Natrium dropper Schuppenflechte Full text of "A practical treatise on diseases of the skin, for the use of students and practitioners" Natrium dropper Schuppenflechte

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Full text of " A practical treatise on diseases of the skin, for the use of students and practitioners " See other formats Plate I. A PRACTICAL TREATISE DISEASES OF THE SKIN FOR THE USE OF STUDENTS AND PRACTITIONERS FOURTH Natrium dropper Schuppenflechte REVISED EDITION JAMES NEVLNS HYDE, A. TO THE CHICAGO HOSPITAL FOR WOMEN AND CHILDREN: ELIZABETH HOSPITAL, CHICAGO ILLUSTRATED WITH ONE HUNDRED AND TEN ENGRAVINGS AND TWELVE PLATES IN COLORS AND Schrott Psoriasis Suite in Minsk JAN 29 Natrium dropper Schuppenflechte The sudden demand for a fourth edition of this Natrium dropper Schuppenflechte has restricted the labor of revision to a few months ; but Natrium dropper Schuppenflechte this limited period of time it has been possible to alter, and, it is believed, also to im- prove, almost every page.

Crit- ical corrections also have been made, or new paragraphs added, in the chapters devoted to General Therapeutics, Lichen Planus, Der- matitis Herpetiformis, Eczema, Verruca, Molluscum Epithelial e, Fibroma, Xanthoma, Elephantiasis, Angioma Pigmentosum et Atro- phicum, Tuberculosis, Erythema Induratum, Leprosy, Carcinoma, Acne, Lupus Erythematosus, and Trichophytosis.

The doctrines based upon the recent progress of dermatological science which have not been Natrium dropper Schuppenflechte established have been for the most part briefly noted, while essential facts, those Natrium dropper Schuppenflechte resting upon pathological and bacteriological research, have been set forth and, when practicable, considered in detail. By the omission of material that no longer possesses value it has been found possible to make required additions without increasing the size of the book.

Three new plates and five new engravings have been introduced as additional illustrations. The author is pleased in this edition to place the name of his asso- ciate upon the title-page as an evidence Natrium dropper Schuppenflechte valuable assistance in the preparation Natrium dropper Schuppenflechte this fourth edition. The thanks of the author are tendered to Dr. Robinson for effective aid while the work has been passing through the press.

Visit web page TO THIRD EDITION The labor of preparing for the press a third edition of this treatise has been expended with a Natrium dropper Schuppenflechte to the correction and improvement of every page.

The greatly increased attention to the subject of Dermatology, Natrium dropper Schuppenflechte largely by the transactions of scientific bodies both in America and Europe whose work has been limited to the field of cutaneous medicine, and the numerous important publications devoted to the same theme in most of the modern languages of the civilized world, have rendered it difficult to secure for a text-book of this scope comprehensiveness and conciseness in an equal degree.

Thirty-five new diseases are with greater or less fulness considered in the present edition. The chapter on Tuberculosis has been wholly rewritten and considerably enlarged, with a view to furnishing an exposition Natrium dropper Schuppenflechte this important subject from the point of view of modern bacteriology and histology.

Lupus Vulgaris has been in that chapter properly relegated to Natrium dropper Schuppenflechte position among the verrucous and other Natrium dropper Schuppenflechte neous manifestations of tubercle-infection. Among other new and important chapters added may be named that on Pityriasis Rubra Pilaris, on Keratosis Follicularis, with several minor disorders tem- porarily considered in the same category, on Actinomycosis, on Leu- cokeratosis Buccalis, on Xanthoma Natrium dropper Schuppenflechte, and on Pemphigus Vegetans.

Among the several chapters of minor importance Natrium dropper Schuppenflechte added may be named those on SavilFs Disease, on Scarlatiniform Erythema, on Acanthosis Nigricans, on Angioneurotic Edema, on Acromegalia, on Alopecia Follicularis, on the Parasitic Forms of Eczema, on several varieties of Gangrene of the Skin, on some of the rarer diseases of the tropics, and on a few of those the hair and continue reading, both simple and parasitic.

It has been found necessary, with a view to the needs of the prac- titioner and student, still to adhere in part to the classification of the viii PREFACE TO THIRD EDITION. This has served as the ground- work for a Natrium dropper Schuppenflechte demanded by the later advances in dermatology. For convenience, the coccogenous and bacillogenous dermatoses of inflammatory type Natrium dropper Schuppenflechte been here grouped together under a common heading.

The new and original illustrations designed Natrium dropper Schuppenflechte for this edition consist of five plates and twenty-two woodcuts. The colored and other draw- ings of cutaneous disease are reproduced either from paintings in oil or from photographs of clinical patients. The author has to express his special indebtedness to the valuable second edition of the work of his friend, Dr.

Natrium dropper Schuppenflechte Crocker, of London, which has appeared since these pages have been passing through the press; also to the second edition of the practical and compendious treatise of Brocq, and to the current International Atlas of Rare Skin Diseases, which has become the important exchange for the dermatological experts of all nations.

He is also greatly indebted for aid in proof-reading and indexing click to see more his associate, Dr Frank H. Montgomery, and to his assistant, Dr. Chicago, September 1 PREFACE TO FIRST EDITION The increasing recognition of the gravity of many cutaneous dis- orders and of the importance of their accurate study is shown by the rapidly augmenting number of observers in this department of medicine and by the numerous valuable contributions constantly Natrium dropper Schuppenflechte to it, both in this country and abroad.

For the convenience of the general practitioner it therefore Natrium dropper Schuppenflechte necessary at shortly recurring intervals that some one should attempt Natrium dropper Schuppenflechte task of pre- senting in a comprehensive form the results of the latest observation and experience.

The author is aware of the degree to which he must claim indul- gence in the present effort to perform this duty. The extent of the subject and the limitations of a single volume require the omission of much detail of secondary importance.

With regard to that which it has seemed proper to include, he has endeavored to write concisely, to set forth only what can be held as the truth, to be frank in the admission of the weakness with which the most skilful physician stands in the presence of Natrium dropper Schuppenflechte grave and not a few benign dis- orders, and to cultivate a wholesome doubt of that which has not been shown to be worthy of trust. How far he may have fallen short of more info this end Natrium dropper Schuppenflechte pages will declare.

He has to express his indebtedness to the standard works on der- matology of foreign authorship, especially to the exhaustive and invaluable work of Hebra, and to the Lectures on the Diseases of the Skin lately Natrium dropper Schuppenflechte to the profession by Professor Kaposi, which contain the mature conclusions of his vast experience. With these should be named the writings of Sir Erasmus Wilson, Dr.

Behrend, and the syphilographers, to whose works special reference is Natrium dropper Schuppenflechte in the chapter devoted to their theme. Among the books of American authorship, Salben und für Psoriasis is under special obligation to the sterling work of Dr. Duhring, of Philadelphia, and to the excellent treatises of Drs.

Pif- fard, Fox, and Bulkley, of New York. All these are named by title in the brief and selected bibliography appended at the close of the volume. No less valuable aid has been x PREFACE TO FIRST EDITION. Bulkley, and the current Journal of Cutaneous and Venereal Diseases, Natrium dropper Schuppenflechte by Click here. Piffard and Morrow, deserve special mention.

The author is also very greatly indebted to Dr. Charles Heitzmann, of New York, not merely for the information gathered from the study see more his original researches in pathology, but particularly for his kind- ness in furnishing advance sheets of the chapter on the skin, in his work on Microscopic Morphology, which has just issued from the press.

From this work, with Dr. The first of the drawings representing sections of the skin is from the faithful pencil of Dr. Schmidt, of New Orleans, who, in order to Natrium dropper Schuppenflechte it, interrupted, without hesitation, his arduous labors in connection with the subject of path- ology.

To his colleague, also, Dr. Mercer, of Chicago, the author is glad to Propolis Moskau-Psoriasis, die geheilt mit his indebtedness for the skill with which a number of pathological specimeus have been prepared and mounted for special study, and original drawings produced for the first and subsequent article source of the book.

Duhring, of Philadelphia, he is further indebted for valuable suggestions made during the course of preparation of the manuscript. It is to be noted, how- ever, that the latter are not in all cases literal translations of the terms of the former, many of the formulae, especially those for preparations designed to be topically employed, being metrically composed, the relative proportions of the ingredients remaining unchanged.

The changes which it has been advisable to make in the matter nomenclature, classification, and other equally important subjects are concisely explained in the chapters devoted to each.

CONTENTS Anatomy and physiology of the skin. DISORDERS OF THE GLANDS. Or can elecampane Tinktur Psoriasis deutlichsten Sweat-glands Hyperidrosis. Sudamen Miliary fever Hydrocystoma Anidrosis Bromidrosis. Chromidrosis Greenish sweating Uridrosis Haematidrosis Of the Sebaceous Glands Seborrhea Asteatosis Comedo Milium Steatoma Congenital fibro-sebaceous disease Multiple dermoid cysts Rare consequences of sebaceous disease 97 97 xii CONTENTS.

PAGE Exanthemata Morbilli Rotheln Scarlatina Variola Varioloid Varicella Vaccinia Erythema Erythema intertrigo Erythema scarlatiniforme Erythema multiforme Urticaria Urticaria pigmentosa Angio-neurotic oedema Dermatitis A Traumatica. PAGE Impetigo herpetiformis Pemphigus Acute Chronic vulgaris Pruriginosus Hypertrophies of Pigment Lentigo Chloasma Chloasma uterinum Argyria Anomalous discoloration of the skin Chloasma from arsenic Tattooing Hypertrophies of Epidermal and Papillary Layers Keratosis A Pilaris.

D Palmaris et plantaris CONTENTS. Callositas of the hands with unusual complications Perforating ulcer of the foot Clavus Oornu eutaneum Verruca Multiple cutaneous tumors accompanied wit Synovial lesions of the skin Papilloma. Nevus pigmentosus Acanthosis nigricans Xerosis Ichthyosis Simplex Hystrix Congenita harlequin fetus Linguae. Onychomycosis Syphilitic onychia Congenital dystrophy of nails and hair Hypertrichosis. Hypertrophies of Connective Tissue Edema neonatorum Acute circumscribed oedema of the skin Circumscribed and persistent oedema Sclerema neonatorum.

Eosacea Natrium dropper Schuppenflechte Erythematosa B Hypertrophica Frambesia Parangi Donda ndugu Verruga peruana Peruvian wart pruritus PAGE XVI CONTENTS. C Vitiligo D Canities Of Hair Alopecia Congenital. Premature Alopecia furfuracea Alopecia areata.

Alopecia follicularis Keloid-acne Ulerythema aphryogenes Atrophia pilorum learn more here. Fragilitas Natrium dropper Schuppenflechte Trichorrexis nodosa Monilethrix.

Nodose swellings of shafts of hair Concretions upon the hair-shafts Lepothrix Piedra. Achromia unguis Of Cutis Atrophia cutis Atrophia senilis. Partial idiopathic atrophy Atrophia maculosa et striata Diffuse idiopathic atrophy Glossy skin. Branching atrophy of the skin Multiple benign Natrium dropper Schuppenflechte new-growths Kraurosis vulvae PAGE CLASS VI. Of Connective Tissue Keloid Colloid metamorphosis of the skin.

PAGE Acne group of tuberculoses Pigmentary Papulosum Natrium dropper Schuppenflechte acuminate Large acuminate Generalized primary non-melanotic sarcoma Eecurrent fibroid of skin. A Pruritus Pruritus narium Genitalium Ani Palmse et planta?

Vaso-motor and trophic neuroses Myxedema Disorders due to Natrium dropper Schuppenflechte Parasites Tinea favosa Craw-craw Cysticercus cellulosse cutis. Dipterous larvae in and beneath the human Ixodes.

Ctilex Natrium dropper Schuppenflechte Protozoa and sporozoa skin PAGE ERRATA. Section of skin from the palm of the hand 2. Vertical section of skin after injection from beneath with Berlin Natrium dropper Schuppenflechte 5. Article source and nervous papillae. Scalp of a colored man — horizontal section. Pacinian body, after silver staining Section of papilla containing a tactile body from the skin Transverse section of nervous papilla Section of hair-follicle during the formation of a new hair Hair-follicle in longitudinal section Lower portion of hair-pouch Natrium dropper Schuppenflechte the lip Psoriasis und Wodka a kitten.

Transverse section of hair and follicle Sebaceous glands of the second class from the alas of the nose Coil of the sweat-gland The sweat-pore traversing the epithelial layers of the skin Section of the skin from the palm of the hand.

Thin section of the skin of the finger removed at the site of a sweat pore Vertical section of one-half of Natrium dropper Schuppenflechte and matrix Implantation of the nail at its border Section of a comedo. Cysts of the scalp Microphotograph of the bacillus scarlatinas Vertical section of pustule at the beginning of verschrotten Suite Psoriasis in variola Natrium dropper Schuppenflechte section of one-half of an undeveloped Natrium dropper Schuppenflechte PAGE 18 20 21 22 23 24 26 30 31 32 35 35 37 Natrium dropper Schuppenflechte 41 42 43 44 46 Natrium dropper Schuppenflechte 49 91 91 91 91 91 91 91 92 92 92 Natrium dropper Schuppenflechte xxii LIST OF ILLUSTRATIONS.

Papilloma, due to the ingestion of the iodin compounds. From a painting in oil. Vertical section of anthrax Section of anthrax Malignant pustule bacilli and pus-corpuscles Longitudinal section of the third spinal ganglion of the right lumbar region, from a case of lumbo-inguinal zoster Vertical section of skin from a patch of psoriasis Molluscum epitheliale Molluscous corpuscles Varieties of cutaneous horns Vertical section of the summit of a pointed wart.

Ichthyosis hystrix Ichthyosis hystrix, vertical section The Russian " dog-faced man" Elephantiasis of the foot and leg Vitiligo in a negro boy Neuroma of the skin ; external appearance Microscopic structure of neuroma Lupus vulgaris of the face.

Lupus vulgaris of the leg. Verruca necrogenica Section of a lupus nodule. Section of lupus of the face Lupus Natrium dropper Schuppenflechte of the face. Facial cicatrices of tubercular syphilodermata after twenty-five years of infection Vegetating condylomata of the vulva. Palmar syphiloderm Ulcerative tubercular syphiloderm Syphilitic gummata of head and face Lepra tuberculosa Anesthetic leprosy with mutilating results. Larynx of patient affected with lepra tuberculosa.

Larynges of lepers affected with lepra tuberculosa Bacilli of leprosy Superficial papillary Natrium dropper Schuppenflechte of face. Mycosis fungoides Achorion Schonleinii Epidermis invaded by trichophyton Hair invaded by trichophyton Filaments and spores of trichophyton from the beard.

Osseous lesions in mycetoma Microsporon furfur Female acarus Demodex folliculorum Leptus autumnalis Acarus hordei Larvae from body of child Ova of head-louse Pediculus corporis Pediculus pubis LIST OF PLATES.

Acne-keloid of the Back. Malum Perforans Pedis, with Symmetrical Keratoma of the Palms and Soles. From a water-color sketch. Elephantiasis Telangiectodes of the Upper Lip and Portions of the Face. Multiple Fibroma of the Back. Xanthoma of the Hands, Elbows, and Knees. Lupus Hypertrophicus of the Face. Large Pustulo-crustaceous Syphiloderm of the Scalp and Body.

From a photograph of a cachectic clinical patient. Tubercular Syphiloderm, Resolutive and Serpiginous. From a photograph of a hospital patient. ANATOMY AND Natrium dropper Schuppenflechte OF THE SKIN. The skin is the living envelope of the human body; it is closely associated with underlying structures, and by its situation is brought into intimate relation also with the external world. The skin is a complex, elastic, and sensitive organ, varying greatly in different conditions of climate, age, sex, health, and race; and varying also in Natrium dropper Schuppenflechte characteristics exhibited in different localities upon Natrium dropper Schuppenflechte same indi- vidual.

The skin varies also in pliability and thickness, being delicate and lax over the eyelids, the lips, and the prepuce; and much Natrium dropper Schuppenflechte and more firmly attached Natrium dropper Schuppenflechte the palms and the soles. It is important to note that the appearance of the skin, even in con- ditions of health, also changes within appreciable psoriatischer Forum die Behandlung. It is the exposed parts such as the face which the eye of the physician most frequently searches, and which betray evidence of mental emotions, physiological fluxes, sedentary or active habits of life, and fatigue or unusual conditions of vigor.

Viewed externally, the skin is seen to be traversed by superficial and deeper furrows, dotted by numerous depressions representing the mouths of its follicles, and provided very generally with coarse or with fine downy hairs which in some parts are of sufficient growth to conceal the skin from view.

This pilary growth serves not merely as an ornament of the body, but also as a Natrium dropper Schuppenflechte to some of its regions most sensitive to thermal changes. By its extraordinary sensitiveness to different degrees of temperature and to the physical properties of the bodies with which it is Natrium dropper Schuppenflechte into contact, the skin becomes, even when unaided by the eye, a valu- able means of preserving the human frame from Natrium dropper Schuppenflechte injury.

This protective function is, in part, due to the horny character of its outer layer, as a consequence of which the loss of essential fluids and the ingress of noxious substances are equally restricted. One of the most important functions of the skin is the part it plays in regulating the body-temperature. The temperature-variations at its surface, modified naturally by the character and quantity of the clothing when Natrium dropper Schuppenflechte is w T orn, produce corresponding variations in the smooth muscles and contractile blood-vessels of the skin.

By enlarge- ment or diminution of the lumen of these vessels, whether resulting directly from Psoriasis Kürbiskernöl für action of heat or of cold at the surface, or indirectly through an effect upon the vaso-motor centres, large quantities of blood are brought to or removed von Behandlung Psoriasis Flamme Eine the superficies of the body.

In one case the blood is cooled by evaporation at the body-surface; in the 2 18 DISEASES OF THE SKIN. This process is materially influenced go here acceleration or retardation of the Fig. It is also modified by the occurrence of sweating, as a result of which heat in varying amounts is rendered latent, and either watery vapor escapes from the surface or sweat is exuded iu Natrium dropper Schuppenflechte, the aggregate of which may be several pounds in weight in the course of twenty-four hours.

To a limited degree, the skin is capable of acting as a respiratory agent, eliminating carbonic acid gas with watery vapor, and possibly also absorbing oxygen in small amount. Its power of absorbing ali- ments, medicaments, and toxic substances has as yet but imperfectly been determined. Substances in liquid state are practically not ab- sorbed so long as the horny layer of the epidermis is intact.

The loss of this external protective layer, however, permits the ready absorption of many liquids. Many gases are readily absorbed by the unbroken skin, as to a less extent are some fats and oils, as well as a few substances in a finely powdered state. Such absorption, when it occurs, is probably effected through the portal of a hair-follicle and the ducts of the cutaneous glands. The skin is provided with a natural unguent, by which, in a state of health, it is constantly anointed.

The fatty and oily secretions of the skin are concerned, not merely in the anointing of the general sur- face and of the hairs, but also in the regulation of the body-tempera- ture, by preventing maceration of the tissues by the sweat.

The complex organ which is called " the skin" is Natrium dropper Schuppenflechte to the life of the individual. The sexual, and possibly other Natrium dropper Schuppenflechte of the human body, may have their functions arrested, or Natrium dropper Schuppenflechte may read more be obliterated by destructive processes, and life still continue; but if all the functions of the skin were suspended for a sufficient period of time, the result would be fatal to human life.

In its important relations alone to the complicated processes by which the heat of the body is maintained at a relatively fixed standard the skin exhibits its impor- tance to the general economy.

It is thus seen to be, not an isolated membrane stretched mechanically over an artificial machine, but is one of several living and potential systems mit Aktivkohle Bewertungen the body, each system being in intimate union with all others.

The integument of the body, when studied Natrium dropper Schuppenflechte the aid of the micro- scope, is found to be composed of several organic parts, which are: Beside these parts, the skin con- tains oil-glands, sebaceous glands, hairs, blood-vessels, lymph- vessels, muscles, pigments, and nerves.

It will be instructive to study the deeper parts of the skin before those more superficially disposed, as their mutual relations will thus be made clearer. The subcutaneous tissue is differentiated from the corium between the third and the fourth month of foetal life.

It is a structure serving a mechanical purpose as a receptacle for fat, and for the support of Natrium dropper Schuppenflechte DISEASES OF THE SKIN. It contains, also, coil-glands, some of the hair-follicles more deeply seated than their fellows, and Pacinian cor- puscles. There is no distinct boundary-line between the upper limits Natrium dropper Schuppenflechte the subcutaneous tissue and the overlying corium, to which it pro- jects columnar masses of fat, extending obliquely to the coil-glands and the hair-follicles above, often with lateral, horizontally disposed pro- longations Natrium dropper Schuppenflechte similar shape.

It is built up Natrium dropper Schuppenflechte loose connective-tissue bundles, prolonged from the aponeuroses, fasciae, and the membranes lying beneath. Subcutaneous fat-tissue, the fat having been extracted by turpentine: B, bundles of fibrous connective tissue, carrying injected blood-vessels ; C, capsules of fat-globules, with oblong nuclei.

The subcutaneous tissue is firmly attached to the skin over the extensor surfaces of the articulations, the palms, the soles, and the groins by short, coarse bundles, between which are single or multiloc- ular spaces lined with endothelia, secreting a visit web page fluid.

These this web page are the bursse mucosae. Elsewhere, as Natrium dropper Schuppenflechte the eyelids, the Natrium dropper Schuppenflechte, the Natrium dropper Schuppenflechte, and Natrium dropper Schuppenflechte auricle of the ear, the attachment to the skin is by loose, delicate connective tissue, containing no fat-globules.

All other fibrous tracts are arranged obliquely ; they admit, by their exten- Psoriasis-Biopsien, of various degrees click at this page pliability, and inclose rhomboidal spaces containing more or less numerous fat-globules. These spaces are lobu- lated, are bounded by a delicate fibrous connective tissue, and are abundantly supplied with blood-vessels.

This layer is termed the panniculus adiposus. The deposit of fat in the body is greatly reduced in all diseases pro- ductive of Natrium dropper Schuppenflechte, but never wholly disappears in life.

Natrium dropper Schuppenflechte cases of obesity, fat is deposited in excess of normal limits, and it may then ANATOMY AND PHYSIOLOGY OF THE Natrium dropper Schuppenflechte 21 be concerned in the production or the aggravation of disease. It is largely due to the greater or lesser volume of the panniculus adiposns that the Natrium dropper Schuppenflechte outlines of the body are made to the eye graceful and attractive, or the reverse.

The Corium Derma, Cutis Vera, or True Skin is composed of bundles of fibres of Natrium dropper Schuppenflechte tissue, whose decussations produce a dense felt-work, coarsest toward the subcutaneous tissue, upon which it rests inferiorly, and Natrium dropper Schuppenflechte in the outermost portion, which is in con- tact with the epidermis above.

The bundles are composed chiefly of fibres of white fibrous tissue, but are accompanied by a varying num- ber of elastic fibres. Connective-tissue corpuscles are also present in Fig. Vertical section of skin showing: Thomsa and other observers describe a " cement- substance," or Natrium dropper Schuppenflechte, surrounding all the fibres and holding the various elements of the skin together.

Other observers, however, deny its existence. The derma hatte Psoriasis-Behandlung Banane cum rich in blood-vessels and capillaries, especially in Natrium dropper Schuppenflechte papillary layer, and contains many nerves, nerve- endings, and terminal nerve-organs.

It further contains lymphatics, smaller muscle-fibres, hairs, Natrium dropper Schuppenflechte, and sebaceous glands. Corresponding with their anatomical structure the upper and lower portions of Natrium dropper Schuppenflechte derma are called respectively Natrium dropper Schuppenflechte " papillary layer" and " reticular layer.

The bundles of the connective tissue of the derma accompany Natrium dropper Schuppenflechte elongations of an epithelial character. They produce the follicles around the root-sheaths of the hair, the capsules around the coil-glands, and the Natrium dropper Schuppenflechte which surround their ducts. Vertical section of skin after injection from beneath of areolar tissue with Berlin blue: The reticular layer of the corium is made up, as has been seen, of interlacing connective-tissue bundles, with inter- spaces increasingly larger from without inward.

The fineness of the bundles decreases, in the same way, from within outward, being finest where the minute papillae of the corium project into the rete, and coarsest near the subcutaneous tissue. The papillary layer of the corium lies in con- tact with the rete above, and is connected below with the deeper retic- ular portion of the true skin.

Between the rete and the papillae of the derma a hyaline substance is interposed which Unna believes to be identical with the Natrium dropper Schuppenflechte "cement-substance" described by some authors as surrounding and separating Natrium dropper Schuppenflechte fibrillar of the corium.

The basal membrane, once thought to be stretched between the rete muco- sum of Ointment Psoriasis epidermis and the papillary layer of the corium, cannot be demonstrated to exist. Viewed obliquely, with an amplification of about three hundred diameters, it will be seen that long and slender filaments from the prickle-cells Natrium dropper Schuppenflechte the mucous layer of the epidermis encircle in a oder Dermatitis Schuppenflechte direction both nervous and vascular papillae.

At the apices of the latter these threads completely surround the connective-tissue Natrium dropper Schuppenflechte. The name Natrium dropper Schuppenflechte this portion of the derma is intended to describe its chief characteristic, the existence of numerous digital prolongations of the corium, made up of delicate connective-tissue fibres, which do not ANATOMY AND PHYSIOLOGY OF THE SKIN. The papillae spring each from a single, or several from a common, ovoid base; their bulbous, conical, or blunt Natrium dropper Schuppenflechte reach into the rete, which also dips down between them.

The papillae differ in size in different parts of the body, and also in their click at this page and shape, being in places arranged in linear series, and in other in concentric whorls, with defi- nite centres, thus producing crossing-furrows, visible to the naked eye as markings upon the outer surface of the epidermis.

In horizontal sections of the skin the papillae, being transversely divided, appear as circular or ovoid areas, in which can be recognized centrally a transversely or obliquely divided capillary loop. Between these areas is seen the interpapillary reticulum of the mucous layer.

When the papillae are completely exposed, after removal Natrium dropper Schuppenflechte the over- lying so-called " cement-substance" and of the epidermis above, their exterior surface is seen to be uniformly marked w T ith series after series of alternating furrows and ridges of exceeding delicacy, and more or less concentrically disposed. Into the grooves are admitted corresponding 24 DISEASES OF THE SKIN. They may, however, be the furrows Natrium dropper Schuppenflechte after separation of the long prickles wrapped about the papilla?

Two varieties of papillae are distinguished — the vascular and the nervous; Natrium dropper Schuppenflechte former contain the terminal loops of a minute artery and vein, and the latter the terminations of medu Hated nerve-fibres. The greater number of the papillae are of the vascular variety, being traversed Natrium dropper Schuppenflechte a vertically disposed loop of vessels, consisting of an arte- rial and a venous capillary.

The office of the vascular loops is Natrium dropper Schuppenflechte dently not merely to supply nutriment for the epidermis above, but also to provide for the cooling of the blood when brought in large quantities Natrium dropper Schuppenflechte the surface of the body. Occasionally, two or more of such loops can be Natrium dropper Schuppenflechte in a single papilla.

The nervous papillae contain the tactile corpuscles, which subserve an important purpose in providing for the sensibility of the integument. The tactile corpuscles are described in connection with the nerves of the skin. Ultimate terminations of nerves can be recognized in the vascular Natrium dropper Schuppenflechte, and at times minute vascular Natrium dropper Schuppenflechte can be seen in the papillae largely occupied with the corpuscles of touch.

The Epidermis Scarf-skin, or Natrium dropper Schuppenflechte is the most external of the several membranes Natrium dropper Schuppenflechte the body, being in close contact on one side Fig. R, rete mucosum ; Pi, row of columnar epithelia cut obliquely supplied with dark-brown pigment-granules; Pa, papilla, cut transversely; D, derma.

The latter surface is therefore rela- tively drier, while the former is constantly moistened by fluids from the vessels which ramify beneath it. The epidermis is developed from the ectoderm, the corium from a superficial layer of the mesoblast. Their behavior both in health Natrium dropper Schuppenflechte in disease is marked by the widest difference.

The epidermis differs greatly in thickness in different portions of the body, for example, that of the palms and soles exceeding, in ver- tical section, that which covers the dorsum of these same organs and that protecting such sensitive parts as the eyelids, lips, temples, aud prepuce. The epidermis is composed of the following layers, named in order from within outward: Each of these strata, or layers, is histogenetically derived from the one which is deeper in situation. The Stratum Mucosum Mucous Layer, Prickle-layer, Eete Mucosum, Rete Malpighii or Malpighianum Natrium dropper Schuppenflechte the deepest of the epidermal layers, and rests upon the corium below.

The corium is intimately united with it by a series of interdigitations which are commonly described as prolongations Natrium dropper Schuppenflechte the derma into the substance of the rete, but it is equally true that the rete sends just click for source prolonga- tions into the Natrium dropper Schuppenflechte. The two, in the need of an intimate union to resist friction and to insure vascular supply, are thus closely locked together.

The stratum mucosum is built up of Natrium dropper Schuppenflechte epithelial cells, poly- hedral in outline and diffusely colored. These cells are masses of granular protoplasm, living matter, which by their relation to one another form a protoplasmic network euveloping the entire surface of the body and lining all channels and cavities in direct or indirect con- nection with the surface. These elements are flattened by reason of their apposition, and are separated from one another by an intercellular substance, which has been described as " cement-substance.

All are, how- ever, uninterruptedly united by delicate spokes, known as prickles, spines, or thorns. The living matter, which produces a delicate retic- ulum within each protoplasmic body, its points of intersection being termed nuclei, nucleoli, and granules, furnishes the already described filaments, which thus produce continuity through all the living layers of the epithelial elements, as well as through the underlying layers of the connective tissue.

The epithelia are Natrium dropper Schuppenflechte with either blood- or lymph-vessels; but, when living, are supplied with a large number of nerves, Natrium dropper Schuppenflechte, in the shape of very minute beaded fibres, traverse the intercellular substance, and which are in direct communication with the reticulum of living matter within the protoplasmic bodies them- selves, The living masses of protoplasm, just described, play the most im- portant part in all the pathological and physiological continue reading observed in the skin.

It is probable that, in the embryo, all the appendages of 26 Natrium dropper Schuppenflechte OF THE SKIN. Prickle-cells from a condyloma magnified about diameters: The dots on the surface of the protoplasmic mass represent the appearance Natrium dropper Schuppenflechte the prickles when directed toward the eye of the observer. Some of the protoplasmic threads are seen passing from one cell to another.

Next the corium is a layer of cells, Natrium dropper Schuppenflechte in form, and arranged with their long axes nearly at right-angles to the plane of that portion of the corium upon which they are superimposed. More externally the cells are rounded or cuboidal in shape, with large, distinct nuclei. They are not arranged in definite strata Natrium dropper Schuppenflechte in the very Natrium dropper Schuppenflechte layers, where the cells are somewhat flattened and elongated.

Between the Natrium dropper Schuppenflechte in the deeper layers Natrium dropper Schuppenflechte leucocytes may at times be recognized. The Stratum Granulosum, or Granular Layer of the epi- dermis, is built up of one or two, rarely Natrium dropper Schuppenflechte, rows of horizontally disposed granular Natrium dropper Schuppenflechte, united to one another by short, broad threads.

Between these bodies the intercellular spaces are so contracted that nutritive fluids cannot easily filter outward; and the nuclei of the cells are usually shrunken. These have carefully been studied by Eanvier, Kolliker, Walcleyer, and Natrium dropper Schuppenflechte. According to these observers, the roundish granules which give this layer of epithelium its peculiar name and appearance consist of eleidin or kerato-hyalin, a substance essen- tial to the process of cornification in the elements making up the horny layer of the skin, nails, etc.

These granules begin to appear lange Gluten und Psoriasis Gottes the neighborhood of the nuclei of some of the large prickle-cells in the rete, but they are best studied in the granular layer, whose cells are often completely filled with them. According to Unna, the color of the skin in the white races aloue depends upon this layer.

The stratum lucidum thus marks with tolerable distinctness the boundary-lines of the rows of cells above and below it. Its epithelial bodies have suddenly lost the source, shining granules Natrium dropper Schuppenflechte kerato-hyalin, conspicuous iu the stratum granulosum below.

These granules are generally supposed to have dis- appeared iu consequence of their solution in the protoplasm of the cell- body, which has thus acquired an added brilliancy and clearness. The Stratum Corneum, or Horny Layer of the epidermis, is its outermost and widest layer, extending from the stratum lucidum below Natrium dropper Schuppenflechte the external environments Natrium dropper Schuppenflechte the body.

In its lower portion, the polygonal plates of which Natrium dropper Schuppenflechte is composed indicate very clearly their relationship to the cells in the prickle-layer. The nuclei appear in places only as shrivelled and inconspicuous relics of the protoplasmic threads.

Occasionally, on the edges, rudiments of the prickle-threads may still be recognized. More externally, the dried, lifeless, horn- like plates of which this Natrium dropper Schuppenflechte is composed become mere cornified shells, generally lying in horizontal strata, and becoming more curled and wrinkled as the surface of the skin is reached, often being imbri- cated, but preserving the polygonal outlines of epithelia relieved of the forces of pressure and counter-pressure exerted in the deeper parts of the epidermis.

These elements are rarely pigmented, save in the case of the negro, in whom the intense staining of the deepest parts of the mucous layer is to a degree spread to the external strata. This staining in the colored races is produced by granules of pigment arranged about an unaffected nucleus in the prickle- read article. According to Unna, after digestion with pepsin and trypsin, it is seen that the horny cells are connected by more or less persistent threads, visible after more prolonged digestion as a large-meshed retic- ulum, with strands formed from a double row of cornified filaments united by short horny bridges.

Welcker, 1 Minor, 2 and Bowen 3 have de- scribed a layer of large cells, with round nuclei much larger than those of the epidermal layers beneath, Natrium dropper Schuppenflechte the entire body Natrium dropper Schuppenflechte the human embryo Natrium dropper Schuppenflechte the early months of its existence.

This layer, histo- logically, is quite distinct from the outer cells of the stratum corneum and corresponds with the epitrichium of certain animals. It usually disappears before the sixth or the seventh month of uterine life. The Arteries and Veins supply the skin from subcutaneous branches which penetrate the underlying fascise, and proceed by sub- 1 Ueber die Entwickelung und den Bau der Haut und der Haare bei Bradypus.

They are always more abundant upon the flexor Creme mit Propolis gesunde upon the extensor faces of the Natrium dropper Schuppenflechte. Just beneath the papillary layer of the corium there is a minutely ramifying plexus of fine capillaries, the loops of which extend into the papillae above.

This and the coarser plexus in the deeper portion of the derma are so well defined that they might Natrium dropper Schuppenflechte designated as superior and inferior partes vasculares of the corium. A third vascular tissue is found in the subcutaneous connec- Natrium dropper Schuppenflechte tissue where the vessels are numerous. The arterioles which supply the sweat-glands surround the coils of the latter in a delicate basket-like plexus, and Natrium dropper Schuppenflechte in two or three veinlets, one of which always accompanies the duct of the gland upward as far as the papillary layer, where it anastomoses visit web page the vessels of that part of the skin.

The ascending arterioles supply the sebaceous glands and hair-follicles, and, breaking up into smaller and yet smaller branches, finally furnish a single or a double Natrium dropper Schuppenflechte loop to each papilla.

The capillaries of the papillary layer anastomose freely with those transversely arranged in the upper portion of the hair-follicles, from which loops also pass to the sebaceous Natrium dropper Schuppenflechte. The hair-papilla has a vascular supply similar to that of each of the other papillae of the corium.

Unna divides the vessels distributed to the skin into the papillary system and the system of the coil-glands and fat-tissue. The first system includes the ascending loops which traverse the vascular papillae, and the branches supplying lower portions of the corium.

The second system embraces the vessels running upward to Natrium dropper Schuppenflechte coil-glands and downward to the fat-tissue. In the papillary vascular system the arteries are narrow and the veins wide.

Each of the vessels consists merely of an endothelial tube augmented, as the subcutaneous tissue is reached, by both media and adventitia. According to Hoyer, there is a singular duplex arrangement of vessels in the distal phalanges of visit web page fingers and toes, in consequence of which there is a distinct com- munication between the arteries and veins.

Other observers deny the existence of such anastomosis. Vaso-motor nerves are twined around these vessels in all their ram- ifications. The whole vascular system, as thus arranged, plays a most important part in all the healthy and morbid processes which occur in the skin, as well as in the sudden physiological changes distinguish- able to the eye in the phenomena of blanching and blushing.

The skin in all its parts is provided with a system of lymphatic channels, designed to subserve the necessities of the important pro- cesses of absorption, and traversed by lymph whose currents are con- tinuously directed to Natrium dropper Schuppenflechte large vessels of the structures beneath the skin.

Unna divides these Natrium dropper Schuppenflechte into: The juice- or lymph-spaces Natrium dropper Schuppenflechte the epithelial bodies which make up the stratum mucosum of the epidermis, and they also extend be- tween the protoplasmic threads or prickles that unite them.

In the latter case these Natrium dropper Schuppenflechte would be comparable to the impressions made by thrusting at random a pencil into a mass of soft putty. At times this intercel- lular substance seems capable of obstructing the conduits by which it is tunnelled. These juice-spaces exist in the papilla? They also sheathe the connective-tissue fibrillae of the corium and sur- round the fat-cells. The lymphatic vessels are relatively few, but they form a continuous meshwork with transversely and vertically disposed branches supply- ing all parts of the skin below Natrium dropper Schuppenflechte epidermis.

The juice-spaces com- municate with these vessels in the papillary portion of the corium through minute orifices in the vascular walls, the vessels themselves being here represented by blind terminal loops. The current of the lymph flows from the papillary apices in every direction to all parts of the rete, like the currents in the go here of a river, a reflux occurring at the lower limit of the interpapillary depres- sions of the rete downward, possibly through the sweat-pores which traverse the epidermis at these points.

Thence the current Natrium dropper Schuppenflechte freely downward to the lymphatic vessels in the corium, but the stream from the juice-spaces about the coil-glands and fat-tissue is retarded by reason of a more restricted communication with the lymphatic vessels below. In consequence of the retardation due to this anatomical pecu- liarity the formation of fat by filtration is facilitated. Non-medullated and medullated nerve-fibres, each in places being substituted for the other, are supplied to the skin from horizontally disposed bundles of nerve-twigs in the subcutaneous tissue.

These fibres traverse the corium in connection with the blood-vessels, and become finer as they ascend, until they form a subepithelial plexus just below the epidermis. Exceedingly delicate Non-medullated Fibres penetrate in great abundance to the epidermis between the epithelia. Here, traversing the intercellular substance by the side of the juice-spaces, they either terminate between the prickle-cells as ultimate bulbous terminations of finely beaded fibrillse, or they penetrate the epithelia themselves in pairs.

Each prickle-cell is supplied with a pair of these beaded 30 DISEASES OF THE SKIN. Above the stratum granulosum these nervous threads cannot be recognized. Similar nerve-filaments are supplied to the sheaths of the hairs and the ducts of the coil-glands. It is by means of these numerous and delicate fibres that the perception of sensation in the skin is accom- plished. Motor filaments, discovered by Thomsa, are also distributed to the sheaths of the blood-vessels, in which they are finally lost.

Other motor filaments supply the muscles, and Natrium dropper Schuppenflechte nerves are distributed to all the secreting-organs of the skin and to all its protoplasmic formations. The Medullated Nerve-fibres of the skin have carefully been studied by Robinson. Some of these fibres, after such reversion, again ascend an adjacent papilla; others are supplied Natrium dropper Schuppenflechte the Pacinian and tactile corpuscles.

The Pacinian Corpuscles, named from the anatomist Pacini, also called Corpuscles of Yater, exist subcutaneously only upon Fig. L, lamellar envelope; g. Natrium dropper Schuppenflechte corpuscle consists of Natrium dropper Schuppenflechte series A Manual of Dermatology, by A. ANATOMY AND PHYSIOLOGY OF THE SKIN 31 of concentric, nucleated, vascular capsules, arranged after the manner of the Natrium dropper Schuppenflechte of the onion, more closely Natrium dropper Schuppenflechte at the periphery than at the centre, and surrounding a protoplasmic core.

The medullated nerve to which the Natrium dropper Schuppenflechte is attached gradually loses its myeline Natrium dropper Schuppenflechte ope, and terminates in the centre of this core, after traversing the Fig. Section of a papilla still covered by a portion of the stratum mucosum and containing a Natrium dropper Schuppenflechte body from the skin of a finger.

The corpuscle of Meissner is seen to consist of minute lobules, made up of a homogeneous protoplasm, with numerous oval nuclei and nervous fibrillse wound in a spiral direction about the mass of Natrium dropper Schuppenflechte corpuscle. The extension of the fibrillse to the mucous layer is shown. The sources Natrium dropper Schuppenflechte the nerve-filaments are demonstrated to be: The myeline sheath is lost in the tissue of the concentric capsules.

According to Ranvier, the nerve may, after supplying one capsule, penetrate a second, or even a third. In such cases the nerve regains its sheath as it issues from the corpuscle at its opposite pole.

Robinson believes that the nerve forms a plexus or loop within the corpuscle, and leaves it at one of its poles. The precise function of the Pacinian corpuscle is unknown. Its connection with the tactile sense is suggested by its location, since these bodies are most numerous in the subcutaneous tissue of the nipple, the penis, the digits, and in parts similarly sensitive. These corpuscles bear an evident analogy to the organ of vision, each body having a capsular character; Natrium dropper Schuppenflechte being provided with a special nerve-filament, which enters the corpuscle at one pole; each also receiving its impres- sions at the extremities of the capsule opposite that where it receives its nervous supply.

According to Natrium dropper Schuppenflechte, the Pacinian corpuscles are concerned in the appreciation of impressions produced by pressure and traction. Whether specially concerned in Natrium dropper Schuppenflechte distinguishing of sensations orig- inating in heat, cold, moisture, pressure, traction, or weight, it is evi- dent that they contribute but little, if at all, to the reception of ordinary impressions upon the skin, and, as yet, they are not known to play any part in cutaneous diseases.

The Tactile Corpuscles Corpuscles of Meissner, or of Wagner are other oval-shaped bodies found in about one in four of the papillae in the pars papillaris of the corium. They are each composed of from Fig. Transverse section of nervous "papilla surrounded by cells of the stratum mucosum: Minute lobules of a this web page protoplasm Natrium dropper Schuppenflechte oval nuclei are found in each.

Source receive medullated nerve- Natrium dropper Schuppenflechte and are made up of closely compressed, flat, connective-tissue ANATOMY AND PHYSIOLOGY OF THE SKIN. A somewhat denser connective-tissue capsule encloses each.

The myelin e sheath of the nerve-fibres is lost Natrium dropper Schuppenflechte the fibrous tissue of the corpuscle. Externally viewed, they seem to be trausversely striated.

The Natrium dropper Schuppenflechte of the nerve-filament distributed to each divides into numerous delicate nerve-threads which in part encircle the cor- puscle and Salbe Kinder Psoriasis für wirksame für penetrate within.

According to Robinson, each corpus- cle is provided with an afferent and efferent nerve, the former approach- ing the corpuscle from the subpapillary region and entering at or near its base. Occasionally the afferent fibre is furnished by an adjacent papilla. As the filament that enters the corpuscle frequently divides, two or more efferent fibres may then escape from it. Afferent fibres reach the rete above after encircling the tactile corpuscle; others, side by side, arrive at the rete without coming into contact with the former.

The discovery of nerve-filaments in and among the epithelia of the epidermis in such abundance as to provide fully for tactile sensation in the skin, leaves the exact function of these corpuscles in partial ob- scurity. There can be little doubt, however, as to their association with the perception of certain qualities of foreign bodies with which the skin may be brought into contact. The hue of the Natrium dropper Schuppenflechte integument is due in part to Natrium dropper Schuppenflechte degree of vascularity and distention of the vessels in the corium, and in part also to pigmentation of the epidermis.

This pigmentation depends upon a distinct and uniform coloration of the epithelia, chiefly those found in the lower strata of the epidermis, and also to minute granules of pigment entangled in the reticulum of living matter in the same part.

Extreme variation in the distribution of pigment is noticeable both in health and in disease, and in individuals and races, being at times proportioned to climatic and similar influences. This fact is well illustrated by the wide range between the flaxen-haired, pink-eyed albino, and the blackest specimens of the negro, each, with small exception, being of African descent.

It has already been noted that in the colored races the pigment may stain the epithelial cells and their nuclei as high as the granular layer; and that to this layer only is due the peculiar color of the skin of the white races. Pigment is not normally found either in the horny layer of Natrium dropper Schuppenflechte skin or in the subepithelial tissues. TValdeyer claims to have Natrium dropper Schuppenflechte it in normal connective tissue.

The relation existing between the two Natrium dropper Schuppenflechte of skin-coloration, viz. Natrium dropper Schuppenflechte unaided eye, looking at the outer surface of the body, makes little distinction between these two color-sources. It is indeed probable that the pig- ment originates from the coloring-matters of the blood. It is certain that solar heat exerts a manifest influence upon both, Bleich Schuppenflechte that in 3 34 DISEASES OF THE SKIN.

Striated Muscular Fibres extend from the subcutaneous tissue into the derma; in the case of man they Natrium dropper Schuppenflechte found chiefly upon the face and neck, where they are the analogues of more powerful skin-moving muscles possessed by several of the lower animals.

Some, as those in the region of the face, serve to give expression to mental Natrium dropper Schuppenflechte by the production of movements in the features. Non-striated Muscular Fibres exist either as minute oblique fasciculi in connection Avith the glands and follicles of the skin; or as annular bands, such as those which Natrium dropper Schuppenflechte the nipple; or as radiat- ing and more or less parallel rods, such as antagonize the orbicularis in the lids.

Natrium dropper Schuppenflechte Arrectores, or Erectores, Pilorum are muscles found usually in connection with the hair-follicles. They originate by minute multiple fasciculi from the papillary portion of the corium, and are inserted at several points into Mangel Psoriasis Vitaminen bei an outer layer of several adjacent hair- follicles, just above the plane of the apex of the hair-papilla.

Their general direction is oblique, and their muscle-bundles are embraced and traversed by elastic fibres which form a dense network about them. Elastic threads Natrium dropper Schuppenflechte connect them intimately with the connective- tissue bundles of the corium, Psoriasis ladoshechny serve as tendons at either extremity of Natrium dropper Schuppenflechte muscular fasciculus. The muscles, by virtue of their oblique direction and mode of attach- ment, include in the angle this web page by their muscular fibres the sebaceous glands connected with the hair-follicles.

It follows, there- fore, that by their contraction they can aid in the expulsion of the seba- ceous secretion formed in the gland; their intimate union with the elastic tissue, which is evenly aud generally distributed throughout the framework of the corium, results in their discharge of a still more important function in connection with the regulation of the body- temperature.

Their Natrium dropper Schuppenflechte connections are such that contraction of the arrectores pilorum serves to approximate several of the papilla?

Thus, by their contraction the sebaceous secretion may be extruded, or, as is more particularly exhibited in the lower animals, such hairs as the bristles of the boar may be erected. But by virtue of direct compression exerted upon the skin the blood may be driven from the Natrium dropper Schuppenflechte in a centripetal direction and its cooling to a great degree prevented, as in the well-known phenomena resulting in the pro- duction of the cutis anserina or "goose-flesh.

AX ATOMY AXD PHYSIOLOGY OF THE SKIX. Hairs are cylindrical, elongated, and pointed epithelial filaments, derived from the epidermis, and obliquely implanted in depressions in Fig. Section of hair-follicle during the formation of Natrium dropper Schuppenflechte new hair: Hairs occur in three tolerably distinct classes: There are the fine downy hairs, or lanugo, covering the face, the trunk, Natrium dropper Schuppenflechte the limbs; the long soft hairs, such as those implanted upon the scalp, the pubes, and the axillae; and the short hairs, includ- ing Natrium dropper Schuppenflechte soft varieties seen upon the brow and the stiff hairs of the eyelids.

The hairs are first developed in the third month Natrium dropper Schuppenflechte foetal life, when a short epithelial cone is formed, whose base is gradually surrounded by connective-tissue cells, and Natrium dropper Schuppenflechte indented from below by a rudi- mentary hair-papilla.

Gradually the tip of the rudimentary hair perforates the primitive hair-cone, and becomes a mature filament. The term bed-hair is applied to Psoriasis-Behandlungen Rezept hairs unprovided with papillae, and implanted in shallow follicles from the sides of which productive epithelial offshoots have been sent out.

Usually at the end of foetal life these bed-hairs Natrium dropper Schuppenflechte been for two months growing out of the hair-bed, or this web page part of the epithelium found in the central part of the hair-sac. In studying the mature hairs the parts Ekzem, Psoriasis, Neurodermitis be considered are the hair-follicle, and the bulb, shaft, and point of the hair.

The hair-follicle is a sac-like depression Natrium dropper Schuppenflechte the corium, in which depression the Natrium dropper Schuppenflechte is implanted by its bulb, and there firmly secured. The direction or set of this follicle is always at an oblique angle with the plane of Psoriasis und Honig Zimt cutaneous surface upon which it opens; and thus is determined the set of the hairs, which documents sulsena bei Psoriasis article always fixed, and at a Natrium dropper Schuppenflechte angle.

Viewed as a whole, the integument of the body over its entire area exhibits determinate whorls of both short and long hairs with definite centres, such as those which may be recog- nized at the vertex of the scalp, the centres of the lips, the umbilicus, etc.

By this disposition the symmetrical appearance of the hairy parts is preserved, and, as a consequence of the same provision, physiological loss of the hair of the head is not productive of deformity, but rather adds dignity to the aspect of the elderly man. The hair-follicle embraces the lower two-thirds of that portion of the hair which is imbedded in the skin, together with the envelopes of the latter, termed the hair-sheaths. Above the sebaceous glands Natrium dropper Schuppenflechte limits of the hair-follicle are lost in the papillary layer.

It is consti- tuted of the connective tissue of the corium in three layers: At the base of the sac a fibrous pedicle may often be traced as low as the Psoriasis Israel tissue. If the hair-pouch were made artificially by thrusting into the skin from without inward a blunt-pointed pin before which the tissue was gradually pushed, it is evident that Natrium dropper Schuppenflechte external layer, the stratum cor- neum, of the epidermis would be the first depressed, and finally cover the inner surface of the pouch.

This represents the inner Natrium dropper Schuppenflechte of the hair. Next to this Natrium dropper Schuppenflechte pin would carry before it the mucous ANATOMY AND PHYSIOLOGY OF THE Kann ich essen Avocados 37 layer of the epidermis, which then would form the outer root-sheath of the hair.

Outside of both would lie the connective tritt Psoriasis-Behandlung auf den Beinen Foto nach of just click for source corium; this is the hair-follicle.

Lower portion of hair-pouch from the lip of a kitten: F, follicle ; T, transverse section of con- Natrium dropper Schuppenflechte bundles of derma; M, arrector pili muscle; IS, inner root-sheath ; OS, outer root- sheath ; P, papilla ; C, cuticle ; R, root of hair ; H, hyaline, or so-called " Natrium dropper Schuppenflechte " membrane. The Outer Eoot-sheath, or, as some prefer to call it, the " prickle- layer " of the hair-follicle, accompanies the involutions of the stratum corneum and the stratum granulosuni from without into the funnel- shaped neck of the hair-pouch, as far as the openings of the ducts of the sebaceous glands.

There, abandoned by the two other layers of the das besser hilft mit Juckreiz, the root-sheath is thinned in proportion as the papilla, which rises from below and which it closely surrounds, increases in size. It thus forms a hollow cylinder traversed by the hair and its envelopes, with a relatively wide, external, funnel-shaped opening, only partially Natrium dropper Schuppenflechte by the shaft of the hair, and a narrower opening within, which embraces the neck of the hair-papilla.

The Inner Root-sheath, or, as Umia prefers to call it, the " matrix" of the root-sheath, is externally in relation with the outer root-sheath or prickle-layer of the hair-follicle.

The protoplasm of the cells of which it is constituted contains kerato-hyalin in varying quantities, the amount being naturally greater in the cells lying nearest the hair-filament. Both these terms are now falling into desuetude as not being actually descriptive of distinctly different structures, but only of one structure in different situations. This structure, whether it is termed the internal Natrium dropper Schuppenflechte, or the matrix of the root-sheath, springs from the neck of the papilla, and rises as high as the neck of the follicle.

It contains kerato-hyalin, which is actively concerned in the cornification of the hair-tissue. Between this internal root-sheath and the cells constituting the cor- tex of the hair there is found, according to Unna, the common matrix of the cuticuloe, forming respectively the cuticle of the root-sheath and the cuticle of the hair.

The former is composed of cells with their long axes parallel Natrium dropper Schuppenflechte the circumference of the hair, while those forming the cuticle of the Natrium dropper Schuppenflechte are arranged perpendicularly to the sur- face.

These cuticulse are securely locked together by projection of their cell-edges, while united in the hair-follicle. The Bulb, or Root, is that portion of the hair imbedded in the skin, toward which the shaft of the hair gradually increases in thickness as it descends. The bulb is embraced Natrium dropper Schuppenflechte the hair-follicle, though its root-sheaths are interposed and implanted below at the base of the sac upon a nipple-shaped prolongation of the corium that may be Natrium dropper Schuppenflechte as analogous to the vascular papilla3 of the papillary layer of the corium.

The bulb of the hair embraces the papilla, and is constituted of pig- mented cells externally, forming what is called the " cortex" or cor- tical portion.

This is the larger of the two structures of which the hair is composed, Natrium dropper Schuppenflechte its cells become vertically elongated and narrow as they are pushed outward in the process of growth. The innermost structure of the hair is Natrium dropper Schuppenflechte its " medulla," a tissue composed of non-pigmented, horizontally broadened cells containing kerato-hyalin.

It rests directly upon the apex of Natrium dropper Schuppenflechte papilla below, and passes thence through the centre of the shaft of the hair like a delicate cylindrical core. Air-spaces occur between its epithelial cells as Natrium dropper Schuppenflechte rises toward the funnel-shaped opening: The Shaft of the Hair is that portion which extends from the exit of the hair at the surface of the skin Natrium dropper Schuppenflechte its extremity; the latter, when uncut, always tapers to a Natrium dropper Schuppenflechte acuminate point, as illustrated by the uncut hairs of the eyelids, and those of the lower ANATOMY AND PHYSIOLOGY OF THE SKIN 39 Fig.

The hair-shaft is either straight, curled, wavy, or alternately varied in diameter, producing the peculiar character of the growth seen Natrium dropper Schuppenflechte the scalp of the negro, these va- riations being due to the different degrees of flattening of the hair-shaft in a trans- verse Natrium dropper Schuppenflechte. The color of the Natrium dropper Schuppenflechte is dependent upon the pigment it contains, the proper color of the hair-cells, and the quantity of air con- tained in the medulla.

Variation in these three factors produces the wide range be- tween a snowy whiteness and an ebony - black. The membrane which invests the shaft of the hair is Natrium dropper Schuppenflechte cuticle composed of nu- merous flattened plates, regularly overlaid so as to resemble fish-scales when viewed under the microscope on the flat side, and the overlapping shingles of the roof of a house when seen on the ecW.

Transverse section 01 hair and follicle. The Cortical, or main, Substance of the Shaft of the hair is composed of flat, nucleated, fusiform, epidermal cells. The strength, elasticity, and extensibility of the hair are chiefly due to the cortical substance, and in particular to the firmness with which these epidermal cells are attached to Natrium dropper Schuppenflechte another.

The Medullary Substance of the Shaft of the hair is found best developed in the short, strong hairs of the beard and eyelashes, being wanting in the lanugo hairs.

It consists of a loosely packed mass of epidermal elements, differing in shape, developed in the centre of the axis of the shaft. This part of the hair contains also the pig- ment and fatty matters, which are here arranged as in the rete of the epidermis. Seen under the microscope, the medulla appears as a con- Natrium dropper Schuppenflechte or interrupted longitudinal band, extending from the bulb, or the part implanted in the follicle, to the extremity, Natrium dropper Schuppenflechte point of Natrium dropper Schuppenflechte hair.

The purpose of this difference in the constitution of the cortex and medulla of the hair is doubtless to insure, on well-known mechan- ical Natrium dropper Schuppenflechte, a maximum of strength, extensibility, and elasticity, with a miuimum Natrium dropper Schuppenflechte volume. The coloring-matter of the hair is stored in both its horny and medul- lary portions, and is distinct both within and between the epithelial elements of Natrium dropper Schuppenflechte the hair is composed.

This pigmentation corre- sponds, as Heitzmann has shown, in great part with the amount of pigment distributed to other parts of the integument, and sustains a close relation to the general nutrition of the body. Its subjection Psoriasis-Behandlung in the influence of the trophic nerves is well demonstrated by the phe- nomena of rapid blanching of the hairs. Excessive sweating, whether physiological or induced by the action of pilocarpin, has also a dis- tinct influence upon the shade of color of the Natrium dropper Schuppenflechte. On transverse section hairs present an ovoid or ellipsoidal outline, suggesting an irregularly compressed circle.

The degree of this flat- tening differs in different races, and is the cause of variability with respect to or curl mess.

As hairs are to a marked degree hygroscopic, and not only absorb but can be deprived of a portion of their water, these states of waviness are subject to variation according to the Natrium dropper Schuppenflechte condition of the media by which an individual is sur- rounded.

Hairs differ from nails not only in their anatomical features, but particularly as to their physiological reproduction. Hairs are period- ically cast off and replaced by new filaments; the nails are shed and re-formed only in disease, in health they enjoy a continuous growth during the life of the body.

Natrium dropper Schuppenflechte a hair is about to be shed it separates from its papilla in the hair-follicle and rises in the latter till it reaches above click to see more level of the papillary apex. It is for a time held in place with sufficient firmness by the prickle-layer only, thus forming the bed-hair already described. Later Natrium dropper Schuppenflechte epithelial bud is projected either into the vacant follicle below or into the corium on either side, from which a new hair is formed, somewhat as the hair is formed in the primitive cone of foetal life.

Later the growth outward of Natrium dropper Schuppenflechte new papillary hair pushes the bed-hair from its connection just click for source the prickle-layer, and is shed. The sebaceous glands are pyriform bodies, usually racemose in devel- opment, situated in the corium, never in the subcutaneous Natrium dropper Schuppenflechte they furnish a more or less consistent and fatty secretion destined to anoint the skin this web page hairs.

They can usually be distinguished as of three classes, though only two of these classes include glands which are asso- ciated with hairs in the embryo. The first class, as proposed by Sappey, includes the sebaceous glands, which, strictly speaking, are appendages of the hairs and hair-follicles. They are developed early in foetal life from minute, lateral, bud-like prolongations from the outer root-sheath of the hair. From two to six of these prolongations spring from the prickle-layer of the hair- follicle; and the prickle-cells in the axis of each bud speedily undergo fatty metamorphosis.

In the mature gland each acinus is formed of a membrana propria, on which are ranged layers of Natrium dropper Schuppenflechte cuboidal epithelia undergoing fatty metamorphosis. Protopic Salbe für Bewertungen the fatty cells are pushed outward toward the duct of the gland, where, sooner or later, their rupture releases numerous drops of fat just where the hair emerges read article the closely applied follicle below to the Natrium dropper Schuppenflechte mouth Natrium dropper Schuppenflechte the hair-pouch above.

Externally, each gland is provided with a layer of connective tissue. On account of the clearly defined relations of these bodies Unna would call them the " glands of the hair-follicles. The second class includes the large and complex glandular structures ANATOMY AND PHYSIOLOGY OF THE SKIN. These glands are chiefly found upon the so-called " non-hairy " por- tions of the skin, as upon the face in both sexes, and upon portions of the trunk and extremities.

The third class, much the smaller number, includes those sebaceous glands opening directly upon the surface and unconnected with hairs or hair-follicles. Such are the gland ulae odoriferse of the male and female genitalia glands of Tysonthe Meibomian glands, and those Natrium dropper Schuppenflechte about the lips and in the areola of the nipple. These glands might be designated as the u glands of the mucous orifices.

The extrusion of the secreted sebum from the ducts of these glands is greatly favored by Natrium dropper Schuppenflechte action of the arrectores pilo- rum muscles, by whose contractions Natrium dropper Schuppenflechte gland is to a degree compressed. This is the reverse of what occurs in the coil-glands, whose secretion is impeded by the action of these same muscles.

The Coil-glands, termed also Sweat or Sudoriparous glands, are globular coils situated in the subcutaneous tissue and in the deeper portions of the corium. They appear first in the fifth month of foetal life as buds projected downward from the prickle-layer of the epider- mis. Unna demonstrated that das hilft bei Psoriasis auf dem Körper projections always form between the papillae of Natrium dropper Schuppenflechte corium, and spring Natrium dropper Schuppenflechte the prolongations of the rete between these papillae.

Long, thin cones of epithelium thus grad- ually traverse the corium, and become slightly bulbous at the lower extremity to form later the coil. The lumen, when formed, extends rapidly to the epidermis, and after this is reached there is made from within outward an opening, which becomes the sweat-pore.

Coil of the sweat-gland: Magnified diam- eters. These glands after birth are found in all parts of the body, but in certain regions, such as the axillae, the groins, the palms, the soles, and about the anus, they are either numerous, of unusual size, or pecu- liarly arranged.

They are specially numerous in the palms Natrium dropper Schuppenflechte soles, where, according to Krause, there are between two and three thousand to the square inch. The coil is a convoluted tube terminating in a caecal pouch, lined with cubical epithelia of granular appearance, which are the secretory cells of the gland.

Outside of the are muscular fibres running parallel with or in a spiral direction about the coil. Surrounding both muscle-bundles and epithelium is a connective-tissue membrane.

The glomerulus, or Natrium dropper Schuppenflechte, is globular in outline and reddish- yellow in color. In the larger glands irregular dilatations and constrictions of the tube are conspicuous. ANATOMY AND PHYSIOLOGY Natrium dropper Schuppenflechte THE SKIN 43 The excretory duct of the coil-gland passes from the glomerulus below to the epidermis above, in a straight or a spiral course. It is lined with a delicate hyaline cuticle Natrium dropper Schuppenflechte by Hey n oldbeneath which is a double layer of cuboidal epithelium.

Externally is a rneni- brana propria, unprovided with muscular fibres. Its outermost sheath is the usual connective-tissue layer. When the duct reaches the border- line of the epidermis its inner cuticle and external connective-tissue sheath are both lost; here it becomes the sweat-pore.

BP The sweat-pore traversing the epithelial layers of the skin: BP, papilla with injected blood- vessels; V, valley between two papillae; D, duct in the rete mucosum; E, E, epidermal layer; PL, coarsely granular epithelia, deeply stained with carmine ; P, duct with corkscrew-windings in the epidermal layer.

The Sweat-pore is a continuation of the excretory duct of the coil-gland after the loss of its cuticle and connective-tissue sheath. It is the loss of these sheaths and the consequent article source relation of the canal to the epithelia of the epidermis that furnish the special basis for this distinction. The sweat-pore is merely Natrium dropper Schuppenflechte wall-less canal or chan- nel, spirally directed or running a straight course from the duct of the coil-gland below to the outermost stratum of the epidermis above.

It has no other wall than that by the cells of the prickle-layer below and of the other layers of the epidermis, which successively surround this canal, narrow below and funnel-shaped above. Hence the lumen of the sweat-pore, if Natrium dropper Schuppenflechte a term be permissible, is in free communication with the juice-spaces of the epidermis.

The secretion of please click for source coil-glands consists largely of globules of fat and granules of pigment. The function of the coil -glands, therefore, is plainly the lubrication of the skin with unguent, a task performed only in small part by the sebaceous glands, and by them chiefly for the pilary covering of the body.

The palms of the hands and the soles of the feet are thus lubricated with fat by the coil-glands. Link total number of coil-glands in the Natrium dropper Schuppenflechte is estimated to be 44 DISEASES OF THE SKIN.

These figures serve to give an approximate idea of their very great physiological importance, and of the extent Fig.

The function of the sweat-pores, which communicate directly with the excretory duct of the coil-glands, is distinct from that of the coil- glands, since it provides for the transmission outward of the watery fluids of the skin.

The channel described as the sweat-pore is in ample and free communication with the intercellular spaces of the epidermis; and this anatomical peculiarity provides fully for all the needs of evap- oration at the surface of the body. Please click for source sweat excreted by the body differs under varying conditions of temperature, humidity of the air, and the amount and character the articles ingested by the individual, either as food, drink, or medic- ament.

Nearly 98 per cent, of the secretion is pure water, the remain- ing proportions representing the saline constituents of the other fluids furnished by the animal in life. In all chemical analyses of the sweat a source of error lies in the difficulty of securing the fluid secretion unmingled with that produced by the sebaceous glands; and the same, it may be said in passing, is true of the chemical analysis of the sebum.

According to Duhring, the iodid of potassium, benzoin, and succinic and tartaric acids may be excreted with the perspiration. Unna, Natrium dropper Schuppenflechte in the lines indicated by Meissner, asserts Natrium dropper Schuppenflechte the coil-glands actually produce the subcutaneous fat-cushion; and the anatomical basis of such a statement is clear. The coil-glands and the fat-cushion appear article source the same period of foetal life and develop in the same proportions.

At birth the clusters of fat are most conspicu- ous where the coil-glands are most numerous. In the adult the greater number of coil-glands are subcutaneous in situation and are closely surrounded by fat-tissue; while those glands which do not descend below the corium, though not thus surrounded, are regularly met by columus of fat advancing toward them from below. The credit of discovering and naming these fat-columns belongs to Warren, whose studies were principally directed to the anatomy of the thick cutis vera.

The follicles of the lanugo hairs penetrate only the superficial layers of the cutis. These columns are 4 millimetres in length, and are Natrium dropper Schuppenflechte wider than the hair-follicles above. The long axes form a slight angle with that of the follicle, but Natrium dropper Schuppenflechte are nearly parallel with that of the erector pili muscle.

Two horizontal prolongations are given off on either side of the middle of this axis, partly Natrium dropper Schuppenflechte. Near this point Warren called attention to ". The connec- tive-tissue click to see more seem Natrium dropper Schuppenflechte terminate Natrium dropper Schuppenflechte at the edges of these col- umns. The cleft slightly widens below, and on the side toward which its axis leans the fibres of connective tissue form a Natrium dropper Schuppenflechte penetrating below to the subcutaneous fat.

The erector pili muscle is inserted partly into the base of the follicle and partly into the apex of the fat- canal. These columns correspond in number with that of the hairs. The blood-vessels they contain, which spring from the subcutaneous plexus, bifurcate at the lateral clefts.

The later studies of Unna demonstrate very clearly that the fat- columns, first recognized by Warren, invariably advance toward the coil-glands, the latter either singly or in groups, and that the connec- tion of the fat-columns with ASO Psoriasis Foto und seine Ursachen that hair-follicles is a mere incident of that advance.

The cavities or spaces seen in the epidermis are, some, apparently uncolored ; others are blackened by the action of osmic acid npon fat originally Natrium dropper Schuppenflechte in either cells or spaces between the latter. The effect is due to excretion of fat by the coil-glands, and the condition shown is not exhibited in all sections of the skin made at the same level. It is probably transitory and most apparent when the skin is macerated by sweat.

The alternation of muscular fibres with the secretory cells of the duct of the coil-glands is a provision for the extrusion of the gland- secretion Natrium dropper Schuppenflechte. The same anatomical arrangement permits free communication between the epithelia and the lymph-spaces which reach into the connective-tissue sheath of the gland.

As a result, the lymph flows freely Psoriasis der Kopfhaut Salbe Kopf the secreting elements of the gland and its duct. This lymph, loaded with fat, streams away from the coils, and before it reaches the lymphatic trunks its fat-globules are filtered away in the subcutaneous tissue. The skin of the human body in health is the constant source of odorous emanations, which, in pathological conditions, may greatly be increased or otherwise changed.

The nature and exact sources of these emanations Natrium dropper Schuppenflechte as yet imperfectly understood. Were they exclusively of a volatile, gaseous, or vaporous composition, even though such fluids were capable of condensation upon external bodies, it could scarcely explain the well-kuown fact that some of the lower auimals are capable of tracing the track of the human being for miles over a wind-swept path, until the soil pressed by the foot is covered with water.

There is strong reason to believe that these emanations are vehicles by which certain contagious and infectious diseases are communicated from one individual to another. They at times contain living matter derived from the protoplasm of the body, and are capable of conveying bac- teria in compact masses and enormous quantities through the atmos- phere when agitated by a current of air.

Some of the schizomycetes weigh but one-ten-billionth of a milligramme, and are transported through space in the most attenuated of media. These emanations are properly regarded as having their origin in the secreting system of the skin, but in what proportion the several secreting glands participate in their product it is difficult to establish. The sweat at times, even to human nostrils, exhales a distinct odor, though, just click for source before indicated, to what extent this is due to the admixture of sweat with Natrium dropper Schuppenflechte material it is difficult to determine.

Peculiarly fetid and disgusting odors occasionally originate in chemically Natrium dropper Schuppenflechte sebum, where the influence of the sweat-secretion must be, from the locality under exam- ination, partly eliminated.

Xails are dense, elastic, and translucent conravo- convex plates, or shells of horny tissue, placed upon the dorsum of the terminal extrem- ities of the distal phalanges of the Behandlung von Veselka and toes. Each nail has a free border at the distal portion of the visit web page of the digit, with sides and proximal borders let into distinct furrows of the skin.

The con- vex surface of the nail is exposed, the concave regarding the phalanx, and is implanted upon the nail-bed beneath. In the embrvo the first change looking to the future formation of a nail consists in a peculiar smoothness and brilliancy of the Natrium dropper Schuppenflechte covering the dorsum of the distal phalanges.

Later, an epithelial ridge or line with a groove in front of it traverses the tip of the finger. Thus, three regions are defined: A collection of large prickle- cells at the orifice of the nail-fold soon furnishes the first trace of the rudimentary nail. Mature nail-cells finally push forward between the prickle Natrium dropper Schuppenflechte horny layers of the nail-bed, which, by fan-shaped bundles of follicles, is firmly united to the periosteum Natrium dropper Schuppenflechte the phalanx.

Lastly, 48 DISEASES OF THE SKIN. Vertical section of one-half of nail and matrix: In the adult, what is termed the matrix of the nail is the tissue from which springs the horny plate. The matrix is separated, as shown by Hans Hebra, into, first, a posterior part, filled with from three to six rows of papillae, einfache Fotoformate next, in advance of this, is a lentic- ular space with curved borders, the anterior limit of which corresponds with the anterior border of the lunula.

The area included in these two divisions is Natrium dropper Schuppenflechte with papillse grouped in symmetrically converg- ing ridges, decreasing in size as they pass forward. This forms the matrix of the nail. Further forward, the nail-bed proper und Medikamente zur Behandlung von Psoriasis habe in click here words, the tissue von Psoriasis China Wann supports, rather than produces the horny plate — is composed of higher ridges of papillse whose grooves and summits are covered with prickle-cells, and whose height is uniformly main- tained as they stretch forward toward the pulp of the finger.

The Nail, or, as termed by Unna, the true nail, or nail-plate, orig- more info only from the floor of the nail-fold as far forward as the anterior edge of the lunula.

As to its formation, it may, therefore, be imag- ined as springing from its matrix vertically in the form of an involuted, shield-shaped plate, its convexity regarding the proximal phalanx. It may then be viewed as pressed just click for source over its nail-bed in front, with partially unfolded edges enwrapped by the epidermis of the sides, the narrowed point of the shield, elongated when untrimmed, Natrium dropper Schuppenflechte ing at some distance beyond the tip of the finger.

With this conception it is easy to understand that the nail is consti- tuted of horny filaments, or coherent strata of cornified cells, passing from the matrix or floor of the nail-fold. The upper surface of the nail grows, therefore, from the bottom of the nail-fold; the under surface from the lunula; and the intermediate layers proportionately from the between, that interlock with corresponding grooves on the upper face of the bed.

It is formed of connective tissue, whose bundles are inter- penetrated by numerous coil-glands and fat-columns. The Essentiale Psoriasis beneath the nail exhibits prickle, granular, and horny layers.

As the nail is gradually liberated from its bed both at the sides and point, the cornification of the horny layer becomes more complete, so that finally, as the nail-plate is pushed forward, it no longer rides over the cells of the rete, but over a completely cornified tissue. Implantation of the nail at its border: If the pulp of any nail-bearing phalanx be pressed with moderate force against any firm object, the naked eye can detect upon the surface of the nail, just behind its free border, a yellowish-white band, convex anteriorly and somewhat increasing in width laterally.

This line is also visible Natrium dropper Schuppenflechte no pressure is exerted upon the digit, its width vary- ing under the conditions described. This border represents the space in which the three layers of the epidermis from the Natrium dropper Schuppenflechte of the point of the finger, viz.

The lunula is the relatively light-colored space extending from the middle part of the nail-fold posteriorly to its well-defined convex border in front. After artificial removal of the nail-fold the lunula is seen to extend to the posterior and enclosed border of the nail-plate.

It, therefore, represents that part of the matrix of the nail not con- cealed by the nail-fold. Its color is not due to absence of vascularity, but is solely due to opacity of the keratogenous cells Ranvier which are concerned in the production of the horny threads that form the nail. In Natrium dropper Schuppenflechte, as in other diseases, the clinical signs or symptoms of the morbid process are those by which the disease is recognized alike by the patient and the physician.

These signs and symptoms are divided into subjective and objective: It should be remembered, however — and Natrium dropper Schuppenflechte is a matter of some importance in this connection — that there are manifested to the eye and touch of the patient many objective signs which are liable to be interpreted or misinterpreted Natrium dropper Schuppenflechte him, with consequences not to be ignored. The purely subjective symptoms of a dis- ease of the skin are those manifested to the patient by sensations other than those connected with vision and his own sense of touch.

They include sensations of itching, smarting, tingling, pricking, and burn- ing; sensations as of increased or diminished susceptibility to the con- tact of foreign bodies; of increased or diminished temperature; pain in various grades of severity; and disordered sensations, such as the crawling of insects over the part, the passing of currents of hot or cold vapors or liquids, and the compression of portions of the skin as by either cords, bands, or closely fitting plates.

The character of the subjective sensations experienced by a patient often proves an aid to the physician in recognizing the nature, not merely of a present disease, but also of one which has preceded. Thus, the sensation produced by an attack of Natrium dropper Schuppenflechte is rarely an itching, while the latter is highly characteristic of eczema and scabies; the pain of zoster and the tingling of urticaria being distinctly different, not only from each other, but also from the subjective symptoms named above.

The study of the objective symptoms of a cutaneous disease is of paramount importance. In no respect does the skilled physician so distinguish himself from one who is unskilled as in ability to recognize the typical or atypical objective characters presented in diseases of the skin.

This study is one which no diag- nostician can safely neglect, and its rewards are precious Natrium dropper Schuppenflechte every department of medical science. These symptoms are spread before the eye, and their legibility increases with every hour of careful obser- vation These signs of skin disease — or, more literally, skin injury — are called " lesions," and it is usual to classify them as primary and sec- ondary.

Such division, however, is open to criticism, since, in point of time merely, some of the so-called u primary lesions" of the skin become in turn secondary and even tertiary.

Thus, a papule which GENERAL SYMPTOMATOLOGY. In the following pages these symptoms of skin disease are distinguished as elementary and consecutive.

In describing the average size of cutaneous lesions it less con- venient to state their measurement in fractions of a line or of a milli- metre than to convey an approximate idea by a comparison with familiar objects of relatively fixed dimensions.

The objects usually selected for this purpose, beginning with the smallest, are seeds of the poppy, mus- tard, and rape; the coffee-bean; the pea; the bean; the cherry; the finger-nail; the please click for source the horse-chestnut; the egg of the hen and of the goose; the orange.

To these Anamnese Psoriasis pustulosa also be Natrium dropper Schuppenflechte the point and head of a pin. The bei Schwefel-Salbe für Psoriasis Bewertungen den will find it useful to familiarize him- self with the size of the small click the following article mentioned, that their names may at once suggest to him the relative size of the lesions with which they are compared.

Macule spots, or stains are generally circumscribed alterations in the color of the integument, differing as to size, shape, hue, and duration of the dyschromia, and unaccompanied by elevation or depression of the skin sur- FACE.

Maculae may be due to arterial or venous hyperemia, to the escape of the coloring-matters of the blood into the skin, to acquired and congenital telangiectases, and to pigment-anomalies. Examples of mac- ula? Spots of various color and device are also produced by the inten- tional or accidental introduction of pigmented particles beneath the epidermis, as by the process of tattooing, the explosion of gunpowder, etc. This difference has suggested the employ- ment of such descriptive terms as roseola, erythema, and purpura, 52 DISEASES Natrium dropper Schuppenflechte THE SKIN.

A macula which encircles another lesion, as, for example, the halo around the vaccine- vesicle, is called an " areola. These exceedingly common skin-symptoms vary greatly in their shape, color, location, career, and significance.

Thus, they may Natrium dropper Schuppenflechte flattened at the apex, acuminate or pointed, conical, rounded, or de- pressed at the summit to form an umbilication ; they may be pale, rosy, dark- or lurid-red, purplish, or even blackish; they may develop in transitory or persistent processes; Natrium dropper Schuppenflechte may be transformed into lesions containing fluids; may desiccate and furnish scales either at apex or base; Natrium dropper Schuppenflechte degenerate into ulcers; or may enlarge into tubercles or tumors; may be scratched, torn, or Natrium dropper Schuppenflechte so as to lose their typical appearance; may come and go; may be sensitive to sudden changes in the blood-current, and yet be persistent.

The mixed forms described above are generally named vesico-papular or pap ulo- vesicular, papulo-squamous, papulo-pustular lesions, etc. Lesions which simulate the papule and which, though described under that title, really belong to another category, are the small, semi- solid elevations visit web page the surface that form at the orifices of click the following article ducts of the cutaneous glands and follicles.

Thus they may consist of little heaps of epidermis about the hair-follicles lichen pilaris, keratosis pilarisor of inspissated sebum collected in one of or in all the acini of the sebaceous glands milium, comedo.

The concomitants of an eruption of papular type also vary. Thus there may be a febrile Natrium dropper Schuppenflechte, or extensive infiltration of the skin about and beneath the papules Natrium dropper Schuppenflechteor itching of the most in- tolerable character eczema papillosumor production of trifling sen- sations of annoyauce, as a read article burning without other subjective symptoms acne, lichen planus.

Papules transformed into moist lesions become covered with a crust. Papules scratched or torn by the finger-nails usually betray the fact in the minute and flat blood-scale dried upon Natrium dropper Schuppenflechte surface.


The Natrium dropper Schuppenflechte wheal is seen in the disease known as " nettle-rash " GENERAL SYMPTOMATOLOGY. Wheals are firm to the touch, and arranged in patches, circles, bands, gyrations, or striations, often disappearing in a brief time and recurring with or without a renewal of the cause. They are occasioned by a rapid exudation of serum into the rete or pars papil- laris of Natrium dropper Schuppenflechte corium.

This is supposed to be due to clonic vascular spasm, producing irregularities in the lumen of the skin -capillaries, under the influences of the vaso-motor nerves which supply a small area of the superior pars vascularis of the derma.

The sensations pro- Natrium dropper Schuppenflechte by read more are particularly stinging, burning, pricking, and itching.

They are often surrounded by an areola. Relics of disappeared wheals are usually transitory erythematous macula? It Natrium dropper Schuppenflechte be borne in mind that at times the wheal-like condition is assumed by papillae, as also by Natrium dropper Schuppenflechte resulting from such traumatism as the bites of insects, reptiles, horses, dogs, etc.

TUBERCULA OR TUBERCLES ARE CIRCUMSCRIBED, SOLID, GEN- ERALLY INCOMPRESSIBLE AND PERSISTENT, NODOSITIES OF THE SKIN, VARYING IN SIZE FROM THAT OF A COFFEE-BEAN TO THAT OF A CHERRY. Tubercles may largely be projected from the free surface of the integ- ument, Natrium dropper Schuppenflechte be deep seated in the skin, and but a small portion become evident to the view externally.

Their varieties as to shape, color, size, and other features correspond in great part with those described in connection with papules. They may be attached by a broad base to the skin, or be pedunculated, or even pendulous. Their seat is usually in the deeper portions of the corium, or in Natrium dropper Schuppenflechte subcutaneous connective tissue.

Degenerating and ulcerating Natrium dropper Schuppenflechte are followed, as might be supposed in view of their volume, by considerable destruction of tissue, and correspondingly in cases of repair by extensive cicatrices.

Tubercles are seen in such diseases as fibroma, molluscum epitheliale, syphilis, leprosy, sarcoma, and cancer. Tubercles are often described as merely enlarged papules, but the distinction between these two forms of lesions will better be recognized when attention is paid to the particular portion of the skin in which each takes Natrium dropper Schuppenflechte origin.

Papules spring oftenest from the superficial layers of the derma; tubercles from the deeper layers. This fact being remembered, it will be clear that at times a tubercle Natrium dropper Schuppenflechte project from the surface to a Natrium dropper Schuppenflechte extent than a papule, though its larger volume is evident as soon as the skin within which Natrium dropper Schuppenflechte has developed is handled.

Tubercles due to a cellular Natrium dropper Schuppenflechte may cease to be circumscribed, and by coalescence furnish a diffuse iiwolveuient of both the skin and the subcutaneous tissue. Phymata tumores, or tumors are masses of solid tissue, or of solid tissue more or less commingled with fluids of variable consistency, differing in size, shape, color, and in the benignity or malignity of their career, located either within or beneath the skin, or being attached to the skin, projecting from it to a variable extent.

The mere fact that a lesion of Natrium dropper Schuppenflechte skin approaches in dimensions the size of a tumor is in itself an element of gravity. Tumors may orig- inate in mere hyperplasia of the living matter; may consist of new formations of greater or lesser danger to the vicinage, or to the general economy; may be formed of blood- or of lymphatic vessels, or of both in the same lesion; may embody large fluid-containing cysts; may be built up of nerve- tissue, fat, bundles of connective-tissue fibres, gland- Behandlung Psoriasis von bei der hormonelle Salben elements, and indeed of any of Natrium dropper Schuppenflechte elements which exist physio- logically in the human integument.

Examples of tumors are seen in fibroma, sarcoma, Natrium dropper Schuppenflechte, and rhinoscleroma. Natrium dropper Schuppenflechte vesicles are seen in the minute, transitory lesions occurring in the vesicular form of eczema.

They are usually filled with a clear serum. Variations from this type, however, are common. Thus, they may be either flattened, acuminate, roundish, umbilicated, or conical; may be fully distended or partially collapsed upon their contents; source have a short or long duration ; may be distended with a milky, chylous, or blood-stained fluid; Natrium dropper Schuppenflechte be opalescent, yellowish, reddish, or blackish in color; several may coalesce to form a many-chambered lesion; one or several Natrium dropper Schuppenflechte undergo transformation into pustules or bullae.

Vesicles may terminate by accidental or spontaneous rupture, Natrium dropper Schuppenflechte contents freely flowing forth upon the surface of the peripheral integument; or they may desiccate to a crust; or may even terminate by one of the ulcerative processes. They may or may not be accom- panied by pruritus.

Minute vesicles, which are read article the external apices of large-chambered accumulations of fluid beneath, occasion- ally form upon the surface of the skin. Such are seen in the course of lymphangiectasis. The typical pustule contains pus, and is colored yellowish, yellow- ish-green, or brownish-green, according to the admixture of its contents with blood.

The pus being an inflammatory product, necessarily indi- cates the occurrence, at the base of the pustule, of an inflammatory process. Pustules, like vesicles, may be roundish, acuminate, globoid, Natrium dropper Schuppenflechte, or umbilicated, and surrounded by an inflamed or normal GENERAL SYMPTOMATOLOGY. They may be seated either Natrium dropper Schuppenflechte the free sur- face of the skin, or at an orifice of a follicle, in which case they rep- resent an inflammation with purulent product in the duct or the gland beneath.

Pustules may originate as such, or as a consequence of transforma- tion Natrium dropper Schuppenflechte vesicles, or after a change in a papule, which may thus come to have a purulent apex. According to Auspitz, they invariably originate from vesicles. Pustules Natrium dropper Schuppenflechte result in the formation of crusts, the latter varying in color according as the pustules from which they originated contained a clear serum or blood.

Transitional forms between vesicles and pustules are termed vesico- Natrium dropper Schuppenflechte. Pustules of a large size, Natrium dropper Schuppenflechte upon an indurated, Natrium dropper Schuppenflechte, and elevated base are often called " ecthymatous.

They all contain pus-cocci. Bullae or blebs abe superficial Natrium dropper Schuppenflechte deep-seated eleva- tions OF THE SKIN HAVING FLUID-CONTENTS, DIFFERING IN COLOR, SHAPE, AND CAREER, AND VARYING IN SIZE FROM THAT OF A COFFEE-BEAN TO THAT OF A GOOSE-EGG. Blebs have been described as large vesicles; but this fails to define exactly their pathological character.

Like vesicles they may contain serum, lymph, blood, or pus, and may variously be colored according to the Natrium dropper Schuppenflechte in which their contents become visible through a semi- transparent roof-wall. They may be globoid, hemispherical, oval, crescentic, semi-crescentic, or article source, aud may even exhibit angles. They may be seated upon an apparently unaltered or an evidently morbid integument; and may or may not present a peripheral areola.

Bullae Natrium dropper Schuppenflechte persist or may rupture; may desiccate or may degenerate into ulcers; may collapse after the escape of their contents, and the roof -wall become glued to the base from which it was originally raised. Bullae usually occur in extremely debilitated states of the system, and are, as a rule, of graver portent than other fluid-containing lesions of the skin.

They occur Natrium dropper Schuppenflechte scalds and burns, in pemphigus, leprosy, erysipelas, syphilis, and moist gangrene. Squamae or scales Natrium dropper Schuppenflechte attached or exfoliated epithe- lial LAMELLAE, WHICH HAVE BECOME APPRECIABLE AT THE SUR- FACE AS THE RESULT OF SOME MORBID PROCESS IN THE SKIN. There is constantly in progress over the superficies of the body physio- logical desquamation, the evidences of which are not pronounced in skins properly cleansed by ablution.

In morbid processes, however, Natrium dropper Schuppenflechte mation may occur as a distinct symptom in various forms. Thus, the 56 DISEASES OF THE SKIN. Furf uraceous desquamation is that form in which fine bran-like scales are shed from the surface. Scales are frequently intermingled with other lesions, often Natrium dropper Schuppenflechte ing Natrium dropper Schuppenflechte latter.

Thus, a papule may scale at its apex, or surround its base with a collarette of loosened epidermal plates, beneath or between which a macular stain is visible. Again, they may develop from macule, tubercle, or tumor. Though generally conceded to be evi- dences of a dry and non-discharging disease of the skin, they are at times accompanied or succeeded by Natrium dropper Schuppenflechte of the part affected.

The term scales is sometimes applied to the flattened plates of dried sebum that form on the scalp Nov Foto Psoriasis erste Stufe have on Natrium dropper Schuppenflechte of the trunk in sebor- rhoea sicca.

Scales occur in eczema, psoriasis, pityriasis, ichthyosis, syphilis, and in several of the parasitic diseases of the skin. Crusts never occur as primary symptoms of disease. When formed by the desiccation of serum only they are of a yellowish, straw-yellow- ish, or reddish-yellow hue; when composed largely of dried pus they are colored greenish, or greenish-yellow; and, wheu there Natrium dropper Schuppenflechte been an admixture of blood, they are usually brownish or blackish.

At times they suggest in appearance gum, honey, or Natrium dropper Schuppenflechte turpentine; in shape they may have the form of the concavo-convex lid of a watch- case; in color and shape they may resemble the half-shell of an oyster, or the carapace of a small turtle. They may be delicate and thin, bulky and thick, friable or mealy; may be firmly attached to the sub- jacent tissues, or readily separable; may cover a sound, though tender and reddened epidermis; may conceal a superficial, or a deep, foul- based ulcer, by secretions from beneath which they are raised above the plane of the skin and increased in thickness; they may be circum- scribed and no larger than a small finger-nail; may envelop an entire limb or organ, as the leg or the penis; or, finally, may be so irregu- larly disposed among other lesions, papules, pustules, excoriations, and open ulcers, that it is difficult to define their outline, and even to Natrium dropper Schuppenflechte nize their identity.

Crusts formed of dried sebum Natrium dropper Schuppenflechte greasy to the touch, dirty-yellowish in shade, and usually seated upon a non-infil- trated base. Crusts are common in eczema, syphilis, leprosy, seborrhoea, and in a large number of other diseases of the integument. Excoriations, in appearance amog the most trivial of skin lesions, possess a value from the diagnostic point of view which can scarcely be overestimated.

They occur as striated, linear, punctate, circular, or irregularly shaped furrowed wounds, at times involving areas of flat Natrium dropper Schuppenflechte, oozing with serum or blood, covered with dried blood or crusts, yellowish or reddish in hue, and for the most part both induced and accompanied by severe pruritus. They may coexist with hypersemia and infiltration of the skin beneath, brought on by the irritative char- acter of the continuous, or, more frequently, interrupted cause by which they were begotten.

Excoriations become significant according as they indicate scratch- ing, tearing, or other species Psoriasis Entfernen Rötung wounding by the finger-nails, and the rubbing of portions of the integument with foreign bodies. In the former case they are significautly recognized Natrium dropper Schuppenflechte those portions of the body most Natrium dropper Schuppenflechte to the hands, though in the case of Ziel für children and infants they may originate by the rubbing Natrium dropper Schuppenflechte of the knees, or the rubbing of one leg by the feet and Natrium dropper Schuppenflechte of the other leg.

The loss of Natrium dropper Schuppenflechte may extend deeper than the rete — at times invading the papillae of the corium, which bleed in consequence.

Thus, macules, vesicles, pustules, and papules may undergo change; and the recognition of the type of the existing disease may correspondingly be difficult. Excoriations are common in skins wounded by lice, bed- bugs, and gnats; in the subjects of eczema, scabies, intertrigo, and prurigo; and in individuals with special sensitiveness of the integument to the action of a medicament employed either internally or externally.

Rhagades or fissures are linear solutions of continuity, usually occurring in previously infiltrated portions of THE SKIN. Fissures may extend to the derma, and even invade yet deeper struc- tures; may be painful, or the reverse; may be dry, secretory, or incrusted; are often hemorrhagic, and usually are formed with sharply cut walls.

They are of frequent occurrence in the vicinity of the articulations, in which situations they are induced or aggravated by the joint-movements stretching or Natrium dropper Schuppenflechte tissues whose extensibility has been diminished by any morbid process.

Fissures Natrium dropper Schuppenflechte terminate in ulceration; they vary as to length, curve, and tenderness; they are often exquisitely painful, and greatly complicate the skin disease in which they form; they may follow the curve traced by the boundaries of bodily organs near which they occur — as, for example, the line of the posterior junction of the ear with the head, or that of the breast of a woman with the thoracic wall upon which it rests.

Fissures occur in click at this page, syphilis, dermatitis, and lichen ruber. Ulcera or are losses of substance resulting from a previous pathological process involving the corium, and, in some cases, the subcutaneous tissue.

Cutaneous ulcers differ greatly Natrium dropper Schuppenflechte size, Natrium dropper Schuppenflechte, color, edges, base, career, and, indeed, in all their characteristics. Every ulcer has an outline, a base, a floor, edges, and a secretion. The outline may be circular, crescentic, reniform, ovoid, serpiginous, or with horseshoe- like contours. The base, or underlying tissue, may be soft, supple, Natrium dropper Schuppenflechte, or in a state of active inflammation, with consequent infil- tration.

The edges may be clean-cut, having a punched-out appear- auce, undermined, everted, ragged, irregular, or contracting, with a whitish inner border of advancing cicatrization. The secretion may be scanty, limpid, puriform, profuse, ichorous, and odorless, or exhale an offensive stench. Natrium dropper Schuppenflechte may be so crust-covered as to be Natrium dropper Schuppenflechte, or so exposed and erosive in action as to render the affected surface in the highest degree unsightly.

Natrium dropper Schuppenflechte may be Natrium dropper Schuppenflechte or chronic, insensi- tive or productive of intense pain; may heal by cicatrization, remain open for a lifetime, or prove fatal either by destruction of parts essen- tial to life, or by exhaustion of the vital forces.

Cicatrices or scars are new-formed substitutes for lost connective tissue. Scars never succeed excoriations, fissures, or other solutions of con- tinuity in the skin, that have not penetrated as far as the derma and resulted in destruction of a portion of the elements of which the derma is built up. They possess the highest importance Natrium dropper Schuppenflechte the diagnostician, since they point invariably to a pathological process whose career is terminated, the characteristic features of which termination they fre- quently embody.

They may be regarded as the special and persistent imprints Natrium dropper Schuppenflechte the integument of the serious disorders from which it has suffered.

To a certain extent, as already shown, scars retain traces of the spe- cial peculiarities of the lesions, and even of the diseases, which they Natrium dropper Schuppenflechte. The identification, however, of the individual predecessor in each instance is, in the present state of our knowledge, not always possible from a study of cicatrices alone.

The extent of knowledge in this direction, however, is rapidly increasing; aud in many cases the certainty thus acquired is of incalculable value to the diagnos- tician. Scars are remarkable for their tendency Natrium dropper Schuppenflechte contraction and gradual decoloration. They may be minute, punctate, extensive in area, attached to underlying tissues, depressed, raised above the plane of the peripheral skin, seamed with furrows, pliable and soft, indurated, trav- ersed by ridges, knotted, or as irregular in contour as the ulcers already described.

They may extend in digital, linear, or annular prolonga- tions toward contiguous portions of the skin, and by subsequent con- traction induce considerable distortion and deformity. Thus, they GENERAL SYMPTOMATOLOGY. When recent, they are usually reddish Natrium dropper Schuppenflechte tint; when older, may be pigmented in centre or circumference; or, as is common, may exhibit a gradual decoloration, centrifugal in its progress.

They may be the seat of pain from an entrapped nerve-filament; may reopen to ulceration ; or may be unac- companied by subjective sensation. Not rarely they become the origin of the disease known as " cicatricial keloid. As implied in the definition given above, scars may result from any disease or injury of the skin that involves loss link connective-tissue elements in the corium.

To the several lesions defined above Bazin adds, as elementary forms, the mucous patch of syphilis, the cuniculus, or furrow, produced in the skin by the acarus scabiei, and the sulphur-colored crusts of favus. These, however, are not general, but special features of individual disorders, and are best Natrium dropper Schuppenflechte in connection with the latter. The elementary lesions of the skin are Natrium dropper Schuppenflechte by Auspitz, anthe- mata ; groups of such lesions, synanthemata ; and, in accordance with common usage, generalized eruptions affecting the entire surface of the body, exanthemata.

Just click for source word erythanthema is used to describe groups composed of several of the elementary lesions of the skiu, as, for example, of papules, vesicles, and pustules rising from a common reddened and hyperamric base.

In addition to Natrium dropper Schuppenflechte names of the lesions of check this out skin just enumerated, certain peculiarities of cutaneous symptoms are described in qualify- ing terms, which here require definition. They relate chiefly to the color, shape, distribution, and method or period of evolution of lesions as Natrium dropper Schuppenflechte are observed in individual cases.

The more important of these terms, as used by modern writers, are alphabetically arranged below, with a brief explanation appended to each. A much larger list of obsolete adjectives, employed by older authors, is purposely omitted. Located on the abdominal surface. Having a pointed apex. Occurring in adult years. Occurring Natrium dropper Schuppenflechte the summer season. Acute, or angry in appearance.

Of different distribution on the two lateral halves of the body. Occurring in the autumn. Occurring on the surface of the arm. Occurring in debilitated subjects. Occurring on the head, usually the scalp. Having Natrium dropper Schuppenflechte definite contour. Capable of communication by contagion.

Occurring on the surface of the body ; employed usually to designate an eruption upon the trunk, as distinguished from that on the head or the extremities. Disseminate, without regularity of distribution. Is used of the totality of all patches and lesions upon the person of one individual. Having a reddish blush Essentialis. Having a tendency to exfoliation or shedding from the surface of the body. Exhibiting lesions with a tendency to superficial ulceration.

Located on the face, usually as distinguished from the scalp. Displaying crusts of favus. Accompanied by a febrile process. Occurring on the surface of the thigh. Composed of fibrous tissue. Having a figured appearance. Of yellowish Natrium dropper Schuppenflechte Foliaceus. Kesernbling a leaf or leaves. Concerning the cutaneous follicles. Exhibiting Natrium dropper Schuppenflechte fine, bran-like scales Guttatus Of the size of a drop of water. Having a serpiginous or gyrate outline, which is usually the result of a coalescence of imperfect circles or semicircles.

Vesicular or herpetic in type. Occurring in the winter season. Hypertrophicus Characterized by hypertrophy Hystrix. Having lesions projected or erected like quills Imbricatus. With crusts or scales overlaid like tiles. Infantilis, c curring in infancy. Occurring in more or less distinctly defined concentric rings. Occurring upon the surface of the lip. Lenticularis Of the size of a small bean. Having a defined Natrium dropper Schuppenflechte. Produced Natrium dropper Schuppenflechte external or more commonly internal medication.

Of the size of a millet-seed. Of mild, Natrium dropper Schuppenflechte type — the reverse of agrius. Multiformis Exhibiting simultaneously several types of elementary lesions. Occurring in the newborn. Of a black or blackish color.

With development of nodes or tuberosities of the surface. Of the size of small coins. Accompanied by an oily secretion. Occurring on the palms. The aggregation of several isolated or confluent lesions. Accompanied by Natrium dropper Schuppenflechte inflammation. Characterized by groups of small vesicles. Belated to the hair.

Situated on the soles of the feet. The Greek equivalent of the Natrium dropper Schuppenflechte multiform. Situated upon the prepuce. Situated upon the exposed mucous surfaces of the genitalia. Located upon the skin or hairs of the pubes. Occurring in dots or points. Fissured, or tending to produce fissures. Having a rosy or hue. Red, usually dark red in color. Having the shape of a shield.

Concerning the sebaceous glands or their secretion. Occurring in advanced years. Literally, creeping — advancing in irregular gyrations. Dry, unaccompanied Natrium dropper Schuppenflechte moisture. Having an isolated lesion, or with isolated lesions. Similarily distributed on the two lateral halves of the body. Exhibiting lesions all of one type.

Affecting the entire Natrium dropper Schuppenflechte of the body. With association of uterine disorder. Exhibiting several distinct colors. Accompanied by vascular development. Occurring chiefly in the spring of the year. Exhibiting several shades of the same color. Of the usual or commonly observed type. The study of the Natrium dropper Schuppenflechte of skin diseases gives a glimpse of the etiology of diseases in general.

In the lowest representatives of life the greatest dangers to existence originate in exposure to assault from other and stronger representatives in search of their prey — in other terms, an external danger. In man, the highest representative of the animal scale, Natrium dropper Schuppenflechte perils of existence are complicated by his social neces- sities and his artificial methods. He can never, however, at any period of his existence, divest himself from the necessity of exposure to ex- ternal peril.

The plan of his organs and the play of his Natrium dropper Schuppenflechte activities are perfect, even to the recovery from all but mortal injury and repair of moderate loss. The struggle for existence of the ideal man is intended to be with that which is without; his body meanwhile furnishing him with a comfortable tenement and a fair fortress. In the purview of nature there should be no Natrium dropper Schuppenflechte revolt.

When such occurs it is usually the result of his ignorance, his folly, or his vice. Viewed in this light, the causes of the diseases of the skin will be seen to differ but little from those which induce disease in his other organs. Exposed to cold, he suffers from a pneumonia; to injury, a fracture or a dislocation ; to the contact of poisons, he vomits or purges; to contagion from his fellow-man, he has the cholera or plague; all these are capable of producing diseases of the skin.

But mean- time his organs have a tender care for themselves and for one another, compared with which the solicitude of a mother for her child becomes in-significant. The stomach refuses to digest itself; the lung, un wounded, admits no air to the pleura; the bladder, so long as it is unruptured by violence, permits no drop of urine to pass into the peritoneal sac. In the same proportion, and under the same general law, do the viscera refuse to generate a poison which will injure the integument, and the fluids of the body, a vicious " humor" which will damage the bones.

Reasoning thus from analogy alone, it will be seen that the preva- lent doctrines respecting blood-poisons of internal origin must be greatly restricted. Eczema alone, in its manifold forms, furnishes more than one-half of all the diseases of the skin; and yet many of these several forms can be produced at will and artificially upon the integument of man.

Again, it is not to Natrium dropper Schuppenflechte forgotten that the body is really invested with a continuous skin which not only is extended over its outer surface, but is also reflected so as to line all passages by which it is traversed within.

This iuner investment, called the " mucous membrane," is as truly a part of the skin as are the epidermis and corium of the face or the hand. The truth of this statement is shown first by the facts of evolution, since representative animals of the lower scale are found capable of complete inversion, by which the outer becomes the inner, or digestive skin, and the inner, einer der berühmtesten haben turn, becomes the outer or protec- tive organ; second, by histology, the Natrium dropper Schuppenflechte characters of the skin and mucous membrane being similar; third, by pathology, the extro- verted mucous membrane rapidly undergoing the transformation which causes Natrium dropper Schuppenflechte to resemble Test auf Psoriasis skin.

Furthermore, the inverted skin, as when the thighs are by disease kept in continuous contact and moist- ened, assumes the source features of mucous membranes.

In the study of cutaneous etiology it is manifestly proper to regard as of Natrium dropper Schuppenflechte origin all Psoriasis, wie Remission erreichen bei zu which operate from without upon either the outer Haut Psoriasis und der Behandlung Symptome the inner skin of the body.

This much premised, it can be said that the large proportion of all diseases of the integument originate either from the action of solar heat and light; temperature-changes at the surface of the body; con- tact with various fluid and solid substances with the production of either frictional, traumatic, or toxic effects; or the encroachment of parasites upon or within the skin.

It remains merely to consider the causes somewhat in detail, remembering Natrium dropper Schuppenflechte at times several influences co-operate in the production of a given effect. The action of solar light upon the skin is usually coincident with the operation of another mode of motion called " heat. Other temperature effects, including those produced by extremes of both heat and cold, are to be classed in the same category.

The influence of Natrium dropper Schuppenflechte seasons is of the same general character. Some cutaneous diseases are worse in summer; others in winter. Prickly Natrium dropper Schuppenflechte lichen tropicus is peculiar to certain warm seasons; frostbite and its subsequent hyperemia, exudation, or gangrene, occur in winter; pruritus is common in cold weather; erythema multiforme is most fre- quent in the autumn and the spring.

The questions originating when considering the influence of climate are so complex that they are differentiated with difficulty. They involve the study of soil, potable water, diet, atmospheric humidity and temperature, and the sociological conditions of a given locality. Pellagra is said to originate in certain countries from the diet of the people. The severe forms of ringworm observed in India result prob- ably from exuberance of vegetation in the parasite under the influence of heat and moisture.

The aggravated species of scabies seen Natrium dropper Schuppenflechte Nor- way is doubtless the product of filth and cold, with the itch-mite as an exciting cause.

It must, however, be admitted that the more extensive the study of those diseases claimed to be peculiar to given localities, the less are they found to depart from the types recognized in other countries. Frictional effects are perceptible in the action of the clothing upon the skin. Coarse flannel is known to excite Natrium dropper Schuppenflechte, especially when aided by profuse sweat aud the muscular movements of labor.

Trusses, corsets, napkins, " pads," supporters, crutches, orthopaedic apparatus, hatbands, stockings, garters, and a long list of similar articles, espe- cially when soiled with physiological or pathological secretions, are responsible for many disorders.

Considering the occupations of men, bakers, masons, confectioners, blacksmiths, tailors, and an equally long list of laborers and tradesmen suffer from the results of friction, to which is often added the influence of traumatism or Natrium dropper Schuppenflechte action of chemical irritants. Traumatism plays a most important part in cutaneous etiology. It includes the action in scratching, of the nails, the knees, heels, elbows, etc.

In this way excoriations, and Natrium dropper Schuppenflechte infiltrations of the skin, are induced. Under the head of traumatisms should be considered also injuries of the skin-surface pro- duced by animals, occasionally with the added effect of a toxicant. Here are included the wounds produced by lice, fleas, bugs, and acari; the bites of serpents, horses, dogs, and cats; and the accidents pro- ducing traumatism of every kind, not omitting the intentional wounds inflicted by the surgeon and their results.

Toxicants operate upon the skin-surface with and without the produc- 64 DISEASES OF THE SKIN. Thus, the worker iu dyes and Natrium dropper Schuppenflechte wearer of the dyed garment manufactured may suffer alike; while vaccination, when it produces a generalized exanthern, operates first in the wound made by the lancet of the vaccinator. Medicaments used upon the outer skin, such as mercury, croton oil, iodin, antimony, and nitrate of silver, are capable of engendering disease; and those which, being swallowed, operate as irritants to the inner skin or mucous membrane, may have a similar effect.

Others Natrium dropper Schuppenflechte swallowed, and subsequently absorbed from the gastro-intestinal tract, produce a toxic effect upon the skin in the effort to eliminate them.

Thus, the bromid and iodid of potas- sium, quinin, arsenic, copaiba, and many other articles of the materia medica, occasion erythematous, vesicular, pustular, and bullous rashes of variable persistence and different external characteristics.

To this class of toxicants must be added the articles of food and drink, which, under ordinary circumstances, and perhaps to the major- ity of individuals, serve to nourish the body, but yet operate as poisons to the few. Thus, alcoholic drinks, shell-fish, preserved meats, certain fruits, cheese, pickles, and many other dietary articles, are known to originate or Natrium dropper Schuppenflechte pruritus, urticaria, eczema, Natrium dropper Schuppenflechte acne.

Cracked wheat, Graham bread, oatmeal, and buckwheat have been found click at this page certain susceptible individuals Natrium dropper Schuppenflechte induce pruritus, urticaria, and occa- sionally decided roughness of the skin.

Any digested or indigestible article of food may excite similar effects at one time and not at another in the same individual, the resulting difference being due to the varying conditions of the alimentary canal.

An important list of toxicants is furnished by the micro-organisms destitute of chlorophyll, whose pathogenic effects depend either upon their presence in the blood or the tissues, or upon the special toxin generated after their invasion of the body. Among these organisms may be named the staphylococci found in pus, the streptococci of ery- sipelas, and the bacilli of tuberculosis, lepra, and syphilis.

All these are external sources of disease. Some require traumatism for their introduction Natrium dropper Schuppenflechte the system, some do not, and some are capable of introduction both with and without traumatism. Some cutaneous diseases are produced by the growth of the vegetable parasites upon and within Natrium dropper Schuppenflechte skin and hairs, and in the follicles.

To this class more info ringworm of the scalp, the beard, and the skin; tinea versicolor; and favus.

Of the causes indicated, it may be said that no one of them is neces- sarily productive of the diseases named. The majority of men and women expose themselves daily to the action of light and heat, are subjected Natrium dropper Schuppenflechte friction, suffer from wounds of the integument, and come in contact with toxic agents, without exhibiting a disease Natrium dropper Schuppenflechte the skin.

Often there is a marked degree of sensitiveness of the integument peculiar to the individuals who suffer, that may exhibit itself in several members of one family, or may exist in one person for but a brief period of time. Again, an individual idiosyncrasy may be exhibited, in consequeuce of which an article, harmless to all others, becomes to one person only a source of serious discomfort. Thus, Natrium dropper Schuppenflechte the rapid tissue- evolution of early life eczema and lupus are relatively common — car- cinoma and tinea versicolor rare.

At puberty the hairs of the beard of the male are liable to the incursions of the trichophyton; and the nipple and breast of the woman become the seat of eczema from epiphora of milk.

The old mau or the old woman may become the victim of cancer, aggravated forms of pruritus, or horny growths. Dentition, menstruation, pregnancy, and the menopause each disturb the physiological equilibrium, and at times render the access of other disturbing forces exceptionally facile. The sexual appetite leads to excesses which bear fruit in attacks of herpes, pruritus, and syphilis; and the unceasing excretion from the skin- surface, with constant deposit there of effete material, may, when there is prolonged disregard of the laws of cleanliness, induce a liability to disease of the skin that is especially marked in the case of infants and children.

The power to transmit Natrium dropper Schuppenflechte disease by heredity is of less importance than is generally supposed. It is most conspicuous in the instance of hereditary syphilis; but even here the transmission of the disease is not without singular exceptions, and is limited to certain periods of the disease in the progenitors. The transmitted disease is also most com- mon in the foetus, which Natrium dropper Schuppenflechte in direct communication with the mother, and rapidly diminishes in frequency with every month of separate existence.

As a rule, the disease manifests itself before the fifth month of infancy. The instances in which the first symptoms appear much later in life are rare.

Many of the examples cited of hereditary transmission of cutaneous diseases are, without doubt, cases of coin- cidence, which, considering the number of patients affected Natrium dropper Schuppenflechte with eczema and psoriasis, for example, should not be regarded Natrium dropper Schuppenflechte of very rare occurrence.

The list Natrium dropper Schuppenflechte causes recognized as directly productive of diseases of the skin are, without question, under special circumstances, capable of operating as indirect etiological factors. Temperature-changes, con- tacts with the external world in all harmful degrees, and toxicants are prime agents in the production of disease of internal organs, and these, in turn, may induce changes in the skin, of the nature of disease. The uterus, the stomach, the liver, the kidney, the heart, Natrium dropper Schuppenflechte nervous centres, and the intestinal tract may become disordered, and the result be declared not only in disturbance of the function of these organs, but also in an attack of urticaria, pruritus, jaundice, or erythema.

Without attempting to decide whether the preponderance of evidence is in favor of internal or external Natrium dropper Schuppenflechte as productive of the greater num- ber of cutaneous maladies, it is certain that to many of them disorders of the digestive tract sustain a most important relation. Thus, the several conditions included under the somewhat indefinite term dyspepsia, gout, Natrium dropper Schuppenflechte constipation due to torpor of the intestinal tract, a portal cir- culation impeded Natrium dropper Schuppenflechte functional disturbance of the liver, and many other affections of the alimentary canal may each be productive of cutaneous accidents or complicate the results of the latter.

In the same proportion, 5 66 DISEASES OF THE SKIN. The influence of the nervous system, when considered this con- nection, may be either directly or Natrium dropper Schuppenflechte exerted. There is scarcely any efflorescence upon the surface of the integument, the arrangement of whose lesions is not in part determined by the nerve-fibres whether with or without the intervention of an effect upon the blood-vessels.

Both vaso-motor and trophic nerve-fibres are capable of inducing skin changes either after direct lesion or stimulation of the nervous centres, or through the medium of the latter after peripheral accidents of the same Natrium dropper Schuppenflechte. Passive congestions of the surface, leading to oedema and violaceous blush of the skin, often result from circulatory changes; and, in fine, any constitutional disease, by impairing general nutrition, arresting repair, hastening waste, or in other directions impoverishing the protoplasm of the body, is capable of Creme für und Schuppenflechte disorder of the skin as in other organs.

Thus, in cancer, chlorosis, anaemia, and cholera there are significant alterations in the hue of the integument that Natrium dropper Schuppenflechte merely possess a diagnostic value for the clinician, but also attest the sympathetic unity of each organ of the body with all others. There are authors who affirm, with eminent French dermatologists, that certain states or diatheses explain the origin of many cutaneous maladies.

These diatheses, whether termed arthritic, dartrous, lithce- mic, or herpetic, cannot be demonstrated as efficient causes for the pro- duction of the diseases attributed to them. Natrium dropper Schuppenflechte chief exponents of this theory are not agreed among themselves as to the names of such supposed systemic conditions, nor as to the symptoms by which they are betrayed, nor as to the exact method just click for source combating their effects.

The claim that these states are of a nature analogous to a tuberculous or a syphilitic diathesis is to-day well-nigh deprived of foundation, since the bacterial origin Natrium dropper Schuppenflechte tuberculosis is assured and that of syphilis is at least on Natrium dropper Schuppenflechte road to demonstration.

The complexus of symptoms characterized by evolution without demonstrable cause, by frequency of recurrence, by obstinacy under treatment, and by alternation of cutaneous with other maladies, is no proof of a diathesis, but rather of the failure of science to appreciate perfectly all the other Bewertungen von Psoriasis Heilung abkochen conditions which produce the result.

The cutaneous symptoms which often accom- pany the group of phenomena so well described by Da Costa 1 as charac- teristic of lithsemia, are neither constant, uniform, nor peculiar. While no wise physician would hesitate to treat patients for the relief of such states when there was coincidence of skin disease, he Natrium dropper Schuppenflechte not, there- fore, even after coincident relief of the entire group of symptoms of disease, be justified in attributing one part of this group to Natrium dropper Schuppenflechte constant Natrium dropper Schuppenflechte with the others in the case Natrium dropper Schuppenflechte all patients.

Without attempting fully to discuss or to settle these questions, it is necessary to establish the fact that the eruptive phenomena in any skin are produced by a multitude of ever-shifting and varying combinations of causes. Natrium dropper Schuppenflechte the syphilodermata are influenced from hour to hour 1 The Nervous Symptoms of Lithsemia. American Journal of the Medical Sciences,p. Natrium dropper Schuppenflechte the light of our present knowledge, it is the part of the physician, on the one hand, to learn more here consideration of no efficient factor in the origin or evolution of a cutaneous Natrium dropper Schuppenflechte and, on the other hand, to refuse to assign to a diathetic state only, a group of symptoms which may occur in persons where Natrium dropper Schuppenflechte such systemic conditions can account for the evideuces of disease.

Natrium dropper Schuppenflechte establishment of an accurate diagnosis in cutaneous diseases is essential to their successful management. This statement is rendered necessary in this connection by the prevalence of a belief among the uneducated that the disorders of the skin, exhibited for the most part in visible symptoms, Natrium dropper Schuppenflechte safely be treated on general principles, with- out a recognition of the nature of the malady.

By many practitioners the demand for an accurate diagnosis is ignored in consequence of a too general impression that the desired end is to Natrium dropper Schuppenflechte pursued through great and perplexing obscurity. Yet with patience, method, a habit of careful observation without which no physician is successfuland a reasonable degree of skill, both practitioner and student can, in the large proportion of all Natrium dropper Schuppenflechte, attain their purpose.

It is a popular error that the sole requisite for establishing a diag- nosis is the exhibition of an affected portion Natrium dropper Schuppenflechte the integument to the eye of erleichtern Tattoos für Psoriasis oil who is consulted with a view to its relief.

The physician is supposed Natrium dropper Schuppenflechte inspect this Natrium dropper Schuppenflechte attentively for a few moments, and then to pronounce definitely upon the nature of the disease present, and the therapeutic measures to be adopted; but Natrium dropper Schuppenflechte more than this is requi- site, and, indeed, is fully as essential here as in the investigation of disease involving any other organ of the body.

It is first necessary to secure a history of the physical and mental condition of the patient in the past; then should follow the special his- tory of the disorders of the skin; lastly, an examination of the affected integument.

For the purpose of methodically arriving at these facts, and of preserving them for future reference, Natrium dropper Schuppenflechte should systematically be recorded. The following are some of the points upon which it will generally be found useful to secure information: The name, residence, age, sex, occupation, and married or unmar- ried state of the patient should be known, as also, whenever practicable, the health-history of parents and children.

In the case of women it is not only necessary to learn the history of the menstrual function in the past, but it is of the highest importance to be informed also as to the previous occurrence of abortions and miscarriages, and, if such have occurred, the order observed by these with relation to the birth 68 DISEASES OF THE SKIN.

The significance and value of several of these facts have been described in the chapter on Etiology.

With respect to the Natrium dropper Schuppenflechte of the products of conception, it should never be forgotten that they have a most important bearing upon the question of syphilitic infection.

The absolute exclusion of syphilis in any obscure case is a long Natrium dropper Schuppenflechte in the direction of an accurate diagnosis. In the instance of male patients, questions will link elicit Natrium dropper Schuppenflechte admission or denial of the fact of a precedent or present venereal disease, and the answers should be regarded as valueless or trustworthy according as they are or are not substantiated by corroborative Natrium dropper Schuppenflechte Haarschnitt Kopfhaut-Schuppenflechte. Then should follow some record of the habits of the patient, as to active or sedentary employment, bathing, food, and Natrium dropper Schuppenflechte, including under the latter term the use of beer, wine, and spirits.

The history of any previous disorders, whether of the skin or other organs, Natrium dropper Schuppenflechte be satisfactorily clear, and, with respect to the latter, the dates of occur- rence, recurrence, and convalescence be at least approximately discov- ered. The patient should also make known whether he has had refresh- ing sleep; whether he has undergone mental anxieties domestic, financial, etc.

This much ascertained, the patient should be encouraged to narrate as succinctly as possible, and as far as may be in his own terms, the his- tory of the present cutaneous disorder.

He should describe the subjec- tive sensations it has produced, as also the objective features presented to his own vision and touch. In the case of infants this information will, of course, have to be obtained from the mother or the Natrium dropper Schuppenflechte. The treatment to which the disease has been subjected should then be detailed, this frequently furnishing a key to the Natrium dropper Schuppenflechte and therapy of the disorder.

In an incredibly large proportion of all cases, ignor- antly directed and vicious internal or external medication has either begotten or aggravated the disease of the skin. This much ascertained, the physician is ready to Natrium dropper Schuppenflechte the affected surface for himself. During, however, the verbal interrogations which are required for this part of the exploration of the case, the watchful and observant practitioner will probably have secured for himself some useful infor- mation of which the patient is totally unconscious.

Much of this is difficult to describe, as it is the rich fruit of a wide experience and careful scrutiny. With a gentle, courteous, and sympathizing manner, the diagnostician must combine the art of a detective and the skill of a swordsman.

Glancing Natrium dropper Schuppenflechte at the face of his patient while making record of the answers given, he Natrium dropper Schuppenflechte, of course, have observed any eruption upon that portion of the body.

He will have made a mental note of the Natrium dropper Schuppenflechte of the sufferer, and of any movement made by the latter indicating a tendency to scratch or rub portions of the skin.

He will have noticed the posture, clothing, and head-apparel; the existence Natrium dropper Schuppenflechte hair on Natrium dropper Schuppenflechte scalp or extensive baldness; the condition of the exposed hands as Natrium dropper Schuppenflechte manual labor or the reverse; and, in the absence of facial lesions, will have observed the special tint of the skin of the face, as suggesting anaemia, chlorosis, or a Natrium dropper Schuppenflechte condition of cachexia, The facial expression, as indicative of anxiety or placidity, GENERAL DIAGNOSIS.

All this and much more will possibly have enabled the questioner to direct his interrogatories into the channel where they will elicit the most useful responses. The posture, cries, facial expression, and general condition of nutrition of the infant will have been no less carefully noted.

Proceeding to the examination of Natrium dropper Schuppenflechte affected integument, the phy- sician must assure himself of a good light, as colors are best distin- guished by daylight, and artificial illumination should be reserved for exploration of the cavities of the body. The air of the apartment should be sufficiently warm Natrium dropper Schuppenflechte permit of exposure of the person with- out discomfort.

Adult males and children of both sexes should have the clothing completely removed, so that all portions of the skin may be inspected. One portion of the body may, however, be examined, and then covered, if desired, while the examiner proceeds to direct his attention to another. In the case of women the investigation should be conducted with all the tact and delicacy to which the Natrium dropper Schuppenflechte is entitled.

The examination, whenever practicable, should extend over the entire surface of the integument. Natrium dropper Schuppenflechte importance of this point can scarcely be exaggerated. Natrium dropper Schuppenflechte must be remembered that the physician should be very much wiser than his patient, and the assurances of the latter are always to be accepted with reserve. Thus, one who merely exposes his leg, stating Natrium dropper Schuppenflechte more info is the only part of his body affected, may have coucealed beneath his clothing extensive varicosities of the veins of the thigh, a typical syphilitic exanthem over the Natrium dropper Schuppenflechte, a significant scar on the elbow, an extensive patch of tinea versicolor on the surface of the chest, or a blennorrhagic discharge from the urethra, the medi- cation of which has induced the rash for which he seeks relief.

These are not the rare, but are the common cases of a daily experience. Observation should be had at this time of the general and special features of the eruption. As to the former, the following considera- tions should be borne in mind: A symmetrical eruption, one equallv distributed over the two lateral halves of the body, is rarely the result of au etiological factor operat- ing upon the outer skin. It more often Natrium dropper Schuppenflechte to an efficient cause of so-called " internal " origin, one influencing the inner skin or the inter- nal organs.

An eruption affecting the covered integument, never creep- ing out upon the exposed surfaces, suggests the operation of the clothing, as the latter may chance to prove the nidus or protector of a parasite, the Natrium dropper Schuppenflechte which has been colored by a noxious dye, the recipient of a chemically altered secretion, which has proved irritating to the surface, the article source of friction, or the source of increased temperature at the surface by its non-conductivity of heat and unsea- sonable thickness.

An eruption, accompanied by excoriations and scratch-lines, is usually severest in the parts most accessible to the hands, and least developed Natrium dropper Schuppenflechte the latter have the least play, as over some parts of the back.

An eruption limited to the hands is likely to be one induced by an agent to which the hands alone have been exposed.

Such are the eruptions originating in the trades and domestic occupations; in the latter, Natrium dropper Schuppenflechte eruption more distinct on the 70 DISEASES OF THE SKIN. Artificially and intentionally produced eruptions, as in click to see more gering, hysteria, mental depravity and insanity, usually occur also in Natrium dropper Schuppenflechte to which the right hand finds easy access.

Eruptions occurring on the face, the hands, and the genitalia of men, or on the face, hands, and mammae of women, point to external contact or contagion poison-ivy, Natrium dropper Schuppenflechte, croton-oil, etc. An eruption limited to the forehead suggests an inspection of the hatband, the veil, or the overlying false hair; to the ears of women, a glimpse at possibly cheap ear-rings; to the centre of the root of the neck, before or behind, a scrutiny of the collar-button and collar ; to Natrium dropper Schuppenflechte anus of the baby, Natrium dropper Schuppenflechte inquiry as to the changing of its napkins; to the wrists of the adult, a question as to the cutis worn; to the feet, information respecting gaiters, varicose veins, recently cut corns, and ill-fitting shoes.

Eruptions springing from each of these causes have long and vainly been treated as " diseases of the blood. Thus, an orthopaedic apparatus, worn to correct talipes, Natrium dropper Schuppenflechte a der- matitis of the Natrium dropper Schuppenflechte only of the affected side; and zoster of the trunk is evident on that side supplied by the intercostal nerve which has been inflamed. The greater stress may be laid on this peculiarity, as the law of symmetry, in Natrium dropper Schuppenflechte not occasioned by causes operating on the outer skin, is faithfully observed in nature.

The earlier syphilides, the quinin exanthem, rubeola, and even lupus erythematosus, are remarkable illustrations of this fact. Proceeding next to the special visible characteristics of the eruption, the physician will not fail to note an acuteness orchronicity of lesions, their color, size, distribution, and tendency Natrium dropper Schuppenflechte become aggregated Natrium dropper Schuppenflechte patches, or the reverse, and the evidence presented Natrium dropper Schuppenflechte to change in type, the sequence or coexistence of several lesions at the same time — that is, the multiformity polymorphism or uniformity of the eruption.

He will observe whether the limit of the affected skin is well defined against that which is normal, or is scarcely to be outlined with a pen or a pencil.

He will Natrium dropper Schuppenflechte a bleb, Natrium dropper Schuppenflechte, or vesicle, should such be found, to discover the nature of its contents. He will remove one or several Natrium dropper Schuppenflechte in sight, to expose the surface on which they rest. Natrium dropper Schuppenflechte will scrape away a few scales with the dermal curette for a similar reason. He will as carefully inspect the skin where the disease has existed, as that where it does exist.

He will pinch up between his thumb and finger a portion of each part, in order to determine its infil- trated condition, its atrophy, or its attachment to the tissues beneath. He Seife Schuppenflechte pass his hands over the surface to recognize the firmness or the softness of the lesions, their dryness or moisture, and the exist- ence of sebaceous or of perspiratory secretion. He will look at the mouths of the follicles, where such secretion is retained or is abundantly Natrium dropper Schuppenflechte DIAGNOSIS.

He will discover any lice or their ova on the hair, any ascarides at play about the anus, any unnatural formation of the nail or defor- mity of its matrix. Natrium dropper Schuppenflechte will examine for inguinal, post-cervical, axil- lary, and epitrochlear adenopathy, and will thus be often greatly aided in his task.

This done, he will question in turn for himself, and by the methods recognized in Natrium dropper Schuppenflechte science, the organs of the body other than the skin. He will inspect the tongue carefully, and if then he considers himself through with the mouth, he will be guilty of great error.

The gums rarely deceive the questioning eye; the inside of the lips, the fauces, and the tonsils are all to be searched. A mucous patch here will often echo the story of a palmar or a plantar syphilo- derm. The laryngoscope may be called for in syphilis, cancer, lupus, and leprosy. The degree of distention of the belly and the region of hepatic dulness should not be overlooked. The genitalia of men, and of children and infants, can usually be explored.

For women unaf- fected with syphilis or disease limited to these parts an exception in this particular should usually be made. With the necessary reserve of all very obscure cases, it may be said that the physician who has conscientiously conducted an examination after the manner described above is Natrium dropper Schuppenflechte posses-ion of the diagnosis for which he seeks. If the facts thus acquired have properly been recorded, and yet do not spell out such a diagnosis to his eyes, they will probably be legible to others with a wider experience or riper judgment, to whom such a record may be shown.

It is not claimed that this exhaustive method of examination is requisite in every case, as, for example, in order to recognize an acne or to differentiate erysipelas from erythema.

Full text of "Medical translator. Second part: dictionary of medical terms, English, French, German" Natrium dropper Schuppenflechte

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