Part 74

Exceptionally, mercurial plaster, corrosive-sublimate lotion and ointment (gr. j to j), a plaster containing five to fifteen per cent. of salicylic acid and creasote, repeated paintings with carbolic acid, and the constant application of lead plaster containing twenty per cent. of ichthyol, are valuable.

Of the milder methods, those most in vogue to-day are the Finsen light and x-ray. Either proves extremely valuable in some cases, but the Finsen method is the favorite method.

#What methods are commonly employed for the rapid removal or destruction of lupus tissue?#

Cauterization, scarification, erasion and excision are variously practised; the particular method depending, in great measure, upon the extent of the disease, the part involved, and other circumstances.

#Name the several caustics, and state how they are employed.#

Pyrogallic acid, used as an ointment:--

Ac. pyrogallici, ..................... ij Emplast. plumbi, ..................... j Cerat. resinsæ, ...................... v. M.

It is applied for one or two weeks. Every several days the parts are poulticed, the slough thus removed, and the ointment reapplied, and so on until the diseased tissue has been destroyed. It is useful in those cases in which a mild and comparatively painless caustic is advisable. In most cases several repetitions of this plan are necessary.

Arsenious acid, employed as an ointment--

Ac. arseniosi, ...................... gr. xx Hydrarg. sulphid. rub., ............. gr. lx Ungt. aquæ rosæ, .................... i.--M.

It is painful but thorough; it is spread on lint and renewed daily. The action is usually sufficient in three days, and the parts are then poulticed until the slough comes away, after which a simple dressing is employed. Its application is advisable for a small area only--not more than four square inches--as absorption is possible.

Galvano-cautery.--The diseased tissue is destroyed by numerous punctures with a red-heated point or by linear incision with a red-heated knife. It is often a practicable and satisfactory method. The Paquelin cautery and liquid air and carbon dioxide also have their advocates.

#Describe the operative measures employed in the removal of lupus tissue.#

Linear Scarification.--The parts are thoroughly cross-tracked, cutting through the diseased tissue, and subsequently a simple salicylated ointment applied. The operation is repeated from time to time, and as a result the new growth undergoes retrogressive changes, and cicatrization takes place.

Punctate Scarification.--By means of a simple or multiple-pointed instrument numerous closely-set punctures are made, and repeated from time to time, usually with the same action and result as from linear scarification.

Erasion.--The parts are thoroughly scraped with a curette, and a supplementary caustic application made, either with caustic potash or several days' use of the pyrogallic-acid ointment. The result is usually satisfactory.

The dental-burr is also useful in breaking up discrete tubercles.

Excision.--This is an effective method if the disease consists of a small pea- or bean-sized circumscribed patch.

Of these various operative methods those now most favored are erasion and excision, punctate and linear scarification methods are now rarely employed.

#Tuberculosis Cutis.# (Synonym: Scrofuloderma.)

#What do you understand by tuberculosis cutis?#

The term is applied to those peculiar suppurative and ulcerative conditions of the skin due to the tubercle bacilli.

#How does the common type of tuberculosis cutis begin?#

The most common type of tuberculous ulceration or involvement of the skin usually results by extension from an underlying caseating and suppurating lymphatic gland; or it may have its origin as subcutaneous tubercles independently of these structures. It tends to spread, and may involve an area of one or several inches.

#What are the clinical appearances and behavior of this type of tuberculous ulceration?#

It is usually superficial, has thin, red, undermined edges of a violaceous color, and an irregular base with granulations covered scantily with pus. As a rule, it spreads gradually as a simple ulceration, with but slight, if any, outlying infiltration. Subjective symptoms of a painful or troublesome character are rarely present. Its course is usually progressive but slow and chronic.

Other symptoms of tuberculosis are commonly to be found.

#Are other forms of tuberculosis cutis met with?#