PRURIGO.
Much confusion still exists regarding the recognition and nomenclature of this affection, which, according to Crocker and Comb\-, starts as a lichen urticatus or a papulose urticaria, but afterwards as the wheals disappear nothing is left but an intense pruritus accompanied by a papular eruption. The severe form of the disease known as Hebra's Prurigo or Prurigo ferox is generally fatal, being little influenced by treatment; the common type Prurigo mitis—though seldom capable of permanent cure, can be so alle viated by suitable treatment as to cause little distress. The term Prurigo senilis should be confined to cases of phtheiriasis, the treatment of which consists in absolute cleanliness as described in the article on Pediculi.
The treatment of prurigo mitis should include every agent capable of improving the general hygiene and raising the standard of health and the body nutrition. Cod-Liver Oil is decidedly beneficial. A host of internal drugs has been recommended. Amongst these Arsenic, Phosphorus, Iron, Quinine and Thyroid Extract have been advocated; each of these, whilst apparently beneficial in some cases, aggravates the condition in others. Of drugs administered with a view of alleviating the intense itching Cannabis Indica, Antipyrine, Carbolic Acid and Pilocarpine have often proved of considerable value. The writer has often succeeded in the early stages of the disease in subduing the pruritus by short courses of Calcium Chloride in 3o-gr. doses.
Local treatment is of more importance than the administration of drugs, and, if carried out with patience and perseverance, the disease may be kept in check in the worst cases, and even in severe cases may be ulti mately banished. In children the management and removal of the disease are, for the most part, not so difficult.
Scratching should be avoided as far as this is possible, since the condition is greatly aggravated by the dermatitis caused by the finger-nails. Children should have woollen or cotton gloves tied on at the wrists before going to bed. Variations of temperature should be guarded against.
Warm baths should be given frequently, and these may be made alkaline by adding about half a pound of Bicarbonate of Soda to a large bathful of water, or Soft Soap may be used when the skin is much infiltrated, the object being to get rid of the increased growth of superficial cutaneous cells which have become dry and dead. After each warm bath, and as much gentle friction as will, without increasing the irritation, cause the removal of the loose layers of the cuticle, the patient's body should be dried, and an animal fat should be thoroughly rubbed in. If this be carried out every night for a considerable period, it is sometimes surprising how soon the prurigo will show signs of yielding. Lard, Cod-Liver Oil and Lanoline are the best substances for inunction. The latter is preferable if the patient can get over its disagreeable stickiness. Cod-Liver Oil is valuable, but its disagreeable odour, which increases after it has become mixed up with the dried scales on the surface of the body, is a great barrier to its use, but in the case of children it certainly is the best remedy. Naphthol in the form of an ointment (1 to zo) is recommended by Kaposi; it may be rubbed in after the alkaline bath.
After the skin has been brought into a more healthy condition the animal fats may be replaced by an anointing oil consisting of 19 parts of Olive or Almond Oil and s of Oil of Cade, and with this treatment general massage may be advantageously combined.
Whilst the bath and inunction methods are being carried out the patient may be provided with a lotion or ointment for application to any part which is hypersensitive; any of the formula in the article following may be employed for this purpose. As a rule opiates should not be employed for the relief of insomnia. This is best treated by prolonged immersion in a warm weakly alkaline bath. Any eczema or dermatitis caused by the trauma of scratching should be treated by weak antiseptic ointments. An occasional sponging over with i in 4o Carbolic lotion prevents secondary infection of the skin and relieves itching.