A system of practical medicine. By American authors. Vol. 4

by Unknown

Rx.	Hydrargyri chloridi corros.,	gr. ij;
	Zinci sulphatis,	gr. xv;
	Alcoholis,	fluidounce ij;
	Aquæ rosæ,	fluidounce ij.

M.—S. Apply with a rag. The zinc sulphate renders the lotion astringent, and is often a valuable addition. Ammoniated mercury, thirty to sixty grains to the ounce of benzoated lard or cold cream, will frequently prove serviceable. If the lesions are numerous and are seated close together, the application is to be made to the entire surface of the part; on the other hand, if they are sparse, it may be made to the spots only. The same may be said also in regard to the sulphur preparations. A 5 or 10 per cent. ointment of oleate of mercury, rubbed thoroughly into sluggish and indurated lesions, will often shorten their course by promoting suppuration. In many cases puncturing the lesions with a sharp knife or scraping with a curette before applying the hot water will be of assistance in the treatment. In obstinate indurated lesions, in addition to puncturing the lesions, the apices may be treated with carbolic acid. The protiodide of mercury, in the strength of five to fifteen grains to the ounce of ointment, is well spoken of by some authorities; it is to be used with care, as it is actively stimulant. In some cases rubbing energetically over the parts a mixture of sapo viridis and sulphur, adding enough hot water to make a lather, and allowing it to remain on over night, will, if repeated nightly until the skin becomes slightly inflamed and then followed subsequently by a mild ointment, produce a decided effect.

Acne Rosacea.

Acne rosacea, or rosacea, is a chronic, hyperæmic or inflammatory disease of the face, invading especially the nose and cheeks, characterized by redness, dilatation and enlargement of the blood-vessels, more or less acne, and hypertrophy. The course of the disease divides itself naturally into three stages. There is at first simply a hyperæmia, due to passive congestion. In young subjects the affection is seen in this stage, and rarely passes beyond it. In other cases, however, sooner or later, dilatation and enlargement of the vessels (telangiectasis) take place, and acne papules and pustules are scattered over the parts, constituting the second stage of the disease. This stage is frequently met with, and illustrates the acne rosacea usually seen. Exceptionally, however, the disease progresses, the vessels increase in calibre, the glands are enlarged, and there is more less hypertrophy of the connective tissue and the third stage is developed. The nose may become much enlarged, even lobulated, and in some portions pendulous (rhinophyma). The nose and its immediate neighborhood are the favorite localities for the development of acne rosacea, but it is not infrequently confined to the cheeks, and sometimes is localized upon the forehead, while all these parts are not infrequently affected simultaneously. As a rule, there are no marked subjective symptoms, although in some instances burning or a sense of fulness is complained of.

It is seen in both sexes, but is more frequent in males; in women it rarely, if ever, reaches the same degree of development as in men. It is most common about middle life. The causes are varied. Chronic stomachic and intestinal derangements, anæmia, and chlorosis are common causes. The habitual use of spirituous liquors is not infrequently a source of the disease. Long-continued exposure to excessive cold or heat is in some cases a causative agent. In women, menstrual and uterine difficulties are often the responsible factors; hence in this sex it is much more common at the climacteric period. When occurring in the young about the period of adolescence, it is frequently associated with seborrhoea, and rarely advances beyond a condition of hyperæmia. Pathologically, in the first stage of the disease there is simply a hyperæmia—a stasis; in the second, hypertrophy and dilatation of the vessels are superadded, together with acne and slight hypertrophy of the sebaceous glands; in the third stage there is, in addition, hypertrophy of the connective tissue of the corium.

Acne rosacea is to be distinguished from the tubercular syphiloderm, lupus vulgaris, and acne vulgaris, to which affections it at times bears resemblance. The tubercular syphiloderm is comparatively more rapid in its course; does not necessarily involve the sebaceous glands; has frequently as a consequence ulceration and crusting; is usually confined to a part of the nose; and is unaccompanied with dilatation and enlargement of the blood-vessels. Its history, the firmer consistence, and the more dusky color of the tubercles, and frequently the presence of other evidences of syphilis, are also points of difference. In lupus vulgaris the characteristic soft, yellowish-red papules, the absence of the hypertrophied blood-vessels, the degeneration, ulceration, and cicatricial-tissue formation, the more or less limited character of the eruption, and the history of the case, will serve to distinguish it. A simple case of acne vulgaris can scarcely be confounded with acne rosacea: in many cases, however, the dividing-line is far from being marked; in fact, the disease under consideration is often acne with hyperæmia and dilated blood-vessels superadded.

TREATMENT.—The affection may in all cases be more or less favorably influenced by treatment. The milder cases, although at times obstinate, are curable; but when the disease has advanced to marked dilatation and hypertrophy of the blood-vessels and connective tissue, the prognosis is not so favorable. In all stages of the affection, however, as stated, a great deal can be accomplished by appropriate remedies. External and internal treatment are required in the majority of cases. The former usually proves the more valuable.

Concerning internal remedies, there is no drug that exerts a specific influence. The guide to constitutional treatment should be a study of the etiological causes of the disease. Constipation is frequently present, and hence laxatives, especially the salines, are indicated. Chlorosis in the female is often the predisposing cause, and such remedies as iron, quinine, and strychnia will be found useful. Dyspepsia is one of the most frequent causes, and treatment directed toward a removal of that condition will often be of considerable aid in curing the disease. Menstrual irregularities should be inquired into and the appropriate remedies employed.

There are mainly two classes of external remedies which are used in the treatment—namely, the mercurials and the sulphur preparations. The latter are by far the more valuable, precipitated and sublimed sulphur, the hypochloride of sulphur, and the sulphuret of potassium being the most serviceable. They are prescribed either in the form of lotions or ointments. The officinal sulphur ointment, an ointment of the precipitated sulphur and of the hypochloride of sulphur, of the strength of one or two drachms to the ounce, may be referred to as valuable applications. Sulphur may also be used as a dusting-powder or in the form of a paste, as in the following formula:

Rx.	Mucilag. acaciæ,	fluidrachm ij;
	Glycerinæ,	fluidrachm ij;
	Sulphur, præcip.,	drachm iij.