Cyclopaedia of the diseases of children, medical and surgical / The articles written especially for the work by American, British, and Canadian authors. Ed. by John M. Keating.

  • Keating, John M. (John Marie), 1852-1893.
Date:
[1889-99]
Catalogue details

Licence: Public Domain Mark

Credit: Cyclopaedia of the diseases of children, medical and surgical / The articles written especially for the work by American, British, and Canadian authors. Ed. by John M. Keating. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    which will shortly appear in elevated Hues, often of considerable height and width. Pathology and Pathological Anatomy.—The immediate causation of the wheal of urticaria lies, in all probability, in vaso-motor disturbance, which may have either a central, a peripheral, or a reflex origin. The essential element in the production of the wheals is a spasm of a localized tuft of blood-vessels, followed by relaxation and the consequent eifusion of fluid, producing a localized oedema in the skin: the sensations of itching, burning, or tingling are the natural result of the compression of the sensi- tive nerves by the exudate, or may be in part due to the same direct or reflex irritation which excited the vascular spasm. The eruption disap- pears entirely after death, and microscopic sections taken during life have revealed little more than an oedema, with some transudation of leucocytes, and possibly some dilatation of the lymphatics. Symptomatology.—The first symptom felt is commonly a general feeling of discomfort, with some burning or tingling of the surface, either in some particular spot or diffused over much of the skin. If there is the direct exciting cause of indigestion, there may be some febrile disturbance, but in the main no systemic symptoms are manifest, other than perhaps a little malaise, with a furred tongue and perhaps constipated bowels. The child scratches one and another portion of the body, and when these are examined there will generally be found the wheals already fully developed, or even fading away, and new ones may develop under fresh scratching even while being watched. But very commonly at the time of inspection the phy- sician may not be able to detect a single lesion characteristic of the disease, but must rely upon the history and description as given by attendants, to- gether with the scratch-marks which have been left after preceding eruptions. The lesions of urticaria vary greatly in different individuals and at dif- ferent times. The typical wheal consists of a firm, circumscribed, slightly- elevated spot or patch, from one-quarter to three-quarters of an inch in diameter, of an oval or rounded shape, and of a pinkish color at first, gen- erally becoming white in the centre very shortly. In point of fact, how- ever, they may be of any size and shape, large patches often being produced, and often assuming gyrate or fantastic shapes, largely due to external cir- cumstances, as pressure of the clothes, etc. The separate lesions are com- monly evanescent in character, if undisturbed, even disappearing in a few minutes, or they may remain in the same situation for some hours. When there is a single outburst of the ertiption or one reproduced but a few times, it is spoken of as acute uriicana; when the disease-state is prolonged by continuous or successive crops of the lesions, it is spoken of as chronic urticaria, and the disease may thus last for months or years: other than the chronicity produced by the repeated outbreaks, there is no radical dis- tinction to be noted. Several varieties or forms of urticaria are described, and may be observed clinically.