Definition And Description

Urticaria is an affection usually characterrized by the sudden development of white or red elevations called wheals, accompanied with heat and pruritus. Sometimes these symptoms precede the eruption, and the irritation to which they give rise leads to rubbing and scratching which speedily induce the lesions mentioned. Once out they may last a few minutes only, or persist for a few hours and even for a day or two. In some cases they may appear and disappear several tiroes in a day. The wheals may be few or numerous, and the affection mar terminate after the first crop have disappeared; more frequently, however, there are renewals of eruption for a few successive days, and in some cases this may be kept up for weeks or months, constituting chronic Urticaria.

The pruritus attending an outbreak of urticaria may be intense, and lead to the formation of unmistakable scratch-marks, and these indeed may be the only visible lesion at the time the patient visits the physician. In many persons suffering from urticaria, even in the absence of actual eruption, if the finger-nail or a pencil point be sharply drawn across the skin, a white line, soon becoming red and elevated, will appear. This lasts for a short time and then disappears. Almost every portion of the surface may be the seat of wheals, though I have never seen it on the palms or soles, or upon the scalp. In some cases the appearance of the wheals is preceded by oedema, especially of the face, hands, and feet. This may last a few days before giving place to the characteristic lesion. Occasionally the wheals may present a purplish appearance, due to extravasation of blood, constituting an Urticaria hemorrhagica. The stains last for some days after the wheals disappear. Severe urticarial attacks, and especially the oedematous form, are sometimes accompanied with febrile.

Diagnosis

If the patient offers for inspection veritable wheals no difficulty can arise in determining the nature of the affection. If, however, the wheals are absent, and nothing but scratch-marks are present, the history of the case will give the necessary information. In the cedematous form the presence of a burning heat and pruritus will probably give a clue to what may be expected.

The eruption we are speaking of must of course not be mistaken for the somewhat similar one caused by contact with the common nettle (Urtica dioica, or ureus).

Prognosis

The prognosis is always good, as the acute form can be brought to a speedy termination, and the chronic, as a rule, no less surely but more slowly; at least this has been my own experience of late years. Eiology. - Urticaria is undoubtedly a reflex affection, and in acute cases can usually be traced to disorder of the gastro-intestinal tract from errors of diet - certain foods, as shell-fish, being specially liable in some persons to induce an attack. In chronic cases the gastro-intestinal and hepatic organs, and in woman, uterus and ovaries, are not unfrequently the starting-point of the trouble. In some instances, however, we will not be able to find sufficient evidence to convict any of the organs mentioned.

Treatment

I have tried most of the methods mentioned by authors, and have settled down to the following which rarely disappoint me: In an acute attack give ten grains of Ipecac, or its equivalent in fluid extract every ten minutes, until free emesis is secured. As soon as the patient recovers a little from this, place him in a Turkish bath and let him remain there till free diaphoresis occurs, after which shampoo and dry him. This usually breaks up an attack. If it does not a second application of Ipecac and the bath will almost surely succeed. In the chronic form, careful search should be made for the exciting cause. If uterine, appropriate treatment must be adopted, together with Turkish baths. If the cause be gastro-intestinal or hepatic, a dose of calomel or blue-pill, followed by a suitable cathartic, should be first ordered. This should then be followed by small doses of almost any one of the efficient cholagogues, either alone or combined with small closes of arsenic or nux vomica. Turkish baths two or three times a week should also be taken. Outside of large cities the Turkish bath cannot be readily obtained. In default of this, free diaphoresis, by some other means, should be obtained. Perhaps Jaborandi would answer the purpose. This is simply offered as a suggestion, as I have had no experience with the drug in this connection. Since I have adopted the methods mentioned I have rarely found it worth while to make use of local treatment.

The following drugs have been recommended:

Acidum Sulphuric, 11; Arnica, 22; Belladonna, 32; Quinine, 45; Colchicum, 46; Copaiba, 47; Ergota, 52; Potassii Cyanidum, 93; and Sodii Salicylas, 107.