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

  • Bulkley, Lucius Duncan, 1845-1928.
Date:
1891
Catalogue details

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.

    15/18
    ■ tion is also quite different, and the internal remedies of value in the strumous variety prove prejudicial to the eruption in arthritic patients. No statistics have been prepared to exhibit these features, but from a rough estimate I should judge that fully one half of the patients with psoriasis exhibited to a greater or less de- gree the arthritic element calling for treatment, while in about one half of the remainder the strumous nature of the disease should be recognized; and in the other quarter an accurate determination with regard to these features could hardly be made.. In the large majority of cases of psoriasis the disease maintains its proper characteristics to the end, often during a long period of years; as it recurs after a greater or less subsidence, it may appear as a punctate, guttate, nummular or- bicular, or gyrate eruption, but it can always be recognized as psoriasis. In cer- tain instances, however, it will more or less change its character and approach to a greater or less degree those of eczema and pityriasis rubra, occasionally being quite transformed into one or the other of these affections. As already men- tioned, in no less than 20 instances among the private cases, or 6 per cent., ec- zema was noted as present to a greater or less degree; I have always regarded any tendency in psoriasis to assume an eczematous aspect as a favorable symptom, and in proportion as this is exhibited in patients can the disease be more readily man- aged. Far more rarely does psoriasis develop into pityriasis rubra, but I have seen this to occur in two, or perhaps three, instances; in the case of a gentleman recently seen, now some 50 years of age, the disease had so extended itself dur- ing many years existence that now a large share of the lower extremities and also the trunk is affected with extensive, often red, surfaces, marked by superficial lines, these covering large areas and exactly resembling the tissue seen in pityri- asis rubra. The heat and burning in this is sometimes intense. This patient is also a great sufferer from rheumatism. Bourdillon§ has cited a number of cases illustrative of this. The treatment of psoriasis is a subject upon which very much has been writen and yet one which is by no means clearly settled; indeed, it is one about which there is still the greatest diversity of opinion and, further, is one which, it may be said, is in a very unsatisfactory state. To those who believe it to be incurable as a disease, and who only attempt the benefitting or removal of the eruption present, the task is relatively light, for a number of agents are known which generally succeed in affecting a great improve- ment or causing the eruption to disappear in varying lengths of time. But all agree that their effect is at most but local and temporary, and we find that those who argue most for local treatment speak most'expectantly of the probable return of the eruption with the coming change of season. But patients with the erup- tion naturally seek for more than this, and are very properly desirous that they should be freed from the disease in such a manner that they will not be subjected to the continual annoyance of its recurrence. In a certain small percentage of cases it is trup that when once removed by local means alone the eruption some- times remains absent even for a period of years, but this is so much the exception that it is hardly ever counted upon or expected by localiets. It has already been mentioned that in order to secure a more permanent removal of the eruption treatment must include diet, hygiene and both internal and external medica- tion. To one who has closely studied diseases of the skin in private practice there SBourdllloQ, Loe. olt pp.8, 67, etc.