Zinc Chloride should he confined in its application to eases where scraping or curetting has been performed, and Vienna Paste should never be used at all on the fa( e.
Carbolic Acid, though very superficial in its action, is a most efficient caustic when skilfully applied. It may be employed by two different methods. Drum., after freezing the patch with Ethyl Chloride spray or Carbonic Acid Gas, rubs in the strong acid 'Oust thoroughly over the whole surface of the patch by means of a stout stick whose extremity is covered over with cotton-wool. The cauterised surface is dressed with dry Eugulorm. Carbolic Acid applied in this manner is not free from danger, as it seems possible that a large slough might follow which would cause serious deformity.
A thoroughly legitimate method of using this caustic has been already mentioned by thrusting a piece of pointed matchwood dipped in the acid into each nodule and turning it round so as to well apply the caustic to the lupoid tissue. Hutchinson employs the Liq. llydrg. Pernit. in the same manner, and these may be used to expedite the light or X-ray treatments.
Permanganate of Potassium may he employed like the carbolic acid; thus the dry powdered salt may he sprinkled over an extensive patch after this has been lc:Lise(' and lightly scraped, or a crystal may be thrust into each nodule alter puncturing with a finely pointed piece of wood.
of Mercury is applied by Lima to each punctured nodule in the following solution :—Perchloride 6o grs., Creosote 4 drs., Spirit. Rectif. 21 oz.
Iodine Paste, prepared by triturating equal quantities of pure metallic iodine and tincture of iodine together, and adding to the mixture an equal amount of glycerin, is a manageable and efficient caustic in the ulcerating stage, and effectually destroys secondary infective organisms. A minute quantity may be also thrust deeply into each punctured nodule.
Nitrate of Silver was a favourite remedy with II ebra. It may be used as a solution (6o grs. to f oz.), or as the solid stick, which is better. This may be thrust into the papular or tubercular elevations after puncture with a lancet, and, though terribly painful, it is very efficacious.
Chromic Acid has been recommended to be used in the same manner, but it should never be employed about the face, as it often penetrates deeply, and may cause very unsightly scars.
Iodoform rubbed in deeply after linear scarification is still employed with success by some dermatologists, who report that the resulting cicatrix is very satisfactory.
Ethylate of Sodium Solution is an excellent caustic where there is little tissue calling for destruction. It may be daily brushed over the diseased patch (which should be dried with blotting-paper) by means of a glass brush till a scab forms, which falls off in a few days, after which the applications are to be renewed. If pain is severe,
a drop of Chloroform may be applied. This converts the Ethvla te into Ether and Chloride of Sodium. The scarring is comparatively slight.
Carbonic Acid Snow, though more useful in lupus erythematosus, been reported as giving satisfactory results in ordinary lupus also, the resulting scar being flexible and of good colour.
The various treatments for lupus may be summarised in the following list in the order of their value: i. Finsen Light.
2. X Rays, Radium Emanations and Ultra-Violet Rays.
3. A combination of these methods used alternately, especially when the nasal mucous membrane is deeply involved. In the ulcerative stage the Finsen light may be employed for the periphery and the X rays fur the centre of the patch.
4. Vaccine Therapy in all cases not readily yielding to above, if em ployed in conjunction with their continuance, but of little value when used alone.
5. Excision when the patch is small and is situated upon any part except on the face and neck.
6. Scraping, Thermo- or Galvano-Cautery and Scarification or Multiple Puncture, when combined with the former methods or used in conjunction with caustic treatment, or alone when employed for the disease in mucous membranes.
7. Cataphorcsis or Electrolysis when the diseased action is very super ficial.
8. Caustics (i) when the disease is located in the mucous membrane, scraping having been previously resorted to; (2) when the patches are not on the face; and (3) in lupus verrucosus; (4) in conjunction with light, X-ray, radium, and vaccine therapy, to expedite these methods, the caustic being applied to each nodule separately or more extensively to a freely ulcerating surface on the face.
In a simple case of nodular or ulcerating lupus on the face there is no necessity to resort to any form of treatment save Finsen light when the opsonic index is not low, and when the patient's means permit of a pro longed sojourn at the place of installation. It should be regarded as the most efficient routine and the only one which is absolutely free from all danger of making the patient's case worse even in those rare cases which are refractory.
Scrofulodermia is to be treated upon the same lines as lupus verrucosus; the epithelial casing of the patch being first removed by Salicylic paste, the underlying lupoid tissue may be attacked by Finsen light, X rays, caustics or the cautery; small patches may be excised. Verruca necro genica is to be treated upon the same principles; excision is preferable to caustics.