GOUT). If the nervous system be at fault, remedies tending to increase their nutrition,—strychnine, for instance,— assisted by electricity, especially the static, are indicated. In other words, the general causative factor should be ascertained and appropriately treated. L. D. Bulkley has emphasized the fact that psoriasis is benefited by alkaline remedies, counteracting acidity of the blood and urine.
Jonathan Hutchinson states that in all cases of psoriasis alcoholic stimulants should be forbidden, and that those who persist in intemperance are incurallc. He recommends an ointment containing chrysophanic acid, creasote, liquor car on;s, and ammonio-chloride of mer cury, varying in proportion according to the delicacy of the skin; this must be used very freely, without regard to the underclothing or bed-linen. The regu lar use of a hot bath softens the skin and prepares it to receive the ointment. Arsenic enjoys the confidence of some dermatologists, but, according to Fox, Crocker, and other authorities, it is not only useless, but in some cases it may be injurious. It fails entirely as a prophy lactic, and usually local applications are preferable to its use. When the disease tends to improve, however, it may be of service in hastening recovery.
Of the various local remedies employed chrysarobin stands without a rival. Like arsenic, it is most likely to do good when the acute congestion of the psori atic patches has subsided and the erup tion is tending toward a spontaneous improvement. It not only stains the skin temporarily, but it permanently dis colors the underclothing and the bed linen, if due precaution is not taken. When rubbed in where the skin is thin, or near it, it often excites a very un pleasant dermatitis for a few days; and when by chance a little of the ointment gets into the eye a very severe conjunc tivitis often results. Upon the trunk and extremities a 5- or 10-per-cent. oint ment, made by rubbing up a finely-sifted chrysarobin in vaselin, can he advan tageously used; but upon the scalp and face the ointment of ammoniated mer cury will generally prove efficacious, and is to be preferred to the chrysarobin. George H. Fox (Amer. Jour. Obstet., Apr., '96).
Intravenous injections of arsenic em ployed in 28 cases of psoriasis, in 25 of which no other treatment was adopted. Of these 25, 10 were completely cured, 6 left the hospital much relieved, and 9 were reported as still under treatment, all greatly improved, and 3 nearly cured. The commencing dose is 1 milligramme of arsenous acid, and this is increased daily by 1 milligramme up to 15 milli grammes, the maximum dose, which is repeated daily until the eruption disap pears, generally at the end of six or seven weeks. The following is method of procedure:— After disinfection of the skin by soap, turpentine, ether, and sublimate, and the application of an Esmarch bandage above the elbow to render the veins prominent, the needle of a Pravaz syr inge is introduced as nearly parallel to the skin as possible, and its penetration of the vein ascertained by withdrawing the piston. After the injection of 1
cubic centimetre of a limpid solution of arsenic of the desired strength, the wound is closed with oxide-of-zinc plas ter. Herxheimer (La Sem. MM., '97; Brit. Med. Jour., Oct. 23, '97).
Formula for ointment to be employed in very obstinate eases of psoriasis is:— E Acid. salicylic, 3 parts.
Acid. pyrogallic., 3 parts.
Ammon. sulpho-ichthyol, 3 parts. Olei olivee, 10 parts.
Adip. lane, to 100 parts.
Paul Richter (Slonats. f. prakt. Derm., p. 342, Oct. 1, '98).
Strong alcohol applied at night to the affected part by means of cotton com presses are very effective. The alcohol used varied from 70 to 90 per cent., and contained 2 per cent. of salicylic acid. A rubber darn or some other impervious. material should be used to prevent evapo ration, and the compress left until the following morning, when the parts are washed with soap, and the loosened scales removed. The part is then anointed with lanolin. This method of treatment, be sides being effective, is cleanly, and gives the patient no annoyance. Lau (Jour. de Mkl. de Paris, Nov. 19, '99).
Review of reported cases of psoriasis associated with diabetes and analysis of a case of Senator's. In S out of 25 cases of psoriasis the writer succeeded in in ducing alimentary glycosuria, while in a number of eases of other cutaneous dis eases this was impossible. There must be some connection between psoriasis and diabetes under certain circumstances. F. Nagelschmidt (Berliner kiln. Woch.,. Jan. S, 1900).
Psoriasis is not very amenable to treat ment. Arsenic is, on the whole, the most efficacious drug, but it has to be given in large doses and with great perseverance. When it cures the disease it often leaves pigmentations of the skin, sometimes thickening of the epidermis of the palms and soles, and in very rare cases, ac cording to Hutchinson, •orn-like growths which inay become malignant. In acute forms a a tim o n y is most useful, and nerve-sedatives should be administered if there is any clear indication for their employment. Thyroid feeding leis been found quite useless. For local applica tion, parasiticide substances, such as mercurial preparations, resorein, etc., are useful, but the most efficient of all is chrysarobin. A visit to a sulphur spring will in many eases complete the cure. Whatever plan of treatment. is employed, it must be followed out perse veringly. Alnleolm (New York Sled. ,Tour., Nov. 16, 1901).
The use of thyroid tabloids in psoriasis has been disappointing; nevertheless.
great improvement has been noted in certain cases. (See ANIMAL EXTRACTS, volume i.) As to the prognosis, George Henry Fox states that it is often an easy matter to remove the eruption by treatment, but it is difficult, if not impossible, in many cases, to prevent its speedy return. The prognosis, therefore, is always unfa vorable as regards the permanent cure of the disease.