B. SIIOBER, Philadelphia.
PERNIO (CHILBLAIN).—Pernio is an erythematous local inflammation and swelling of the skin due to cold. (See also ERYTHEMA.) Symptoms.—In the majority of cases there is slight redness, swelling, itching, and burning of the part. These symp toms all become intensified in severe cases, and the inflammation may be so great that vesication and ulceration result.
Chilblains may be followed by a gen eral tumefaction of the regions attacked, which is the result of local asphyxia even more than of chilblains themselves. In the hands and toes this tumefaction gives a peculiar sausage-like aspect to the parts, somewhat like that resulting from a cromegaly. Another consequence, still more rare, of chilblains is the pro duction of localized and persistent vas cular dilatations, true acquired capillary angiomata, on which there are small papillomata resembling warts.
Etiology and Pathology.--Defective or insufficient alimentation facilitates the development of chilblains; inactivity also assists; cold, aided by defective con ditions of circulation and of functions of the economy, is their main cause. It exerts still greater effects when the skin is wet or not properly dried, or when it is suddenly succeeded by heat. Chil blains may often be prevented if the parts which have been exposed to the cold arc slowly and progressively warmed. (Thibierge.) The relation between the lymphatic constitution and a predisposition to chil blains is ascribed by A. E. Wright (Lan cet, Jan. 30, '97) to a lymphatic consti tution, due, in turn, to a water-logging of the tissues through an excessive tran sudation of lymph. A slight increase of transudation converts such a condition of the tissues into perfectly definite lunmatomata such as are seen in chil blains. The subjects of malarial ea chexia are not infrequently also the subjects of chilblains, which are also of very frequent occurrence in haemophilic families.
Treatment.—The obvious indication in a case of chilblains is, according to Wright, to increase the patient's blood coagulability, and in conformity with these indications patients are to be placed upon a regimen of calcium chloride, after duly cautioning them against lo IVering their blood-coagulability by the inges tion of sour fruits, alcohol, or excessive quantities of fluid.
A solution of acetate of zinc, one drachm to the pint of water, applied to the foot will, according to G. J. Monroe, give almost instant relief.
Codliver-oil, preparations of iodine, iron iodide, and arsenic are indicated in all cases. M. Brocq (N. Y. Med. Jour., Jan. 30, '97) obtained good results from the association of quinine sulphate and of ergotine (in doses of from grain to 3 grains) with powdered digitalis (from to grain) and the extract of bella donna (V, grain) in the form of pills, the employment of which was prolonged during the entire winter. Inhalations of oxygen are indicated in subjects in whom the sluggish condition of circulation pre disposes them to chilblains. Regular exercise, walking, gymnastics, cold allu sions, and general stimulating lotions are also extremely useful prophylactic means in the majority of subjects. The hands should be covered with thick and suffi ciently warm gloves, but rough woolen gloves should be avoided. They, like the feet, should be washed in warm water (not in cold) and carefully dried on a towel (never before a fire), and then pow dered with starch or talcum in order to remove every trace of dampness. The hands should not be allowed to remain too long in cold or soapy water. Shoes and stockings should be comfortably large; they should be thick enough to protect the feet against the action of the cold. If sweating accompanies the chil blains, repeated foot-baths must be re sorted to. Foot-baths containing small quantities of astringent decoctions of walnut-leaves, of ash-leaves, of eucalyp tus-leaves, of oak-bark, etc., of from five. to six minutes' duration, constitute a very useful means of preventing frost bites. When the lesions are due to hy with little or no infiltration of the skin, zinc-oxide ointment, such as the following, to which has been added a small quantity of carbolic acid or men thol, will suffice to allay the pruritus and cause the rapid disappearance of the lesions: 4 Zinc oxide, 150 grains.