The Prognosis offers no point of gravity or interest.
The Diagnosis-Roseola is likely to be confounded with rubeola, scarlatina, urticaria, erythema. It is known from measles, in that it possesses no catarrhal symptoms; in that there is no relation between the febrile symptoms and the amount of eruption; in that there is no epidemic influence at work in its production; in that it is irregular in its distribution, non-crescentric, not uniform, not dark-colored; but irregular, rosy, and often commencing in other parts than the face. Rubeola has a regular course, and is not partial in regard to the distribution of its accompanying eruption.
It makes very little difference if roseolas be confounded with erythema, for the one is a red, the other is a rosy erythema.
In Scarlatina, the general aspect of the disease is grave; the fever is marked, the throat is bad, the tongue is peculiar; the skin harsh, dry; the rash general, punctiform, boiled-lobster like. The progress is more uniform, and the disease can be traced to contagious or epidemic influence.
In Urticaria, the diagnosis is at once settled by the discovery or production of a wheal, and the peculiar stinging character of the local irritation, with the capricious character of the eruption.
Treatment-The benign and self-limiting nature of the disease leaves but little need for work under this head. The old-school advise giving salines, aperients, laxatives, etc., and treating any special symptoms. Locally, in removing all causes of irritation-for example, irritated and tender gums, by lancing; acidity of stomach, by magnesia, soda or lime-water; intestinal irritation, by “alternatives,” such as rhubarb, and subsequently tonics, keeping up the warmth of the surface, and if possible, bringing on perspiration. The surface should not be chilled. The patient should be kept within doors for a few days, and have a warm bath at bed-time, followed by cutaneous frictions with oil; the diet should be light and non-stimulating.
Belladonna is the principal internal remedy. Ferrum phos, is highly recommended by some physicians. Large doses of antipyrine produce an erythematous eruption which is cinnabar-red in color, slightly elevated, and consists of rounded spots, disappearing under pressure. At the knees and elbows are found great red patches, chiefly on the extensor surface. The head, palmar and plantar surfaces are not affected.
Urticaria.
Urticaria is an affection of the skin characterized by the development of white or reddish elevations termed wheals, which are accompanied with more less pruritus. These wheals may be few and localized, or, more frequently, they exist in considerable number, and are generalized.
Not infrequently a little heat and itching first appear; and, if the part be rubbed or scratched, the wheals become manifest. The elevations may last for a few minutes only or for a few hours, and disappear, leaving no trace behind. Later in the day, or perhaps the next day, a renewal of the eruption occurs, and these may be repeated for a few days or persist for months, constituting a chronic urticaria.
The degree of pruritus varies, it may be hardly more than an agreeable sensation, or may be sufficiency severe to constitute a veritable torture. The scratching will, of course, be commensurate with the itching, and lead to more lass excoriation and even deep wounding of the skin.
The wheals are chiefly met with on the covered portions of the body, and their appearance is favored by warmth frequently disappearing if the parts be exposed to a draught of cold air. Thus it not infrequently happens that a patient may have a severe attack at home, but by the time he reaches the physician, all signs of the eruption will have disappeared, or perhaps there will be nothing visible on the skin except a few insignificant scratch marks. In these cases, if the finger nail or the point of a pencil be sharply drawn across the skin, it will be followed by a white line, which in a few moments becomes elevated and red, and lasts for a brief period, and then disappears.
Urticaria presents certain peculiarities according as it occurs in the adult and the child, owing, in the latter, to the greater sensitiveness of the skin, and the tendency to the deposition of lymph in the site of the wheals. Some authors treat of urticaria in the adult and in the child. I think this is entirely unnecessary and apt to lead to confusion.
The chronic forms may result from the acute, or develop out of a state of tolerable health, and without apparent cause. There is little pyrexia present in chronic urticaria. When the crops of wheals are of pretty long continuance, the disease is called U. perstans. In other cases the wheals are small and very fugitive;but the skin is irritable, and the itching intense. This is U, evanida. The name of factitious urticaria has been given to that form of the disease which is easily produced by mechanical irritation, and is not idiopathic.
It occasionally happens that in the formation of wheals, instead of serum being poured out, a certain amount of hemorrhage occurs. This effusion of blood in connection with the escape of serosity from the vessels is not confined to urticaria, but may take place under certain circumstances in connection with almost every skin affection which is hyperaemic and inflammatory. When the effusion is conjoined with the development of wheals, the blood generally raises the cuticle somewhat, and produces what is called purpura urticans. The surface that does not heal, and whence a certain amount of bloody fluid may ooze for a while. The name of Urticaria hemorrhagica has been given to this latter disease, and it includes the so- called purpura urticans. The hemorrhage, however, is a mere epiphenomenon, though it indicates a purpuric tendency. These little hemorrhagic wheals are sometimes seen about the neck and face of nervous women and elderly men out of health.
Etiology-In a person predisposed to this affection almost any external irritation may cause an outbreak; and an exactly similar eruption may be provoked in some by contact with certain poisonous plants, as the common nettle. More frequently, however, the eruption is of internal origin, and is but the reflection of pre-existing irritation of the gastro-intestinal or sexual organs. Certain articles of diet-as crabs, lobsters, various shell-fish, and certain fruits-as well as certain medicinal agents, excite a gastro-intestinal derangement, which is chiefly made manifest through the cutaneous disturbance.
Under the first head, or local excitants, rank the acarus, flea, bugs, mosquitoes, lice, flannel, the contact of numerous other irritants, such as “jelly-fish.”
Prognosis.-There is no gravity attaching to urticaria. Acute attacks ab ingestis are of short duration. Chronic urticaria is very troublesome; the intermittent form is also very obstinate.
Diagnosis.-Urticaria ought not to be confounded with any other disease. The sudden appearance of eruption and its capricious character, the tingling sensation, the presence of wheals, gastric disturbance, and irritability of skin are absolutely diagnostic.
Frankworsky urges flagellation of the skin with nettles as a very efficient remedy in anaesthesia, paralysis, and neuralgia. He has witnessed good effects from the same in locomotor ataxia. In asthma, dyspnoea, amenorrhoea, virile impotence, and rheumatic pains, it regulates the disordered functions. In favor of this procedure he cites the rapidity of its action, its innocuousness even after prolonged use, and the total absence of all irritation of the kidneys arising from it. It leaves no scars, and gives rise to no suppurating surfaces on the skin. The flagellation may be either local or general and should be continued until bullae form. Its action is stimulating and refreshing.
Treatment.-The principal consideration in the treatment is the diet, which should be light, nutritious, and easily digestible. To allay the itching the eruption may be frequently dusted with toasted rye or wheat flour, or when the cuticle is not broken it may be washed with brandy and water, or salt and water. Warm vinegar and water lotions may be used to allay the itching and burning. Chloroform, one-half drachm to the ounce of cream, will frequently prove serviceable. Benzoic acid, grs. v-x, water j. is spoken of favorably. A weak carbolic acid lotion at times acts well. The Turkish bath may help when other means fail.
In acute cases, especially those in which it is clear that the trouble has arisen from irritant ingesta, the indications for treatment are clear, and should be promptly carried out. A good emetic, or a free purge, will clear out the alimentary canal, and, thus removing the cause of the irritation, bring the affection to a speedy close.
In children, especially, the diet must be carefully regulated. In chronic cases, especially when caused by eating shell-fish, study Arsenicum; in cases of gastric origin, consult Kreosotum, Bovista and Pulsatilla; in children who are fond of eating salt, Natrum mur.; candy eaters may be benefited by Argentum nitricum.
