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.

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    best of health and enjoying all the surroundings of a healthy/proper life. A study of fche histories of the cases here analyzed fails to discover any single cause or ele- ment or even combination of causes or elements to which the disease may be attri- buted, although, as will be mentioned later, several distinct types of the eruption may be made, out as found in those exhibiting the scrofulous, gouty and rheumatic diatheses. The eruption of psoriasis is seen clinically to develop in various manners, and with quite different degrees of severity; in some very young subjects, even, it ap- peared as quite a sudden outburst, affecting simultaneously or in rapid succession the various parts of the body and extremities, in other instances a few spots ap- peared here and there and developed but slowly, taking very considerable time before a large surface was affected; in some instances the eruption remained con- fined to a particular locality, as the scalp, or back, or chest, for some considerable period, of ten for years, and then, from unknown causes, more or less suddenly de- veloped so as to involve very much of the surface. However or whenever the eruption began, the analysis of these cases show it to have been most chronic and rebellious, lasting in many instances even during the entire life of the patient in varying degrees of severity. The following table exhibits the condition of the disease before the patient came under treatment: TABLE III. DURATION OF PSORIASIS IN ■ 414 CASES AT THE TIME OF APPLYING FOR TREATMENT. Duration. Private Patients. Public Patients. Total. Male. Female. Total. Male. Female. Total. 1 mo. to 3 mos. 8 3 11 5 4 9 20 3 fi to 6 i< 7 8 15 8 9 17 32 6 a to 1 yr. 13 7 20 . 7 2 9 29 1 to 2 yrs. 10 10 20 7 5 12 32 2 (( to 3 (i 9 5 14 4 3 7 21 3 it to 4 tt 12 8 20 4 3 7 27 4 It to 5 tt 10 6 16 4 2 6 22 5 t < to 10 ei 30 24 54 20 13 33 87 10 tt to 15 tt 25 17 42 6 11 17 59 15 tt to 20 tt 17 12 29 4 5 9 38 20 ft to 25 tt 14 2 16 8 1 9 25 25 tt to 30 11 5 0 5 0 3 3 8 30 tt to 40 tt 8 2 10 0 > 0 10 40 tt to 50 tt 3 1 4 0 0 4 Total 171 105 276 77 61 138 414 We see from this table that the natural history of psoriasis is reckoned by years rather than by months or days. Thus, out of 414 cases in which reliable data were preserved it is found that in 231, or 57 per cent., the eruption had existed for a period of over five years, and in four instances it is recorded that the erup- tion had been present between 40 and 50 years before the patient came under treatment. . Comparatively few oases were observed at or soon after the beginning of the dis- ease, only 20 in whom itjiad lasted less than three months. It will be seen later that this is a fact of no little importance in connection with the proper treatment of the disease.