Lectures on clinical surgery. Vol. I. Pt. I. On certain rare diseases of the skin / by Jonathan Hutchinson.

  • Hutchinson, Jonathan, Sir, 1828-1913.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on clinical surgery. Vol. I. Pt. I. On certain rare diseases of the skin / by Jonathan Hutchinson. 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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    one of herpes. This similarity has not escaped Trousseau. They are further not unlike herpes in their duration, rapid decline, and mode of healing. Just as, in herpes, we occa- sionally have long protracted pain in the part, so in varicella we have occasionally long-protracted itching. The parallel fails in this, that we have no such thing as protracted vesi- cular eruptions in herpes; it is the pain alone which lasts. We know that herpetic eruptions are produced through the agency of sensory nerve-filaments; it is even possible that they may arise over or in nerve-papillae. It is just possible, then, following this line of suggestion, that the varicella vesicle originates in irritation of a nerve-papilla. I admit that this is a mere conjecture, but it seems to me not unplausible, and we need some theory by which to explain our facts. It is necessary, however, to keep in mind a few other general facts in reference to prurigo, if we would master the whole of the bearings of these curious cases. Even if we grant the suggestion that, as herpes may leave its well-known after- pain, so may varicella and allied eruptions leave their after- prurigo, we have scarcely explained the whole matter. The next fact which we must acknowledge is, that prurigo, from whatever cause it may have begun,,tends to perpetuate or even to aggravate itself. It causes itching, and the itching causes scratching, and the scratching extends the prurigo, aud thus the patient goes on from bad to worse. This is true of all forms of prurigo, whether beginning from lice, from fleas, from woollen clothing, half-cured scabies, or from some internal cause. If we could entirely prevent scratching, very few prurigos would assume a severe type. This being so, we- can easily explain the alterations which these cases undergo when they persist long. At first it is probable the rash is really a protracted varicella attended with prurigo; its vesicular character proves it to he such; and it may even be the case that the prurigo element is but small. The longer