Pernio, or chilblains, is an inflammation of the skin, occurring as a secondary effect of cold, and appearing for the most part upon the hands and feet. Occasionally pernio attacks the nose and ears, and may appear on any part of the body. It commences after exposure to cold by slight vesication attended with tingling, itching, burning sensations. In mild cases it may it terminate in a few days with desquamation. In severer cases, remissions and exacerbations are prone to occur, and thus prolong the disease for months. The parts are usually left in an irritable state, and are liable to renewed attacks from the slightest causes. Any sudden change of temperature, and especially a combination of cold and moisture, may renew the trouble. In chronic cases the parts become livid or purplish on colour, and are more or less swollen and itchy. Ulcers frequently form. One author claims that the ulcerations of erythema pernio were very frequent in scrofulous patients. Chilblains present special gravity in certain cases, as they might become the starting point of cutaneous tuberculosis, and are specially tenacious when they occur on the fingers of patients affected with spina ventosa.
Prognosis-Pernio when it becomes chronic may last for years, disappearing usually in the summer time, but returning again as winter approaches. Treatment-When there is much inflammation a decoction of marshmallows, locally, acts well.
Tamus communis tincture is recommended as a topical remedy for unbroken chilblains.
Broken chilblains may be dressed with either Oxide of Zinc ointment or the Glycerole of calendula.
Resin ointment is adapted to the ulcers that sometimes follow.
The Galvanic current acts favorably in most cases.
Paint the affected parts every evening with a mixture of
Rx Resorcin, I part
Ichthyol, I part.
Tannin, I part.
Water, 5 Parts.
This will soon turn to a dry varnish on the skin, causing the latter to shrivel and the chilblains to disappear. A very successful application consists of compresses of cotton moistened with a solution of permanganate of potassium. The strength of the solution to be from one to three grains to the ounce of water.
Another excellent application is: Rx Iodini pur., I Part.
Collodion, 40 Parts.
Dissolve the iodine in the collodion, and apply to congested areas once daily.
Chilblains may re relieved by local baths of sulphuric acid and water, a liquor-glass of the former to quart of the latter. Ulceration does not contra-indicate. The baths, lasting about ten minutes, are employed twice daily.
The tincture of benzoin acts as a preventive. It is applied by simply painting it on the skin. The stockings may be prevented from sticking to the feet by rubbing some oil over the benzoin.
The remedies likely to prove useful are:
Agaricus-Violent itching, worse at night; burning in the fingers, lower limbs and toes; itching, burning and redness of the toes.
Arsen. alb.-Ulcerated chilblains; red spots on the feet; violent tearing pains in edges of ulcers when exposed to cold; relieved by warm applications.
Badiaga-Flesh and integuments sore to the touch; sensitive to cold air.
Bellad-Bright red shining swelling, with pulsative pains; burning in skin when touched; tingling itching., worse at night.
Calcarea sulph-Discharging pus.
Cantharis-Itching and swelling of the fingers; blisters burning on touch; burning in the soles of the feet at night in hysteric patients; tearing and ulcerative pains.
Citrus vulg-Itching and swollen hands and arms; general itching, which prevents sleep.
Kali phos-Chilblains on toes, hands and ears, tingling and itching pain.
Nitric acid-Itching of the feet; spreading blisters on the toes; ulcers with stinging and pricking pains as of splinters; offensive profuse perspiration on the feet, causing soreness.
Petroleum-Broken chilblains, with tendency to fester; heel painfully swollen and red with stitches; tips of fingers rough, cracked and fissured, with sticking cutting pain unhealthy skin.
Prunus-Itching on tips of fingers as if frozen.
Pulsat-Blue red chilblains with pricking burning pain, worse toward evening; redness and swelling of joints with stinging pains; feet feel hot and swollen with tensive burning pains; wandering pains.
Rhus tox-Inflamed chilblains with excessive itching; aching pains in the legs; worse before storms and from getting wet.
Sulphur-Thick red chilblains on the fingers which itch severely when warm; predisposition to chilblains.
Urtica dioica-Has been used both internally and externally with good results.
Veratrumvir-Intense painful itching; chilblains on the nose; prickling in the fingers and toes; used internally and locally.
This is a very rare disease, and may best be described by the following case as reported by Drs. J. Darier and G. Gautier:
The patient was aged 24. The disease, the etiology of which could not be definitely traced, had appeared nine months previously. The lesion occupied almost the entire right cheek, extending from the inferior border of the orbit above, limited on the inner side by the nasal furrow, and arrested bellow at a line corresponding to the upper border of the inferior maxilla, and extending over the entire cheek-bone. The surface was of a reddish violet, of the color of certain forms of lupus, and covered in part by scales. The lesion was somewhat elevated and studded with half a dozen hemispherical elevations or nipples of about one centimetre in diameter, some of them ulcerated at the summit and covered with crusts.
The diagnosis was established by the abundant presence in the pus of minute grains of actinomycosis, each drop of pus containing from ten to fifteen of these minute bodies.
The case was cured by the electro-chemical treatment.
This treatment is based upon the decomposition of a solution of iodide of potassium (one to ten), in living tissues, into iodide and potassium by the galvanic current. To obtain this result, Dr. Gautier introduced two platinum needles into the nodules of the tissue, and by means of a syringe injected, every minute during the operation, a few drops of the solution. The two needles were connected with the two poles of a battery. The treatment, which was under chloroform, consisted of three seances, twenty minutes each, at intervals of eight days, with an intensity of fifty milliamperes.
The patient being enciente, the treatment was interrupted for fear of compromising the natural evolution of the pregnancy. Six weeks after her accouchment a final treatment was given, with the result of accomplishing what is apparently a complete cure.
Dr. Ferrier, in 1879, first recorded a peculiar condition of the skin in which certain metals marked it with black lines; this condition he terms”Wash-leather Skin.”
From an analysis of fifty cases, Mr. Emerson concludes that:
1.As a rule, wash-leather skin does not occur in the healthy.
2.It does not occur in many disease.
3.It occurs in patients suffering as a rule, from diseases which directly or indirectly affected either the trophic or the secretory nerves of the skin, such as renal disease, phthisis, erysipelas, and hemiplegia.
4.Silver is the best metal to use for bringing out the marks.
5.It may precede, and in the cases cited did precede, bed sores.
6.It is of diagnostic value in testing vitality of the skin, and the site for the experiment is the lumbo-sacro-gluteal region.
7.So far as one may judge at present, it may be of value of foretelling bed-sores; and should this be established it would be of great use, for the proper precautions might be taken as soon as the black line is diagnosed; this, at present, seems to be its only probable us. The pathology of this phenomenon is as yet only conjectural.
Effects of Rhus tox. on the Skin.
The first toxic action of this species is one difficult to explain. The first noticeable peculiarity is its choice of victims, many persons being entirely devoid of response to its influences, many others peculiarly susceptible.
Another peculiarity is that in many cases it is not necessary to even touch the plant to be severely poisoned.
A third peculiarity is that the plant is more poisonous during the night, or at any time in June and July when the sun is not shining upon it. Absence of sunlight, together with dampness, seems to favor the exhalation of the volatile principle (Toxicodendric acid) contained in the leaves. An acrimonious vapor, combined in the leaves. An acrimonious vapor, combined with carburetted hydrogen, exhales from a growing plant of the poison ivy during the night. It can be collected in a jar, and is capable of inflaming and blistering the skin of persons of excitable constitution who plunge their arms into it.
The symptoms caused by this plant are: First, redness and swelling of the affected part, with intolerable itching and burning, followed by vertigo, weariness, and a sort of intoxication. Infiltration of the face and eyes, and agglutination of the lids after sleep; great restlessness, pain, thirst, and fever. The surface of the skin, after a time, becomes studded with confluent bullae where the cellular tissue is loose, they a dermatitis follows resembling erysipelas; this may spread rapidly and finally communicate to the mucous membranes. This is followed by swelling of the month and throat, cough, nausea, and vomiting. Rheumatoid pains develop about the joints, and a painful stiffness asserts itself in the lumbar region, while the legs and arms become numb. Confusion of mind and delirium may then set in, during which the patient become ill-humored, restless, and anxious, that he will jump out of bed.
The concomitant symptoms are inflammation of the eyes, dilation of the pupil, weakness of vision, and sometimes diplopia; frequent epistaxis; brown coated tongue, with a triangular red up; swelling of the parotid glands, with difficult deglutition; griping in the abdomen; diarrhoea; profuse urination; oppression; rapid pulse; great weakness, weariness, and prostration; soreness of the muscles, worse while at rest, and passing off when exercising; sleepiness; and chilliness, followed by fever and copious sweat.
There are almost as many antidotes recommended for Rhus tox. poisoning as for the bite of the rattlesnake, Prominent, however, among the application are: Alkaline lotions, especially carbolate of soda, alum-curd, and hyposulphite of soda, keeping the skin constantly moist with the agent in solution. A strong infusion of red Sassafras root is strongly recommended. It is applied freely to the parts, and gives almost immediate relief, and this, too, when other remedies fail.
The fluid extract of serpentaria has been used in quite a large number of cases of rhus poisoning with great success. It is best applied by placing cloths moistened with the extract upon the affected parts without any friction.
The internal remedies most likely to prove beneficial are; Agaricus, Apis, Arnica, Belladonna, Bryonia, Croton tiglium, Graphites, Grindelia robusta, Ledum, Nymphoea, Sanguinaria, Sepia, or Verbena urticafolia.