The Treatment of Porrigo Favosa by Carbolic Acid

C. E. Prior
1867 BMJ (Clinical Research Edition)  
358 THE BRITISH MEDICAL 7OURNAL. [Oct 26, 187. tubercle, moist, mild, even warmn climates were thought indicated, as having a favourable inifluence on such inflammiiatory conditions. The relaxing, debilitating character of climates was not considered a contraindication, an(d consumptive patients were drafted to the tropics and to M%ladeira in winiter. 'I'he experience of ouir armiy anid navy surgeons, as also that of their Frenchi lbrethren, all over the world, has shown that these views
more » ... wn that these views are pathologicaliy a: mistalke; that consumptive patients do not rally in a climate that (lebi!itate, still nmore their constitution and impairs the power of their dligestive system. To senid personis suffering from phthisis to such c!imates is, in reality, to treat the epiphenomnena of the dise.aie, an<d at tiie sanme timc to place the patienit undler unfavourable climatic conditions for their recovery from the st.ate of organic debility an(l decay which is at the root of the evil. I believe that Professor IBlennett of Edinburgh was the first to clearly point out this important fact, in the first editioni of his valuable work on consumption. h'lc w-initer climate really indicated in suich cases is one in which the absence or paucity of rain, the absence of fog, of cold moisture in the atmosplhere, atnd the presence of sunshine, enables the invalid to live out of doors, an(d to take passive cxcrciLe all but every day. The temperature also should be cool and bracing, not warm alnd relaxing. Such a climate I have found on the north shores of the Mediterranean, on the Genoese Riviera, from Cannes to M1assa Cararn, that is on the western and easterni slhores of the G;ulf of Genoa. No doubt other equally favoured regions exist oni the north Mediterranean sliores between the Guilf of Genoa and the D)ardanelles. In this region in winter, the north winds, which reign systemically, pass over the tops of the moulntains whichi skirt the shore, and falling into the sea at a distance from the laand, leave the shore ledge free and calm. These winds being dry, because they are cold and have precipitated their moisture oni the mountainis of central Europe, the atmosphere is usually free from watery vapour or cloud anid allows the sun's rays to shine through. The soutl winzds, which only reign exceptionally in winiter, are warm, so that their presence merely brings %varm rains, and does no harm to the chest invalids. As the winds from the north are not felt anid the air is drv, andcl the rain is wvarm rain from thc south, there is an absence of the cold rain that is so conducive to inflammation of the mucous membrancs of the aerial passage in our climate. I have hut little to say on thie medicinal treatment of phtlhisis. I do not believc in the existence of any absolute antidotc to tuberculosis, nor cani we rationally expect to find onic if the disease is wshat I have assumed it to be, viz., a natural mo(dc of death fromn defective organic vitality and decay, hiereditary or acquired. I believe medicinal agencies to be miost valuable, lhowever, in the treatment of tubercular diseases, as a mean.s of removing and miodifying comnplications, of restoring hecalthiy functional activity, and thus of helping, assisting, hygiene and clinmate. Eveni cod-liver oil, althioughi a most valuable therapeutic agent, may be Imiore a, dietetic adjuvant thani a liharmaceutical remedy. It may act mnore by p)romoting thl healtlhy digestion of food than by its miiedicinal l)rloperties. It certainly cani only be taken in the miiore favourable class of cases by those p)atients who are the tnost likely to get well without it, by those whose digestive ftunctionis can be got inito good worliiigorder. My ol)portunities of oblservinig plhthisis have been threefold. In ear-ly life 1 studiedl it as a stuident, and( for miany years an official in the Paris hospitals; in middle age I observed it in a large London consulting practice; (luriing the last eight years I have watched its course on fellow sufferers, as a consumnptive invali(d mviself, in a winter sanitarium, Mcntonie, in the regioni I have described. Eight years ago I was stricken by this (lire disease, and w-heli already in an advanced stage, gave up practice to takeI refuge during the winter, andl die as I and others thoulght oii the Genoese Riviera. To iny utter astonisliient, I have recovere(l, un(ler the combinied influence of hlygienie, climate and medicine, and so lhave many fellov sufferers, principally person1s coninected with my former career, who have followeditie to the south, anid have acted likewuise. In this new fiel(d of obiervation, by comnbining the therapeutic inifluence.s I have above described, I have obtainied results for whichi I was totally unprepare(l by previous Paris and Londcon experience. I have not only saved my own life, but also that of many others. The prinmcipJal points for favourable treatment of puilmonary phlthisis are that there shiould still be enough healthy lung left to carry on the functionxi of life, and that the discasc should not be of a;n unfavourable type. Of course if the lingsare destroyed, or all but destroyed, if patients are existing on a small portion only of onie or both lung, they must die, from (lefective nutrition, from blood poisoninig, from the reaction of in. flamniatory epiphenomenia. Death supervenes in such conditions, even if the fresh deposit of tubercle can be arrested. Again, if the tubercular deposit assumes the acute type, if it is deposited at the same time all over the lung, if it is intensely hereditary, if its appearance in the midst of luxury and plenty is merely the evidence that the patients have lived their life, have come to the natural end of theirexistence, if its presence coincides with a complete constitutional break up, with disease of liver and kidney, then there is but little hope of recovery, or even of prolonged invalid life. On the other hand, there is a fair prospect of arresting the disease, and even of effecting a cure in the more favourable class of cases, if we can conmbine all the means of treatment enumerated. This more favourable class is that in which the disease has only extended to a limited portion of the lungs, leaving sufficient lung tissues in a healthy state to support life, in which the malady appears in a chronic form, and more especially in which it is developed accidentally, as the result of unhygienic causes capable of being permanenly removed. I am myself a remarkable and instructive evidence of such a favourable issuie of the combined influence of these therapeutic agencies. The details of my case, to which I allude for the benefit of others, are well known to many, and especially to my friend Dr. Quain of London, and to my friend and namesake Professor Bennett of Edinburgh, whose researches on pulmonary consumption are so well known to the profession. It was they who gave me the courage to fight the battle 6f life, and to whom, therefore, I owe my present well being. I had surrendered my existence as irreparably lost, and was floating down the fatal streanm in professional harness, when they roused me to exertion, and inspired me with the courage to abandon everything that a scientific observer the most values, to make the effort that has so far been crownedl with success. I may add, as an encouragenment to others, and to my professional brethren, that now, after eight years observation of similar invalids pursuing the same course, I am surrounded by a considerable number of patients and friends, in whose cases the same result has bcen obtained by the same means. IN no department of medical science has a more gratifying progress been made during the last twenty years than in that of the recognition and treatment of parasitical diseases. Scalp-affections, which the student in vain endeavoured to identify, while wandering with bewildered brains fron Alibert to Bateman, or Bateman to Bictt, have been so positively fixed and settled by microscopical research, that there is no longer room for difficuilty. We may beat the weary round of blisters, sudorifics, alk;alies, toniics, or depletion, in our treatment of acute disease, and one or the other may come to the surface with the fashion of the hour, often dependent oni the vigour of assertion of its advocate physician; but the nature of Achorion Schonleinii or of Triclhophyton tonsurans is known once for all, and tde constitutional treatment of local vegetable parasites may be dismissed as an idle dream. If, therefore, I a(lopt the term Porrigo Favosa, I do it as the best which we had at command previously to the microscopical investigation of the disease, and the onie by which it is most generally known. At the present day, the disease, I believe, is not a common one. In a tolerably extensive acquaintance with the diseases of the lower orders, I have met with it but rarely; a second specimen has been recently sought for in vain throughout an extensive district; and the experience of other medical frienids corresponds with my own. My individual opinion is, therefore, niot of much value as to the puzzling distinctions of pomgo favosa and porrigo scutulata, and other varieties. Reasoning from what I have seen, an hii,ghly as I value the light we have derived from microscopical research, I should say that the external appearances of porrigo favosa were sufficiently remarkable to defy confusion-the seat, the slhape of the favi, their colour (whitish sulphur-yellow), such as I have enideavoured to depict in the accompanying photographs-present a tout ensemble very different from any other scalp-disorder (in this point I cannot too highly commend the description of Cazenave and Schedel); while the microscopical appearances are not, unless to an expert, so different from what I have seen in a case of tinea tonsurans or trichophyton tonsurans. As respects curability, all external parasitical discases, as a rule, are curable with attention and with the proper parasiticide remedies; but, practically, attenition flags, and parasiticides are sometimes so injurious to the constitution that their use must be relinquished or suspended. The girl from whom this photograph was taken once passed sixteen * Read before the annual meeting of the South Midland Branch,
doi:10.1136/bmj.2.356.358 fatcat:xnadjnjvc5azvim35cy73szdiq