PRURITUS.
Accepting the term " pruritus " as a sensation of continual itching, without the presence of the papules characteristic of prurigo or of any other visible cause, the first step in its treatment will be to remove any blood condition which may be irritating the peripheries of the cutaneous nerves. Diabetes, gout, Bright's disease, jaundice, dyspepsia and other ailments may be the direct cause and will afford the true indications for correct treatment. Local sources of irritation must, however, not be overlooked, and a search should be diligently made for minute fissures or cracks in the skin, scabies, pediculi, ringworm, and the possibility of the pruritus being the result of certain dyestuffs in the clothing next the skin must not be forgotten. In the local varieties of pruritus there is always a local cause to be found if rigid search be made. In other cases the pruritus appears to depend upon a neurosis, and must be met by remedies which will tend to depress or blunt the exalted sensibility of the fine nerve endings in the skin as Bromide of Sodium in large doses, Cannabis Indica, Carbolic Acid (3 grs.), Ichthyol (so grs.), Antipyrine (so grs.), Tincture of Gelsemium (so mins.), Pilocarpine (1 gr.), Atropine, Digitalis and Ergot.
The following may be found useful: R. Ext. Cannab. Ind. gr. 1.
Acid. Carbolici gr. iss. Cocain. Hydr. gr. 1. Ext. Gelsernii gr. 4.
Fiat pil. Tales xxiv. St. imam onini node.
Excellent results have been obtained by Shoemaker in cases character ised by anxmia and debility, from Cod-Liver Oil, in daily doses of r to 2 drs., injected into the subcutaneous tissues of the back. At the same time, and in all cases, electricity and massage may be relied upon to improve the general condition and afford comfort. Mild local Faradisa tion with central galvanism he finds most effective in nervous, prostrated patients.
Warm or tepid baths are always serviceable, one containing from to 2 lbs. Bicarbonate of Soda to 3o gallons water usually affords temporary relief, and if used before a good half-hour's general massage its effects are often very marked at bed-time, inducing sleep. Sulphuret of Potassium
has been used, though the writer has generally found it to aggravate matters, owing to the very common traumatic eczema induced by previous scratching. Nearly every one of the numerous sedative baths used in the practice of skin therapeutics affords more or less relief from the sensation of itchiness. The starch bath is a favourite, and after coming out of it the skin may be dusted over with the dry powder, mixed with 4 to 5 per cent. Salicylic Acid.
In many cases the careful employment of a soft hair-brush when in the bath in order to remove dead epithelial scales is followed by relief.
Menthol is one of the most reliable drugs for local use. It may be dissolved in oil or spirit; Saalfeld dissolved dr. in r 2 oz. of pure spirit of wine, and this may be painted over the affected region in the same way as the writer has brushed on the Oleum Menthm Piperitm with a camel's hair brush. The menthol cone may be rubbed on the skin, after moist ening the latter with spirit. 2 drs. of Menthol rubbed up with oz. Olive Oil and i dr. Chloroform may be made into an ointment with 21 oz. Lanoline, but in order to influence a large tract of skin a solution of r in 5o of olive oil should be employed. The B.P.C. Liniment consisting of Menthol 3, Chloroform 4, Olive Oil to r6, may be brushed over the skin in localised areas.
Cocaine has been extensively employed, but should only be relied upon, even in localised pruritus, as a temporary agent. Porritt uses a cone of cacao butter impregnated with 2 per cent. of cocaine. As this is rubbed over the irritating patch the warmth of the skin melts the butter, which forms a soothing, emollient shield over the irritable nerve endings.
The following is an elegant and valuable formula where the itching is bad at night: Cocaine Purif. gr. iv.