Upon the nature of the cause depends the contagious or non- contagious quality of any disease. It is generally conceded that parasitic and the acute specific diseases are contagious.
Sex has some influence as a cause of disease; males suffer by preference from sycosis, pemphigus, psoriasis, eczema, and epithelioma; and females from acne, kelis, and lupus especially.
In our own clime race would seem too exert an influence upon lesions of the skin. Dr. Morrison, of this city, has preserved histories of five hundred cases of skin diseases in Negroes, and forms the following conclusions:
“Acne and lesions due to pediculi and insect-bites are uncommon. Mosquitoes, the cimex lectularius, and insects in general, do not produce the same ill effects” (My own observation, which has been quite extensive, would lead me to disagree with the doctor in regard to the pediculi. They are very apt to have lesions from this cause). ” Ainhum is peculiar to the race, two cases having been seen; one man had lost one little tow, and that of the opposite foot was affected.”
Chancre is more indurated, and more frequently complicated with phimosis.
Chloasma appeared to show a lessening of pigment, instead of an increase. (Dr. Heitzmann takes issue with Dr. Morrison on this subject, and asks how can a diminution of the normal pigment be termed chloasma, an increased pigmentation being usually understood by that name.)
Chilblain is common.
Elephantiasis Arabum mostly follows syphilis.
Erythema multiforme is difficult to diagnose, as are all erythematous conditions.
Eczema appears to be more amenable to treatment; 129 cases are recorded.
Favus and pediculi capitis are rare. (The latter is common. D.)
Keloid appears common, especially false keloid after injuries. It is seen following variola and zoster, and after piercing the ears.
Lupus is seldom encountered.
Lymphadenitis is quite common.
Pruritus is much complained of, and it is said that syphilitic lesions itch in this race.
Scabies was rarely seen. (I have seen several cases.)
Syphilis is abundant.
Scaly and pustular lesions are often seen.
Urticaria wheals do not seem to be so elevated, but very itchy.
Dr. Atkinson reported a pustular folliculitis very frequent in young, closely-shaven negroes. The pustules penetrate into the follicles of the beard without producing that degree of irritation which is to be called sycosis. He thinks that fifty per cent. of the young negroes who shave very close have it.
He has noticed that it is common to find deep and permanent pigmentation after the application of a mustard plaster. (I have often noticed the same condition.)
Involution occurs after a time in keloidal tumors; they become flaccid, and, after some years, soft.
Pediculosis appeared to him to be as frequent in colored as in white children.
Acute exanthemata produce, upon desquamating, a peppered appearance, looking as though the skin were dusty or sprinkled with fine powder. In scarlatina it is due to the slight elevation of the papules, which is not evident in Caucasians.
Whatever be the causes of the various cutaneous affections, we are chiefly concerned with the means that the physician has at his command with which to treat them successfully. First of this is hygiene. It goes without saying that recovery is facilitated by the substituting of good hygienic surroundings for bad ones; and under this head we may include fresh air, wholesome food, cleanliness, exercise, and seasonable clothing. It is hardly necessary to go into details on these points, if the fact is recognized and remembered; and in all chronic affections of the skin, and in some of the acute ones, these matters should be inquired into, and corrected when possible. Our resources further include mechanical, chemical, and pharmaceutical remedies, and also electricity. An elastic bandage applied to an old, infiltrated eczema of the leg is an illustration of the first; an active caustic applied to an obstinate ulcer may be considered as an example of the second; but by far the largest proportion of remedial agents will be found in the pharmaceutical division. This class embraces remedies used both internally and externally.
The homoeopathic materia medica is rich in remedies having a direct and specific action upon the skin. And the fact that we always prescribed for the totality of symptoms manifested in our patient, laying stress upon the affection as shown in the skin only as a symptom of the diseased condition, often leads us to prescribe, with the happiest results, a remedy not ordinarily classed among the skin remedies. Great improvements have been made by both schools, in the last few years, in the external applications. Formerly lotions and ointments were almost the only means of making external applications, but within recent years we have learned the value of collodion, of solutions of gutta-percha (traumaticin), mixtures of gelatin with glycerin, starch, etc., plasters and other bland compounds and mixtures, as excipients for the drugs that we desire to bring into direct contact with the diseased parts.
Electricity, also, as a destructive agent (electrolysis), or as a modifier of local nutrition, or as an excitant of reflex action, plays a by no means humble part in the treatment of these diseases.
If physicians would give as much thought and care to the study of these affections as they do to others, not only would our armamentarium be enriched and purified, but our successes would be greater and failure less. They should not be content with the mere diagnosis and naming of the disease, but should study the peculiarities of each case, and the influence exerted by the general health or condition of the patient on the special lesions in question.
When treating of the several lesions, therapeutically, it shall be my endeavor to give the best that is recommended by both schools of medicine. We must bear in mind that “The physician’s highest and only calling is to restore health to the sick.” “The highest aim of healing is the speedy, gentle, and permanent restitution of health, or alleviation and obliteration of disease in its entire extent, in the shortest, most reliable, and safest manner, according to clearly intelligible reasons.”
Keeping these aphorisms of our illustrious master ever before us, we will proceed in the next chapter to take up the different lesions of the skin, and study them with the best light we have at our command.
