve; _b_, terminal nerve bulbs; _l_, cell of Langerhans. (_After Ranvier._)

_c_, corneous (horny) layer; _g_, granular layer; _m_, mucous layer (rete Malpighii). The stratum lucidum is the layer just above the granular layer. Nerve terminations--_n_, afferent nerve; _b_, terminal nerve bulbs; _l_, cell of Langerhans. (_After Ranvier._)

#The Blood-vessels.#

C, epidermis; D, corium; P, papillæ; S, sweat-gland duct. v, arterial and venous capillaries (superficial, or papillary plexus) of the papillæ. Deep plexus is partly shown at lower margin of the diagram; vs—an intermediate plexus, an outgrowth from the deep plexus, supplying sweat-glands, and giving a loop to hair papilla. (After Ranvier)

C, epidermis; D, corium; P, papillæ; S, sweat-gland duct. v, arterial and venous capillaries (superficial, or papillary plexus) of the papillæ. Deep plexus is partly shown at lower margin of the diagram; vs—an intermediate plexus, an outgrowth from the deep plexus, supplying sweat-glands, and giving a loop to hair papilla. (After Ranvier)

#The Nervous and Vascular Papillae.#

a, a vascular papilla; b, a nervous papilla; c, a blood-vessel; d, a nerve fibre; e, a tactile corpuscle. (After Biesiadecki.)

a, a vascular papilla; b, a nervous papilla; c, a blood-vessel; d, a nerve fibre; e, a tactile corpuscle. (After Biesiadecki.)

#The Hair and Hair-Follicle.#

A, shaft of the hair; B, root of the hair; C, cuticle of the hair; D, medullary substance of the hair. E, external layer of the hair-follicle; F, middle layer of the hair-follicle; G, internal layer of the hair-follicle; H, papilla of the hair; I, external root-sheath; J, outer layer of the internal root-sheath; K, internal layer of the internal root-sheath. (After Duhring.)

A, shaft of the hair; B, root of the hair; C, cuticle of the hair; D, medullary substance of the hair. E, external layer of the hair-follicle; F, middle layer of the hair-follicle; G, internal layer of the hair-follicle; H, papilla of the hair; I, external root-sheath; J, outer layer of the internal root-sheath; K, internal layer of the internal root-sheath. (After Duhring.)

#SYMPTOMATOLOGY.#

The symptoms of cutaneous disease may be objective, subjective or both;and in some diseases, also, there may be systemic disturbance.

#What do you mean by objective symptoms?#

Those symptoms visible to the eye or touch.

#What do you understand by subjective symptoms?#

Those which relate to sensation, such as itching, tingling, burning,pain, tenderness, heat, anaesthesia, and hyperaesthesia.

#What do you mean by systemic symptoms?#

Those general symptoms, slight or profound, which are sometimesassociated, primarily or secondarily, with the cutaneous disease, as,for example, the systemic disturbance in leprosy, pemphigus, and purpurahemorrhagica.

#Into what two classes of lesions are the objective symptoms commonlydivided?#

Primary (or elementary), and Secondary (or consecutive).

#Primary Lesions.#

#What are primary lesions?#

Those objective lesions with which cutaneous diseases begin. They maycontinue as such or may undergo modification, passing into the secondaryor consecutive lesions.

#Enumerate the primary lesions.#

Macules, papules, tubercles, wheals, tumors, vesicles, blebs andpustules.

#What are macules (maculae)?#

Variously-sized, shaped and tinted spots and discolorations, withoutelevation or depression; as, for example, freckles, spots of purpura,macules of cutaneous syphilis.

#What are papules (papulae)?#

Small, circumscribed, solid elevations, rarely exceeding the size of asplit-pea, and usually superficially seated; as, for example, thepapules of eczema, of acne, and of cutaneous syphilis.

#What are tubercles (tubercula)?#

Circumscribed, solid elevations, commonly pea-sized and usuallydeep-seated; as, for example, the tubercles of syphilis, of leprosy, andof lupus.

#What are wheals (pomphi)?#

Variously-sized and shaped, whitish, pinkish or reddish elevations, ofan evanescent character; as, for example, the lesions of urticaria, thelesions produced by the bite of a mosquito or by the sting of a nettle.

#What are tumors (tumores)?#

Soft or firm elevations, usually large and prominent, and having theirseat in the corium and subcutaneous tissue; as, for example, sebaceoustumors, gummata, and the lesions of fibroma.

#What are vesicles (vesiculae)?#

Pin-head to pea-sized, circumscribed epidermal elevations, containingserous fluid; as, for example, the so-called fever-blisters, the lesionsof herpes zoster, and of vesicular eczema.

#What are blebs (bullae)?#

Rounded or irregularly-shaped, pea to egg-sized epidermic elevations,with fluid contents; in short, they are essentially the same as vesiclesand pustules except as to size; as, for example, the blebs of pemphigus,rhus poisoning, and syphilis.

#What are pustules (pustulae)?#

Circumscribed epidermic elevations containing pus; as, for example, thepustules of acne, of impetigo, and of sycosis.

#Secondary Lesions.#

#What are secondary lesions?#

Those lesions resulting from accidental or natural change, modificationor termination of the primary lesions.

#Enumerate the secondary lesions.#

Scales, crusts, excoriations, fissures, ulcers, scars and stains.

#What are scales (squamae)?#

Dry, laminated, epidermal exfoliations; as, for example, the scales ofpsoriasis, ichthyosis, and eczema.

#What are crusts (crustae)?#

Dried effete masses of exudation; as, for example, the crusts ofimpetigo, of eczema, and of the pustular and ulcerating syphilodermata.

#What are excoriations (excoriationes)?#

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Vegetarian Dishes Page 12

Dissolve the butter in a saucepan, place in the onions sliced, and fryfive minutes; then add all the other ingredients and boil for one and ahalf hours. Strain before serving. If liked, a carrot and turnip, neatlycut into little strips, may be boiled separately, strained, and added tothe soup before serving.

No. 29.–Vegetable Marrow Soup.

1 large vegetable marrow. 1 quart water. 2 ounces butter. 1 gill of milk. 1 onion. 1 teaspoon salt. 2 tablespoons semolina.

Peel the vegetable marrow, and cut it into rather thin slices, cut theonion in quarters, and put all into a good-sized saucepan in which thebutter has been dissolved; add the salt and water, and simmer for onehour. Strain through a sieve, rubbing as much of the pulp through aspossible; return the soup to the saucepan, shake in the semolina, stirfor ten minutes after it boils, and add the milk just before serving.

No. 30.–Vermicelli Soup.

6 carrots. 6 turnips. 1 head of celery. 6 onions. 1 handful of parsley. 1/2 pint tomato juice. 3 quarts of water. 3 teaspoons of peppercorns. 2 ounces butter. 1 ounce of salt. 3 ounces vermicelli. White of 1 egg.

Clean and slice the vegetables, dissolve the butter in a large saucepan,place in it the vegetables, including the parsley, add water and saltand peppercorns, and boil for one and a half hours, removing the scum asit rises. Strain; return the soup to the saucepan, which should first berinsed, allow it to simmer, pour in the white of egg, re-strain througha very fine sieve (or a piece of muslin placed in an ordinary sievewill answer the purpose). Return again to the saucepan, which must bethoroughly clean, add the vermicelli, and simmer for half an hour. Addthe tomato juice just before serving.

STEWS.

No. 31.–Brighton Stew.

1/2 pound cooked haricot beans. 1/2 pint fresh green peas. 1 small cauliflower. 6 small onions. 1 pint haricot bean stock. 1 ounce butter. 1/2 ounce flour. The juice of half a lemon. Salt and pepper to taste.

Dissolve the butter in a stewpan, peel and halve the onions and fry themfor about ten minutes, but do not allow to brown, stir in the flour, addthe peas and stock, and simmer until the vegetables are tender, stirringfrequently, then add the beans, lemon juice, and seasonings. Boil thecauliflower separately, break up the white part into neat pieces, addthem to the stew, and simmer altogether for a few minutes. Pour into anentree dish and serve very hot.

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Essentials of Diseases of the Skin Page 4

Superficial, usually epidermal, linear or punctate loss of tissue; as,for example, ordinary scratch-marks.

#What are fissures (rhagades)?#

Linear cracks or wounds, involving the epidermis, or epidermis andcorium; as, for example, the cracks which often occur in eczema whenseated about the joints, the cracks of chapped lips and hands.

#What are ulcers (ulcera)?#

Rounded or irregularly-shaped and sized loss of skin and subcutaneoustissue resulting from disease; as, for example, the ulcers of syphilisand of cancer.

#What are scars (cicatrices)?#

Connective-tissue new formations replacing loss of substance.

#What are stains?#

Discolorations left by cutaneous disease, which stains may be transitoryor permanent.

#Distribution and Configuration.#

#What do you mean by a patch of eruption?#

A single group or aggregation of lesions or an area of disease.

#When is an eruption said to be limited or localized?#

When it is confined to one part or region.

#When is an eruption said to be general or generalized?#

When it is scattered, uniformly or irregularly, over the entire surface.

#When is an eruption universal?#

When the whole integument is involved, without any intervening healthyskin.

#When is an eruption said to be discrete?#

When the lesions constituting the eruption are isolated, having more orless intervening normal skin.

#When is an eruption confluent?#

When the lesions constituting the eruption are so closely crowded that asolid sheet results.

#When is an eruption uniform?#

When the lesions constituting the eruption are all of one type orcharacter.

#When is an eruption multiform?#

When the lesions constituting the eruption are of two or more types orcharacters.

#When are lesions said to be aggregated?#

When they tend to form groups or closely-crowded patches.

#When are lesions disseminated?#

When they are irregularly scattered, with no tendency to form groups orpatches.

#When is a patch of eruption said to be circinate?#

When it presents a rounded form, and usually tending to clear in thecentre; as, for example, a patch of ringworm.

#When is a patch of eruption said to be annular?#

When it is ring-shaped, the central portion being clear; as, forexample, in erythema annulare.

#What meaning is conveyed by the term “iris”?#

The patch of eruption is made up of several concentric rings. Differenceof duration of the individual rings, usually slight, tends to give thepatch variegated coloration; as, for example, in erythema iris andherpes iris.

#What meaning is conveyed by the term “marginate”?#

The sheet of eruption is sharply defined against the healthy skin; as,for example, in erythema marginatum, eczema marginatum.

#What meaning is conveyed by the qualifying term “circumscribed”?#

The term is applied to small, usually more or less rounded, patches,when sharply defined; as, for example, the typical patches of psoriasis.

#When is the qualifying term “gyrate” employed?#

When the patches arrange themselves in an irregular winding orfestoon-like manner; as, for instance, in some cases of psoriasis. Itresults, usually, from the coalescence of several rings, the eruptiondisappearing at the points of contact.

#When is an eruption said to be serpiginous?#

When the eruption spreads at the border, clearing up at the older part;as, for instance, in the serpiginous syphiloderm.

#RELATIVE FREQUENCY.#

#Name the more common cutaneous diseases and state approximately theirfrequency.#

Eczema, 30.4%; syphilis cutanea, 11.2%; acne, 7.3%; pediculosis, 4%;psoriasis, 3.3%; ringworm, 3.2%; dermatitis, 2.6%; scabies, 2.6%;urticaria, 2.5%; pruritus, 2.1%; seborrh[oe]a, 2.1%; herpes simplex,1.7%; favus, 1.7%; impetigo, 1.4%; herpes zoster, 1.2%; verruca, 1.1%;tinea versicolor, 1%. Total: eighteen diseases, representing 81 percent. of all cases met with.

(These percentages are based upon statistics, public and private, of theAmerican Dermatological Association, covering a period of ten years. Inprivate practice the proportion of cases of pediculosis, scabies, favus,and impetigo is much smaller, while acne, acne rosacea, seborrh[oe]a,epithelioma, and lupus are relatively more frequent.)

#CONTAGIOUSNESS.#

#Name the more actively contagious skin diseases.#

Impetigo contagiosa, ringworm, favus, scabies and pediculosis; excludingthe exanthemata, erysipelas, syphilis and certain rare and doubtfuldiseases.

[At the present time when most diseases are presumed to be due tobacteria or parasites the belief in contagiousness, under certainconditions, has considerably broadened.]

#RAPIDITY OF CURE.#

#Is the rapid cure of a skin disease fraught with any danger to thepatient?#

No. It was formerly so considered, especially by the public and generalprofession, and the impression still holds to some extent, but it is notin accord with dermatological experience.

#OINTMENT BASES.#

#Name the several fats in common use for ointment bases.#

Lard, petrolatum (or cosmoline or vaseline), cold cream and lanolin.

#State the relative advantages of these several bases.#

_Lard_ is the best all-around base, possessing penetrating propertiesscarcely exceeded by any other fat.

_Petrolatum_ is also valuable, having little, if any, tendency tochange; it is useful as a protective, but is lacking in its power ofpenetration.

Posted in Essentials of Diseases of the Skin.

By yfyc
13/03/2009

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Vegetarian Dishes Page 13

Note.–Good tinned peas will answer the purpose when fresh ones are notobtainable.

No. 32.–Carrot Stew.

3 carrots. 1 large onion. 1 ounce butter. 1 1/2 pints water. 6 ounces cooked rice. 1 teaspoon salt.

Slice the carrots and onion, and fry them in the butter for ten minutes,but do not let them brown; add salt and water, and boil for one and ahalf hours; then stir in the rice, simmer for another half hour,stirring frequently, and serve.

No. 33.–Stewed Cucumber.

1 cucumber. 1 shalot. 1/2 ounce butter. 1/4 pint water. A little pepper and salt.

Peel and slice the cucumber, place it in an enamelled stewpan with theshalot finely minced, the butter, pepper, salt and water. Simmer verygently for about half an hour, or until quite tender.

Note.–May be served plain, or with tomato sauce No. 181.

No. 34.–Stewed Cucumber and Beetroot.

1 small cucumber. 12 slices of beetroot. 1 shalot. 1 ounce butter. 1/4 pint water. A little pepper and salt.

Slice the cucumber and beetroot, and fry them separately in half anounce of butter for about five minutes. Place them together in a stewpanwith the shalot finely minced, the pepper, salt and water, and stewgently for half an hour.

No. 35.–Stewed Cucumber with Sauce Piquante.

2 cucumbers. 2 ounces butter. Pepper to taste. 1 gill of water. 1/2 teaspoon salt. 1/2 pint sauce piquante.

Peel and slice the cucumbers, place them in a stewpan with the otheringredients, and simmer for, half or three-quarters of an hour, leavingthe lid off the last few minutes in order that none of the liquor mayremain. Serve with piquante sauce No. 171 poured over, and sippets oftoast.

No. 36.–Braized Cucumber with Tomato Sauce.

1 cucumber. 1 shalot. 1/2 pound tomatoes. 1 gill of water. 2 ounces butter. 1/2 teaspoon salt. 1/4 teaspoon pepper.

Posted in Vegetarian Dishes.

By yfyc
13/03/2009

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Vegetarian Dishes Page 14

3 teaspoons semolina.

Dissolve the butter in a small stewpan, peel and slice the cucumber inslices about a quarter of an inch thick, remove the seeds with a pointedknife, dry the slices in a clean cloth and braize them in the butteruntil tender (about a quarter of an hour), adding a little salt andpepper. When done (they must on no account be allowed to break), removethem carefully with a fork one by one on to a suitable sized dish, andplace on one side. To make the sauce, cut up the tomatoes and shalot,and place them with the seeds and any rough pieces of the cucumber inthe butter which has just cooked the cucumber, adding water and salt ifneeded; simmer for half an hour, strain, and thicken with semolina, orflour if preferred. Re-warm the cucumber by placing it in the oven, pourthe sauce over, and serve.

No. 37.–Stewed Mushrooms.

For Mushroom Patties, etc.

6 ounces mushrooms. 3/4 pint of milk. Pepper and salt to taste. 1 ounce butter. 1/2 ounce flour.

Place the butter and flour in a small stewpan, and stir over a gentleheat until thoroughly mixed, add the milk and seasonings, and stir untilit boils. Then place in the mushrooms, which have been cleaned andprepared, and boil gently until perfectly tender, stirring all the time.They are then ready for use.

No. 38.–Potato Stew.

6 or 8 small potatoes. 1 gill water. 1/2 pint milk. 1 small shalot. 1 ounce butter. 1/2 ounce flour. 1/2 teaspoon salt. 1/2 dozen peppercorns. 1 strip of lemon peel.

Dissolve half an ounce of butter in a stewpan, place in the potatoespeeled, the shalot finely sliced, milk, water and seasonings (thepeppercorns and lemon peel tied in muslin), and stew until tender. Whendone, lift the potatoes carefully out and place in a hot vegetable dish,remove the seasoning, thicken the liquor with the half ounce each offlour and butter, stirring until it boils; then pour over the potatoes,and serve.

No. 39.–Baked Potato Stew.

Potatoes according to size. 1 1/2 pint good stock or sauce.

Peel sufficient potatoes to cover the bottom of a large and deep pie-dish(a cook’s comfort is the best shape for this purpose), pour over them thesauce or stock, which must be highly seasoned and flavoured with herbsand spices. Bake in a moderate oven for one or one and a half hours,according to the size of the potatoes.

Note.–Light dumplings and boiled cabbage should accompany this dish.

No. 40.–Stewed Green Peas.

1 pint shelled peas. 1 lettuce. 1 gill of water. 1 onion sliced. A sprig of mint.

Posted in Vegetarian Dishes.

By yfyc
12/03/2009

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