Clinical study and analysis of 1,000 cases of psoriasis / by L. Duncan Bulkley.

  • Bulkley, Lucius Duncan, 1845-1928.
Date:
1891
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Licence: Public Domain Mark

Credit: Clinical study and analysis of 1,000 cases of psoriasis / by L. Duncan Bulkley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    readily, especially if they occur in gouty subjects, where this element can be mod- ified by diet or treatment. This brings us to the second point, viz.: that the prognosis of psoriasis de- pends considerably upon the date in the disease at which the treatment is com- menced. When the eruption has existed for a long time and the psoriatic habit has become, as it were, thoroughly pronounced, it of ten seems exceedingly diffi- cult to do more than to give temporary relief, very little being accomplished in the way of preventing relapses or eradicating the real disease. The third element having to do with the prognosis of psoriasis is the character of the treatment employed. I am well aware that there are not a few who, re- garding psoriasis as a local disease of the skin with no constitutional relations, will not at all agree with me in reference to the matters about to be stated. Time does not permit of a full discussion of this most important subject of the con- stitutional relations of psoriasis, and as this is a clinical paper I will only briefly state my own position and belief in the matter as it has been developed from ex- tended study aud observation. In my judgment, it is not sufficient to regard cases of psoriasis solely from the standpoint of removing the eruption which happens to be pi*esent at the time of consultation. I believe that more ought to be accom- plished than this, and I believe aho that with due diligence aud proper care more can be accomplished. While we cannot at present speak of the cure of psoriasis, that is, its permanent cure, with any amount of certainty or satisfaction, in in- dividual cases, it is undoubtedly true that in a certain proportion of instances such changes in the habits and condition of patients can be affected by prolonged and skillful medical care, that the disease, or its skin manifestation, will remain ab- sent. While we must agree with Robinson* and Jamiesonf that the first step m the diseased process is taken by the cells rete Malpigii, which lie next to the derma, and not by the papilla?, and that psoriasis ean not be regarded as primarily an in- flammatory disease or affection of the upper layer of the cutis, wemust still hold to the belief that psoriasis is not a local disease of the skin, as are the parasitic af- fections epithelioma, verruca, etc., but in some way depends upon an unknown con- stitutional condition more or less akin to rheumatism and gout, and that unless this condition is altered the eruption will recur at different periods and with valu- ing severity. To be successful, therefore, the treatment of psoriasis must include diet, hygiene and proper medical measures, including both internal and external medication. The nature and character of the measures necessary to affect this will be con- sidered later under the head of the treatment of the disease. The heredity of psoriasis is a subject of some little interest and one which de- serves more attention than has hitherto been paid to it. The impression is very general that the disease is very commonly acquired by inheritance; indeed, this is about the only etiological element which is recognized with any certainty by most writers upon the disease. It is a little difficult to obtain reliable datain re- gard to this matter and but little value can be placed upon the statements obtain- ed from the mass of patients commonly seen in public practice. In the more in- telligent class of patients seen in office practice, however, we can generally obtain the necessary facts with a little care, and this has been done in a large share of the cases here analyzed, in private practice, patients being interrogated both as to •Robinson, New Vork Medical Journal, July, 1878. „^ ,om tJamleson, Medico-Ohirur^ical Society of Edinburg, November 6tb, 1878.