Douglass Skin Diseases-a comparison with Synthesis Repertory

Dr Jayadeep B P BHMS MD(Hom)

• Name of the book- Skin diseases ,Their Description, Etiology, Diagnosis and Treatment according to the law of the similars
• Author- M.E. DOUGLASS. M. D
• Published in -1899
• Reprint edition-1998
• Published By -B Jain publishers (P) Ltd ,New Delhi
• Printed in India by -J. J. Offset printers, Delhi
• Price-Rs.65

About the author  

MELFORD EUGENE DOUGLASS. M. D

• Lecturer on Dermatology in the Southern homoeopathic medical college of Baltimore, Md.
• author of Characteristics of the Homeopathic Materia Medica (1905) and Pearls of Homeopathy (1903) 

About the book

• Essentially a Homoeopathic therapeutic book on various skin diseases 

Contents

• Preface
• 21 chapters- various skin disorders under various heads are mentioned
• Index

Preface

• In preface author states that book has been written to meet the wants of the Homoeopathic practitioner as well as the needs of the medical student
• He encourages the physician that he should be proficient in the principles of general medicine, & in knowledge of the general course & behavior of skin diseases, in order that he may treat affections of skin intelligently & successfully
• Author gives priority for cause & totality of each skin ailments for a successful prescription. 

Chapters
First 4 chapters  were spent for giving an introduction about General anatomy of skin, general observations  & rules for studying skin diseases,  Classification of the elementary lesions,  Aetiology of skin diseases etc. From general observations, points which are worthy to note are as follows

• Symmetrical presentation of skin ailments are due to blood poison
• among the temperaments -lymphatics are prone for eczema, impetigo, intertrigo, pustular scabies, ringworm; rheumatic for erythema nodosum; strumous for eczema, lupus and florid for psoriasis etc
• considering occupation- cooks are liable to eczema & erythema; bakers, grocers, bricklayers for lichen; chimney sweepers for epithelioma of scrotum; cotton workers for urticaria; butchers & graziers to whitlow, boils, malignant pustules & ecthyma; shoemakers for eczema etc
• General interpretation that diseases of children are the result of malnutrition from deficient of bad feeding; of adults , result of malassimilation & of aged due to degenerative changes
• derangement of 4 organs –stomach, liver, kidney & uterus excites & intensifies skin mischiefs

• Chapter 5 – Local dermal inflammations -include Erythematous diseases, Erythema multiforme , Erythema nodosum , Roseola , Urticaria , Follicular hyperemia, Medicinal rashes
• Chapter VI –The eruptions of acute specific diseases like Variola, Varicella , Typhus rash, Typhoid rash, Measles, Scarlatina , Erysipelas, Rubella, Framboesia
• Chapter VII – Papular inflammations like Lichen planus, ruber, simplex, scrofulosorum , Strophulus , prurigo,
• Chapter VIII -eczema
• Chapter IX -Bullous diseases of & anomalous forms of bullous eruptions like Herpes labialis, Herpes progenitalis, Zoster, Pemphigus, Pemphigus vulgaris & foliaceus , hydroa
• Chapter X – Suppurative inflammations -Impetigo contagiosa, Ecthyma, Furuncle, Stye , Carbuncle, Pustula maligna
• Chapter XI – Squamous inflammations -Pityriasis rubra , Pityariasis pilaris , Psoriasis
• Chapter XII -Diathetic diseases, Scrofuloderma, Syphilis, Condylomata , Leprosy, Morvan’s disease
• Chapter XIII -Hypertrophic & atrophic affections- Corns, Horns; warts, Icthyosis, morphea, scleroderma, scleriasis,  scleroma neonatorum,  keloid, Fibroma, Dermatolysis, Elephantiasis, Milium, Mammilitis maligna, Ainhum, Naevus
• Chapter XIV -Neoplasmata –Lupus, Epithelioma , Sarcoma, Carcinoma, Rodent ulcer
• Chapter XV – Cutaneous hemorrhages- purpura
• Chapter XVI – Pruritis
• Chapter XVII – Chromatogenous diseases- Vitiligo, melanoderma, ephelis
• Chapter XVIII – Parasitic diseases -Phtheriasis , Psorospermosis , Scabies, Favus , Tricophytosis Chromophytosis, onychomycosis , Paronychia
• Chapter XIX -Disorders of glands-include Diseases of the sweat glands and sebaceous glands-
• Chapter XX -Diseases of hair-Alopecia
• Chapter XXI –Various lesions not classified -Pernio,actinomycosis,wash leather skin, effects of rhus tox on the skin

Construction of chapters
A general pattern followed in each skin diseases, is as follows

• A general introduction
• Pathology & etiology
• Diagnosis
• Prognosis
• Treatment-including appropriate External applications  and
• Homoeopathic therapeutics with brief description of symptoms
• many conditions were presented only in brief paragraphs according to their significance, and some are presented without any therapeutics too.

About the Repertory part

• There is no separate section for repertory
• Considered only  in chapter  XIII – under verucae or warts
• Repertory of warts & Repertory of condylomata seperately
• Prepared by Olin M Drake
• used –only single grade of evaluation with typography of Normal Roman
• Followed an alphabetical order of arrangement
• Cross reference were used
• Rubrics for horses & sheep etc too included
• Total number of medicines- 90
• There is another similar repertory section in chapter XVI for PRURITIS with an additional 48 medicines. 

Repertory of warts

• – few general rubrics
• – sub sections like

– Locality- under which various locations are given  as rubrics alphabetically

• Rubrics from ‘Anus, about’ to ‘Tongue upon’

– Objectively considered – where objective findings are given as rubrics

• rubrics from ‘bleeding’ to ‘ulcers’

– Subjective symptoms – Where patients subjective symptoms are rubrics

• Rubrics from ‘burning’ to ‘tickling’ 

Repertory of condylomata

• general rubrics
• subsections like
• locality – rubrics from ‘Anus upon or about’ to ‘Vulva upon’
• objectively considered- rubrics from ‘Bleeding’ to ‘White’
• subjectively – rubrics from ‘Burning’ to ‘Stitches in’

Repertory section for pruritis

• Just like a therapeutic notes of Homoeopathic medicines
• Starting from ‘Itching as from ants’ to ‘wandering’
• Separate section for locality-  ‘Anus’ & ‘sexual parts’ as rubrics

Index
Towards the end of the book index has been done

Comparison with synthesis repertory  & chapter SKIN of synthesis

General comparison
Vvarious skin diseases mentioned in Douglass skin have to search in the form of rubrics in Synthesis not only in chapter SKIN, but also in various other regional chapters & GENERALS chapter

Many of the clinical conditions mentioned under Douglass skin are olden terminologies, thus some are reproduced  with new terminologies in Synthesis & some couldn’t traced out

Remedies given in descripted form in Douglass skin should be searched under appropriate rubrics with an advanced 4 grades of  evaluation in Synthesis

Some clinical conditions are presented with few or no medicines in Douglass skin are upgraded with many medicines in Synthesis

Chapter SKIN of synthesis is arranged well systematically, from Rubric ‘Abscess’ to ‘wrinkled’, with quite a good number of medicines under each of them 

Clinical conditions in Chapter Skin which is not mentioned in Douglass skin diseases
Decubitus ulcer, dermatographism ,freckles, gangrene, goose flesh, intertrigo, graying of hair, rhagades, rupia, stings of insects etc

Clinical conditions in Douglass skin diseases but not seen in Chapter SKIN
Crns, Ephelis, Herpes labialis, Hordeolum, Ingrowing toe nails, disorders of perspiration, paronychia, scleroma, scleroderma, seborrhea,

These all conditions are given as rubrics in other chapters of Synthesis 

Comparison of Repertory part
In synthesis Repertory, Warts are given under chapter skin

Condylomata –in  chapter skin under rubric excrescenses

Subjective & objective symptoms are given as sub-rubrics of both of them

Localities are considered under various regional chapters

Other than chapter skin, rubrics for warts are given under

• nose
• face
• mouth
• external throat
• abdomen
• chest
• back
• Extremities
• skin

Rubrics for condylomata are given under chapters

• Eye
• throat
• rectum
• male genitalia/sex
• female genitalia /sex
• larynx & trachea

They both used as cross-reference to each other in many places

Synthesis have been improved with lot of new medicines under each rubrics than Douglass skin

But repertory part for warts & condylomata separately is an useful aid and has many useful rubrics which are not seen in Synthesis.

Rubrics of Douglass skin which are not seen in Synthesis

Repertory of Warts

• confinement, following, small : c.
• internal :
• isolated : c. Caust., Lyco., Natr. c.
• onanists, upon : Nitr ac., Sep., Sulph., Thuja.
• salt, from abuse of : Natr. mur., Nit. d. s.

Locality

• Anus, about : , Thuja.
• Arms, upon
• left forearm : Sulph.
• wrist (left) : Ferr. ma.
• Body : , Medor., Thuja.
• Buttocks, small scattered, flat, grayish -brown : Con.
• Cheek (left) : Calc. c., Sep., Thuja.
• Conjunctiva : Thuja.
• Cornea, warty in appearance : Sil
• Ears, behind : Calc. c. Thuja.
• Eyeballs, sensation as though was studded with :
• Eyes, under : Sulph.
• Fingers, little finger : Caust. Lac. c.
• Fingers, back of : Dulc., Lach.
• Fingers, side of : Calc. c., Sep., Thuja.
• Fingers, close to the nails : Caust.
• Fingers, rudimentary : Berb.
• Fingers, left hand : Psor.
• Genitals, upon glans penis : Nit. ac., Pho. ac., Thuja.
• Genitals, papilloma urethrae : Eucalyp., Thuja.
• Genitals, prepuce, fraenum and inner surface, bleeding when touched : Cinnab., Eucalyp.
• Hands,ball of the : Berb.
• Hands, wart-like induration in the palm,after a long continued pressure on the part : Borax.
• Head, upon : Caust., Sep.
• Neck, upon : Ant. cr., Calc. c. Lyco., Nit. ac., Sep., Syph., Thuja.
• Sternum : Nit. ac.
• Thighs, upon : Medor.
• Toes, upon : Spig.

Objectively

• Brittle : Ant. cr.
• Cauliflower, like : Nitr. ac., Ran. b., Thuja.
• Color, almost the color of the skin : Calc. c.
• Color, dark : Sep., Thuja.
• Groups or crops, in : Dulc., Lach., Nat. m., Psor., sep., Thuja.
• Incipient or recent : Nat. c.
• surrounded by a hepatic areola, with bran-like desquamation : Lyco.
• Malignant : Ars.
• Rough, upper surface whitish and horny : Calc. c.
• Scrofulous : Aur.
• Seedy : Calc. c., Caust., Medor., Nat. m., Sep., Thuja.
• Spongy : Alum. See soft.
• Sycotic : Alum., Aur., Cinnab., Medor., Mil., Nat. sulph., Phos. ac., Sars.
• Ulcers, having the shape of warts : Ars.
• Ulcers, originating in warts : Thuja.

Subjective 

• shooting : Ars., Bovis.
• Soreness of : Ambra., Ars., Hep., Lach., Nat. carb, Nat. mur., Nit. ac., Petrol., Ruta, Sabi., Thuja.

Repertory of condylomata

• mercury; after the abuse of : Aur., Lyco., Nit. ac., Staph.
• women particularly in : Merc. d., Sabi.

Locality

• Anus, upon or about
• Clitoris, upon or about : Thuja.
• Mouth, upon or about (inner) : Phos. ac.
• Neck, upon or about : Nit. ac.
• Perineum, upon : Merc. d., Thuja.

Objectively considered

• Bulbous : Alum.
• Cauliflower or mulberry like : Staph., Thuja.
• Conical : Ka. mur., Merc. v., Thuja.
• Filiform : Staph.
• Gonorrhoea, complicated with
• Moist, offensive : Medor., Merc. d., Nit. ac.

smelling like fish-brine : Sanic.
herring-brine : Calc. c., Graph., Hep., Thuja.
old cheese : Calc. c., Hep., Thuja.
yellow fluid : Medorrh.

• Moon, worse with the increase of the : Thuja.
• Soft and spongy : Alum., Nat. sulph., Sulph.
• Split : Lyco., Nit. ac., Thuja.
• Strawberry-like : Medor
• Tubular : Thuja.
• Wart-shaped : Benz. ac., Nit. ac., Nux vom., Sars., Sulph., Thuja.
• White : Lyco.

Subjectively

• Painful, even when free from contact : Sabi.
• Painless : Lyco.
• Pain in bones or bone pains, with : Pho. ac.
• Sore, when touched : Euphr., Thuja.
• Stinging : Thuja.
• Stitches in : Euphr.especially when walking : Euphr

Repertory part of pruritis

• Itching as if from ants : Lach., Phos., Puls., Secale.
• Creeping : Sil.
• Dull : Hepar.
• As if electric sparks : Phell.
• Itching as of lice : Arg. n., Canth., Magn. m., Plat., Zinc.
• As from mosquito-bites : Rhus ven.
• As of nettles : Colch., Lupul.
• Painful : Alum., Ammon., Baryt., Cham., Cocc., Lupul., Nitr.
• Pinching : Mosch.
• Pleasant : Merc.
• Prickling : Cin., Plat., Zinc.
• nates, between the : Alum., Con., Seneg.
• Sexual parts

testicles : Merc.
clitoris : Sulph.
vagina : Canth., Con., Kreos., Sulph. 

Rubrics of Synthesis  which are not seen in Repertory of warts & condylomata

• SKIN – WARTS – bathing agg. -psor.
• SKIN – WARTS – cold washing agg. -dulc.
• SKIN – WARTS – growing  -kali-c.
• SKIN – WARTS – smelling like old cheese- Calc. Graph. Hep.  THUJ.
• SKIN – WARTS – thick-  dulc.
• SKIN – WARTS – venereal- med. nit-ac. thuj.
• SKIN – WARTS – warm bed agg.-  psor.
• SKIN – EXCRESCENCES –  condylomata – rapid growing  –Thuj.
• SKIN – EXCRESCENCES – condylomata – syphilitic- Cinnb. Merc. NIT-AC. Thuj.

Conclusion
It is an useful book which has practical value Homoeopathically, but for the sake of getting dermatological knowledge, its not a reliable aid  as the field of dermatology is getting updated by each minute.

Repertory part for warts & condylomata is an useful with a very simple construction, with some worthy rubrics and only 90 medicines which are easier in clinical application. But in Synthesis, they are properly arranged in appropriate heads which are easier for reference, with essential modality rubrics and with a broad number of medicines.