PSORIASIS.
Of the two methods of treating this obstinate affection—the constitu tional and the local—the whole trend of opinion is towards the recognition of the importance of the latter. Though no investigator has succeeded in isolating a specific microbe, the belief in the existence of such is becoming general. However, some authorities still regard psoriasis as evidence of a gouty or scrofulous diathesis, and recommend treatment accordingly, but as a rule such drugging, based as it is upon a wrong hypothesis, only leads to disappointment and mischief. Diet should be such as will be best calculated to maintain a perfect standard of health, and the fancy dietaries insisted upon by some specialists are as useless as they are irksome to the patient. It is nevertheless a good practice to alter the patient's diet periodically, and a few months' course of vegetarianism is often most beneficial in those who eat too much animal food. Several authorities in recent years maintain that excess of proteins is an important factor in the disease, since nitrogen retention is always marked, especially when the eruption is extensive; good results often follow restriction of the intake of nitrogen.
Arsenic is the only drug which has any claim to the possession of a specific action in chronic cases. In acute severe cases it should not be employed. It must be commenced in small doses, say 2 mins. of Fowler's solution, which should be steadily increased till 5, 7, or even no mins. are given three or four times a day, diluted with water, immediately after or along with food. The drug may be pushed till the physiological effects are noticed, and after redness or irritation of the conjunctiva the dose may be diminished or suspended for a short time. This treatment may be continued for many weeks, and should not be stopped upon the removal of the eruption. The Asiatic pills, each containing to gr., the Liquor Sodii Arsenatis or the Liquor Arsenici I lydrochlorici in the same doses as Fowler's solution may be given. gr. of the Arsenate of Iron three or four times a day may be prescribed in the form of pill.
Cacodylates possess no advantage whatever over Fowler's solution, and are open to the objection that they cannot be pushed for long periods; and the newer organic arsenical preparations are more dangerous than the official liquors. When arsenic has been long administered hyperkeratosis
of the palms and soles may be induced as evidenced by great warty thick ening of the skin in these regions and pigmentation of the affected spots of skin, and sometimes peripheral neuritis results.
The much-vaunted Phosphorus is of little use; it is very doubtful if it has any influence save by its action as a restorative.
Iodides unquestionably possess remarkable powers over the affection in a small percentage of cases, when given in heroic doses (2 to 4 drs. daily), but like the following drug their use is entirely empiric, and we have no means of determining beforehand in any given case that improvement is to be expected.
Thyroid Extract is open to the same objection, and like iodides its action is rapid when it acts at all, but it must he administered in doses which border on the dangerous, and the results are as evanescent as those of iodides. The drug may be combined with arsenic.
Perhaps the best routine for internal administration is a combination of Iodide with Arsenic as the following: It. Sodii /Midi 5ij.
Liquor. Arscnicalis Glyeerini Aquce Camphorx ad 3viij.
Ca/ ial icy in die c.v cyathu vinario wince (post cibos.
Each dose of the above will contain dr. of the Iodide, and the total daily allowance will fall short of Ioo grs.
Turpentine is recommended by Crocker, who gave it in an emulsion or in capsules till 30 mins. were reached three times a day.
Copaiba, Antimony, Salicylates, Colchicum, Carbolic Acid, Creosote or Tar, Mercury, Sulphur, Alkalies, Cantharides and various diuretics, purgatives and alteratives have been vaunted, but beyond correcting some temporary or accidental complication they cannot lay claim to any specific action. Malcolm Morris has obtained excellent results from Tartar Emetic in the early stage and in acute varieties of the disease where arsenic is contra-indicated, but the drug should only be given for a few weeks at most.