Ecthyma (Pustulous Scale) is a non-contagious inflammation charac terised by large pustules raised upon a hard circular base of a bright red colour. The pustules are of the largest size, the phlyzacim of Willan, so that ecthyma bears the same relation to pustular diseases that rupia does to vesicular ones. In some stages in fact it is difficult to distinguish one of these diseases from another. Willan describes four varieties of ecthyma, but 'layer recognises but two, acute ecthyma and chronic, ecthyma. Acute ecthyma is a comparatively rare disease; it generally appears on the neck and shoulders, and runs its course in a few days This form requires little treatment ; light diet, diluent drinks, mild purgatives, and warm or cold applications to the part will suffice.
In chronic ecthyma the same kind of pustules appear, which dis charge their contents in the course of two or three days,leaving behind them thick brown adherent crusts, which sometimes fall off, leaving an ulcer behind, but more frequently leaving a cicatrix. This form of the disease comes on in scrofulous and debilitated subjects, and is frequently modified by a syphilitic taint. Just in proportion to the intensity of the constitutional derangement will be the duration and extent of the disease. In its treatment the general health must be especially attended to; it is more a disease indicating a want of action than increased action, and alteratives, tonics, nutritious diet, change of air, and sea-bathing are more beneficial than the opposite kind of treatment.
Acne (Cutts rosacea, Rose-drop) is a chronic inflammation of the skin characterised by an eruption of small pustules surrounded by a hard and inflamed base. They are generally observed on the cheeks, nose, and forehead, and sometimes on the ears and neck. The pustules are sometimes single, constituting the simple form of the disease ; at other times they become hardened and the whole skin becomes red, when the disease bas different designations. This disease has its origin in the oil-tubes, and arises from an obstruction to the performance of their functions, which produces inflammation. The oil-tubes of the face are very liable to obstruction from exposure to the air and other causes, and may be frequently observed tipped with a little black spot, and when pressed they give out a quantity of their oily secretion in the torso of a little maggot. They were at one time supposed really to possess an iudependent animal life. Although this is not the case with the maases of oil in question, it ie now known that a little scams takes up its abode in those oil tubes, and Is well known to zoologists under the name of Demodex Folliculoruuf. This little insect may then in some instances be the exciting cause of acne.
In the treatment of acne, regard must be had to the general health. It is frequently connected with a diseased state of the gastrointes tinal mucous system, which requires attention. Where it is connected
with general debility from a rapid growth, or with a scrofulous constitu tion, tonics and alteratives with sea-bathing and regular exercise will be found of service. As external applications, the preparations of copper, zinc, and mercury, have been found most efficient. Where the face is much swelled and inflamed, fomentations will be of service pre vious to the use of the astringents.
Lichen is a papulous disease, characterised by the simultaneous or successive eruptions of red itching pimples, scattered or disposed in groups over the whole body. It is in the adult what Strophulus is in the child.
Lupus is a disease of the akin which, although it usually attacks the face, may appear on any other part of the body. It is generally attended with inflammatory action and with more or less enlarge ment of the parts attacked. It terminates in ulceration, which on account of its tendency to destroy the tissues which it attacks has got for this disease the name of " wolf." The ulcer is also called the "rodent ulcer," and the term noli me tanyere has been applied to it. The disease may be superficial or it may penetrate more or less deeply, destroying whatever tissues it attacks. There is no doubt about the resemblance of this disease to cancer, especially that form called epithelial. It is, nevertheless, so strongly separated that it would be utterly inconsistent with the present knowledge of the nature of cancer to regard it as originating in the same state of the system. [Comae.] The condition of the system and the nature of the ulceration rather point to the scrofulous diathesis as the originator of this disease.
In lupus no pathological elements can be discovered resembling those of cancer. if removed it does not recur, and there is no ten dency to the production of the same disease in the lymphatics as in cancer. It is therefore a much less formidable disease. Nevertheless, the progress of the ulceratiou in many cases of lupus is sufficiently alarming and demands constant attention.
The treatment must be both local and general. In the local treat ment removal by the knife is mostly out of the question, on account of the extent of surface involved. According to the tendency exhibited by the ulceration to spread a severe or mild system of cauterisation should be pursued. Sometimes the application of sulphate or acetate of zinc or nitrate of silver is sufficient to stimulate the parts to assume a healthy action; whilst at others more violent applications, as the chloride of zinc-and tannic, nitric, or hydrochloric acias, are to be recommended. General treatment is frequently very efficacious, and this according to circumstances. In eases of tuberculosis of the system cod liver oil and quinine and iron may be used with advantage. In another set of cases arsenic has been found efficacious, whilst perhaps a larger number are benefited by preparations of iodine.