PEMPHIGUS.
Pemphigns neonatorum is now regarded as being of the same nature as impetigo contagiosa, an infection commencing possibly as a streptococcic invasion, hut which rapidly passes into the staphylococci('; doubts are held ahout pemphigus vegetems beirig a true pemphigus.
Pemphigns l'ulgaris.— The treatment of this affection, in which bulke arise upon otherwise healthy skin, should immediately he commenced by the administration of Arsenic in gradually increasing doses till the maxi mum amount tolerated by the stomach is reached. Where there is any gastric irritability, Carodylates may he administered hypodermically or by the rectum. In the majority of eases the drug appears to possess a specific action over the diseased process.
Cod-Liver Oil, Malt Extracts, Quinine, Iron and other tonics, together with nutritious feeding. are always indicated in a disease which shows remarkable tendency to become chronic.
Where arsenic fails a host of internal agents has been recommended, as Iodides, Phosphorus, Antimony, Guaiacum, Belladonna, Mercury, Chlorate of Potassium and Strychnine, but there is no real evidence of the value of any of them.
Local treatment at the best is but palliative and symptomatic. In acute cases characterised by great tension in the bulb these may be pricked with a sterilised needle or lancet and dressed with Boric, weak White Precipitate, or Zinc Ointments, or any bland unirritating antiseptic salve. Powders freely dusted over the weeping surface are in some cases better, especially when excoriations are present. Amongst dry applications of this sort are finely powdered Fuller's Earth, Bismuth Carl)., Oxide of Zinc, Chalk, Starch, Prepared Calamine, Oleate of Zinc, &c., either alone or mixed in such proportions as the appearance of the parts indicates.
The following paste is a convenient application both in simple chronic and in the foliaceous variety of the disease: Zinci Oxidi Crc/ca Preeparake Oiei Lini Acpree Colds ana 3i. Misce.
It is advisable to employ lotions at intervals so as to effectually soften and cleanse away any crusts or cakes which are liable to form when powders or ointments have been used for a long period. One of the best of these is a I per cent. Carbolic Solution applied over the excoriated surface on compresses; I per cent. Borax may be added to it. Carron Oil
with 2 per cent. Carbolic Acid relieves itching and smarting.
Perri/ higus Foliacens.--In the treatment of this most chronic and obstinate disease, Arsenic is usually of no value. Whilst constitutional agents are required to combat amemia„ dyspepsia, constipation &c., highly nourishing food should be pressed in order to meet the long drain upon the patient's strength. Local treatment should consist, as in the simple chronic variety of the disease. in snipping the flaccid bulke and dressing the raw surface with any of the bland antiseptic preparations already mentioned.
The best plan is to permit the patient to lie in a tepid bath for several hours daily, after which the excoriations may be dressed with Zinc Ointment to which 5 or so grs. of Calomel per ounce may be added.
drm. of Corrosive Sublimate may be added to 3o galls. of water as a Mercurial bath, hut the patient should not rest in this for any considerable length of time. Baths arc fitted up in which the patient can eat and sleep, and these are of the greatest benefit in very chronic cases associated with much prurigo or itching. Picric Acid, Gelatin, Carbolic Acid, or Perman ganate of Potassium may be added to them. Muller's Fluid, which consists of 22 per cent. of Bichromate of Potassium and i per cent. Sodium Sulphate, has been recommended as an agent for hardening the skin.
The constant use of the Glycerin of Borax gargles of Chlorate of Potassium, or tablets of the Chlorate with Borax are the best local applica tions when the mucous membrane of the mouth is affected.
Pemphigus Vegetans is invariably fatal. The only treatment available is the symptomatic, and will consist in the continuous application of anti septics to the warty ulcerating surface and of constant disinfection of the mucous membrane of the mouth and throat.
Pemphigus Neonatorum is to he treated as Impetigo contagiosa with a bland antiseptic as Boric, Zinc or weak Calomel Ointment. In syphilitic cases Mercury is clearly indicated, and the most scrupulous cleanliness must be maintained in all cases by frequent bathing in weak Permanganate of Potassium solution.