PITYRIASIS RITBRA, OR EXFOLIATIVE DERMATITIS.
Constitutional treatment is of little if any value in this formidable affection, which Ilebra wrongly regarded as invariably fatal. Arsenic should not be given in the early acute stage, even in those cases known as of " secondary " type where the disease originates in the vicinity of a patch of lichen, psoriasis or eczema. Many dermatologists still recom mend small and frequently repeated doses of Tartarised Antimony alone or combined with diaphoretics and diuretics in the early stage.
The best hope of cure lies in local treatment, and this after the patient has been put to bed will do much if conscientiously carried out, the chief indication being to protect the affected part (the entire cutaneous covering of the body) from the irritation produced by contact with the air and variations in temperature. Where the disease is secondary to some other cutaneous affection, the primary lesion must receive attention. Special symptoms will call for endless modifications of detai s.
A weak alkaline bath, containing Bran or Starch should be administered for one or two hours daily; where itching is yen- troublesome a little Carbo'ic Acid may be added. S. Mackenzie recommended the following baths:—Starch, r ib.; or bran, 2 to 6 lbs.; or linseed, r lb.; or gelatin, 3 lbs.; or gluten (size), 6 lbs., to 3o gallons of water; or 3 oz. borax, or S oz. bicarbonate of soda, to the same amount of water. lost reliance is to be placed in inunctions by an animal or vegetable fat. These should be carried out several times daily by an experienced hospital nurse told off for the purpose. Fresh Lard, deprived of every trace of saline matter, answers the purpose well. About 2 oz. of the simple Liniment of Camphor
may be added to each pound of the fat. and in summer Suet may also be added. This may be rubbed in gently and patiently, after the scales have been rcinoc ed by prolonged immersion in the \vat m bath. or by very gentle friction with a soft rough cotton towel. A mixture of equal parts of Lanoline and Soft Paraffin may be substituted for the lard. Zinc Ointment, to which 5 per cent. of Liq. Carb. Detergens and the same amount of Camphorated Oil have been added, is to be then smeared over the limbs, which should be covered with lint or old linen, also well coated over with the ointment, and comfortably bandaged, the body being several times anointed with the lard during the day, whilst the limbs and face need he only dressed morning and night with the ointment.
Strong tarry preparations must, however, be used with great caution, especially in the early stage. ('rocker envelops the patient in bandages soaked in a cream consisting of r oz. Zinc Oxide, 12 oz. Calamine, 21 oz. Lanoline, io oz. Olive Oil aiid io oz. Lime Water. Mackenzie preferred watery applications, and he put the patient into clothes made of lint, and kept saturated day and night with a lotion consisting of S oz. Glycerin of Subacetate of Lead, 8 oz. pure Glycerin, and water tor gallon. Cod-Liver Oil and Olive or Almond Oils may be also used. Sonic cases have been successfully treated by causing the patient to live in a warm bath for many days or even weeks at a time.
The nutrition of the body should be maintained by a generous diet, and Cod-Liver Oil may be given alter each meal in the later stages of the disease.