Glossary

Sources: www.127; www.180; www.224; www.203.

Crural hernia: the term hernia designates the total or partial shifting of one or more organs or anatomical formations from their normal site to another through the wall of the cavity containing them, or through a pathological orifice or yet an orifice that became pathological. Crural hernia, also known as femoral hernia, is the protrusion of abdominal or pelvic viscera through the crural channel, a fibrous conduct which, in Scarpas triangle, contains the femoral vessels. It may be small and asymptomatic, or with slight symptoms and then complicated in virtue of imprisonment or strangulation. The treatment, therefore, is necessarily surgical. As it is an affection accessible to touching, and easily detectable, knowledge about hernias dates back to Antiquity. They are mantioned in Ebers papyrus, 1500 b. C., and represented in very ancient Greek terra cotta pieces. In the first century a. C., Celsus performed several operations of inguinal hernia. In 1869 Joseph Lister practiced the first operation of a strangled hernia using antiseptic principles. The anatomical bases for the development of this type of surgery were established by Antonio Scarpa (1748-1832), Julius Germain Cloquet (1790-1883), Antonio de Gimbernat (1742-1790), Sir Astley Paston Cooper (1768-1841), Franz Kaspar Hesselbach (1759-1816) and, especially, by Eduardo Bassini (1844-1929).

Sources: Ferreira, 1999; Larousse, 1971; Houaiss, 2001; www.154.

Cryptococcosis: known in the past as European blastomycosis, Buschke's disease, or yet Busse-Buschke's disease, it was also called torulosis, because its causative agent had as a synonym the name "histolytic torula". It is an acute, subacute or chronic infection related to a pulmonary, systemic or meningeal mycosis. The agent is Cryptococcus neoformans, an encapsulated yeast existing everywhere and which is generally inhaled. The primary pulmonary infection is frequently asymptomatic and may remain in the lung or develop into a chronic form with lesions in other organs of the body. Cryptococcosis is considered an opportunistic infection, as it mainly affects individuals suffering from immunodepression. The genus Cryptococcus comprises 37 species, but the greatest human pathogen is C. neoformans. Medical literature registers very few cases of cryptococcosis caused by other species (C. albidus and C. laurentii). The disease was described for the first time by Otto Busse and Abraham Buschke in Germany, in 1893. They at first recognized a tumor in the leg of a 31 year old female patient, but as pus was extracted from the bone lesion, doctors were able to identify the parasite in microscopic examinations and in cultures, hence resulting the identification of the first case of cryptococcosis. The disease has already been sporadically observed in all domestic mammals, but it occurs especially in cats and dogs; in a few instances it has been reported in horses. It may cause the appearance of tumoral masses of mucoid aspect or lesions without increase of volume, but of a gelatinous consistence, in any part of the organism, with a marked preference for the brain and the meninges. Although cryptococcosis is called European blastomycosis, in 1934, Rhoda Behnam demonstrated that it is different from blastomycosis. (See Cryptococcus neoformans).

Sources: Stedman, 1979; www.17; www.59.

Cryptococcus neoformans: one of 37 species of the genus Cryptococcus, which reproduce by budding and do not develop spores. Cryptococcus neoformans is an encapsulated fungus measuring from 4 to 7 micrometers, enveloped by a polysaccharide capsule whose thickness varies from 1 to 30 micrometers. The main causative agent of cryptococcosis (also known as European blastomycosis or torulosis), it attacks the skin, the lungs, and, principally, the brain and its membranes. C. neoformans was first isolated from peach juice, in Italy, by Francesco Sanfelice. Almost at the same time, two German doctors, Abraham Buschke e Otto Busse, isolated the fungus from lesions having the appearance of sarcomes. Sanfelice called that cryptogamic yeast Saccharomyces neoformans; Busse called it Saccharomyces hominis. The disease caused by the fungus would be called saccharomycosis. In 1895, the French pathologist Ferdinand Curtis described that fungus as a vegetable parasite belonging to the species of yeasts causing soft tumors in tissues, some of them of a myxomatous appearance. Curtis gave to that encapsulated yeast the name Megalococcus myxoides. In 1901, the French mycologist Jean-Paul Vuillemin transferred the species to the genus Cryptococcus (Greek kryptos, occult), due to the absence of endospores. (See Cryptococcosis; Saccharomyces).

Sources: Stedman, 1979; www.17.

Cryptogams: original designation of one of the two main groups in which Carl von Linné (1707-1778) divided Vegetable Kingdom, including algae, fungi, mosses and ferns. No longer employed as a taxonomic group, its subgroups are nowadays placed in different taxons. In common usage, however, the term may be used to designate any plant devoid of apparent sex organs, reproducing itself by means of spores or gametes instead of seeds.

Sources: Ferreira, 1999; Houaiss, 2001; www.158.

Curschmann's spirals: helicoidal agglomerate found in the spittle of patients with asthmatic bronchitis, described by Heinrich Curschmann, from Leipzig (1846-1910).

Sources: Cardenal, 1954; Dorland, 1947; Stedman, 1979.

 

D

Danielssen, Daniel Cornelius: Norwegian doctor born on July 4, 1815, in Bergen. After graduating in medicine at Christiania University in 1839, he took specialized courses on physiology, chemistry and skin diseases, beginning his investigations on leprosy at St. Jorgens Hospital. In that institution he met Carl Wilhelm Boeck, in July 1840, and started working with him in the research of morphaea. Under the auspices of the Norwegian government, in 1847, they published Om Spedalskhed (On Leprosy), a reference work of modern literature about that disease. The father-in-law of Gerhard Armauer Hansen (1841-1912), Danielssen diverged from his son-in-law about leprosy transmission. As Boeck, he defended the hereditary character of the disease, what did not prevent them of investigating other possibilities of transmission. Meanwhile Hansen, the discoverer of the leprosy bacillus, remained a decided defender of its contagiousness. Danielssen died in Bergen on July 13, 1894. (See Boeck, Carl Wilhelm; Leprosy).

Sources: www.231.

Dematiaceae: a family of Fungi Imperfecti, order Monidiales, producing simple conidiophores (hyphae in whose apex spores are formed). (See Fungi; Hypha).

Sources: Stedman, 1979.

Dermatomycosis: skin infection produced by parasitic fungi. The same as dermatophytia.

Sources: D'Elia, 1926; Houaiss, 2001.

Digitalis: common designation for herbs of the genus Digitalis, family Scrophulariaceae, with about 19 species, native of Europe and the region extending from the Mediterranean to Central Asia. Its flowers are shaped like glove fingers, disposed in raised bunches, hence the Latin name of the genus. The commonest species, Digitalis purpurea, occurring in silicic soils, has purple flowers; that of calcareous soils, yellow ones. Plants of this species are known as Digitalis or foxgloves, and the powder obtained from their leaves is a cardiotonic that diminishes the heart's rhythm, regularizing and reinforcing its contractions. Such properties are due to the glycosides that they contain (particularly digitalin). From the species Digitalis lanata, cardiotonics digoxin and lanatoside are extracted. Digitalic derivatives are employed in pills and drops for oral therapeutics or in injections (intramuscular or intravenous). The use of digitalin for heart diseases was introduced in 1785 by the British doctor William Withering.

Sources: Houaiss, 2001; Larousse, 1971; Koogan-Houaiss, 2004; Stedman, 1979.

Diplococcus: a coconut-shaped bacterium whose elements group in pairs. (See Bacteria).

Sources: D'Elia, 1926; Houaiss, 2001; Landouzy & Jayle, 1902; Littré & Gilbert, 1908; Stedman, 1979.

Duhring's disease: chronic dermatological affection characterized by severe pruriginous lesions and extensive papulo-vesicular eruptions, which principally affect elbows, scalp, knees, buttocks, nape and upper part of the back. It indistinctly affects men and women in the proportion one to every 100,000 people, being commoner among whites than in negroes and less frequent in Asians. Spontaneous cure seldom happens, except in children. The re-incidence rate of the infirmity is very high, but the treatment associating sulphones and alimentary diet devoid of gluten produces satisfactory results. Some scholars consider Duhring's disease as a variation of the coeliac disease, whose more evident trait is the sensibility to oats, rye, corn and other cereals, in all its bearers. Also known as circinated herpetiform blister, Brocq-Duhring or Duhring-Brock's disease, herpetiform dermatitis, multiform dermatitis ou herpetiform hydroa. (See Brocq, Louis-Anne-Jean; Duhring, Louis Adolphus).

Sources: Cardenal, 1947; Dorland, 1947; Stedman, 1979; www.92; www.93; www.123; www.129.

Duhring, Louis Adolphus: North American dermatologist born on December 23, 1843, in Philadelphia, graduated from Pennsylvania University, where he also took his doctorate degree (1867). Before embarking to Europe (Paris, London and Vienna), where he specialized in dermatology, he worked at Bockley Hospital. In 1871, he became professor of skin diseases at Pennsylvania University. He had a very important role in the description of herpetiform dermatitis (1884) or Duhring's disease, also studied by William Tilbury Fox and Louis-Anne-Jean Brocq (1888). He died on May 8, 1913, in Philadelphia. (See Brocq, Louis-Anne-Jean; Duhring's disease).

Sources: Cardenal, 1954; Cardenal, 1960; Dorland, 1947; Stedman, 1979; www.92; www.93; www.122; www.123.

E

Echtyma: a dermatitis of erosive and ulcerating nature caused by streptococci. Commoner in undernourished individuals suffering from diabetes or with affected immunological system. It also occurs under precarious situations of hygiene or as a consequence of small traumas, under the form of unique or multiple bacterial ulcers covered by crusts with a preferential location in the legs. D'Elia (1926) reveals that the term "echtyma" was employed by Ancients to designate various dermatological affections or affections of uncertain definition (furuncles, mange, etc.). Murray (1910) and Landouzy & Jayle (1902) had already employed this term in its present meaning.

Sources: Cardenal, 1960; D'Elia, 1926; Dorland, 1947; Houaiss, 2001; Landouzy & Jayle, 1902; Murray, 1910; Stedman, 1979; www.94; www.130.

Eczema: general term designating an acute or chronic allergic affection of the skin, characterized by erythemas, aedemas, papulae, vesicles and inflammatory reaction with formation of crusts, followed by lichenification, descaling, and occasionally darkening of the erythema; hyperpigmentation is less frequent; but not rarely there is a sensation of itching and burning. The expressions dry dermatosis or scaly dermatosis are colloquially used as synonyms of eczema. During D'Elia's times (1926), a microbial origin was admitted for the disease, although its producing agent had not yet been discovered; it was then considered that its development was favored by constitutional alterations (lymphatism, scrofulas in childhood, uric diathesis, and other "dyscrasies" of adult age); by hindrances of the stomach, liver and kidneys causing modifications in the chemical constitution of the blood and humors; and, probably, by the "disarrangement" of the nervous system. Very frequently, one may still read in D'Elia (1926) that the disease had as a "determinant cause" the influence of external agents (irritating chemical substances, thermal or mechanic irritations, insalubrious jobs, etc.) and local hindrances of the circulation (varices).

Sources: D'Elia, 1926; Stedman, 1979.

Efflorescence: elementary lesion of the skin; it may be primary (purple, pigmentary, vascular spots, exanthemas, papulae, urticary plaques, tubercles, gums, tumors, vesicles, blisters, pustules) or secondary (erosions, fissures, rhagades, lichenifications, ulcerations, crusts, etc.).

Sources: Larousse, 1971.

Eichstedt, Carl Ferdinand: German physician (1816-1892) who, in 1846, recognized the contagious nature of pitiriasis versicolor when, in the scales of lesions caused by that disease, identified its agent: a fungus, later called Microsporum furfur. Those investigations, made at the University of Greifswald, in Germany, began in 1842 and were part of the first mycological researches applied to medicine. (See Vesicular pityriasis).

Sources: www.60; www.63.

Empyema: Pus accumulation in any cavity of the organism, as, for instance, the pleural cavity, the bile vesicle, the cecal appendix and the maxillary antrum. When used without specification, it refers to pyothorax (pus in the pleural cavity).

Sources: Ferreira, 1999; Houaiss, 2001; Koogan-Houaiss, 2004; Stedman, 1979.

Entozoans: several groups of helminths. In ancient classifications, a taxon encompassing several endoparasitic animals, especially intestinal worms such as flatworms, trichinae, and roundworms (Ascaris).

Sources: D'Elia, 1926; Houaiss, 2001; Koogan-Houaiss, 2004.

Erysipelas: also called in Portuguese mal-do-monte, mal-da-praia, maldita and esipra, is an infectious disease generally caused by Streptococcus pygenes group A, involving, in more severe cases, other types of bacteria (Staphylococcus, Pseudomonas). The etiological agent penetrates the organism through lesion caused by mycoses in the patient's nails (onichomycoses) or between his toes (in Portuguese "frieira", "pé-de-atleta"), scratches and skin boils, itching caused by insect bites, etc. The bacterium mostly thrives in the lymphatic vessels of the skin and may reach the subcutaneous cellular tissue. The agent of erysipelas was observed in the pus of deep lesions by the end of the 1870's by Louis Pasteur in France, and Robert Koch in Germany. Pure cultures were obtained from materials extracted from the teeth of persons affected with erysipelas in 1883 by Friedrich Fehleisen (1854-1924) and the following year by Anton Julius Friedrich Rosenbach (1842-1923). It was the first demonstration of the specific germ of a surgical infection. A Viennese surgeon, Theodor Billroth (1829-1894) was the author of the name Streptococcus. Rosenbach gave the variety isolated from suppurative lesions the name Streptococcus pyogenes. The classification was improved in 1903 by Hugo Schottmüller, thanks to the technique of culture in dishes with agar and blood, developed by him. From studies made at the Rockfeller Institute for Medical Research from 1918 on, Rebecca Craighill Lancefield (18951981) demonstrated that group A (S. pyogenes) is specific to human infirmities, and that group B is associated with neonatal diseases. She also demonstrated that the great variety of serum types within the first group is due to antigen variations of a protein of the cell wall which she called protein M. Streptoccus pyogenes is one of the most frequent pathogens of humans. It is estimated that from 5 to 15% of individuals harbor it without showing symptoms of any disease. When the bacterium is introduced in vulnerable tissues, several types of suppurative infection of the respiratory tract, blood stream and the skin may occur, infections which were responsible for many deaths in Adolpho Lutz's times. Besides being the main agent of erysipelas, Streptococcus pyogenes is related to puerperal fever, scarlet fever, pharingitis, tonsilitis, impetigus, cellulitis and other infections, that may result in post-streptococcic aftermaths such as acute rheumatic fever and glomerulonephritis. Patients with chronic venous insufficiency or decrease in the number of lymphatic vessels have a higher predisposition to acquire erysipelas, as is the case of women submitted to mastectomy or bearers of lymphedema. Repeated bursts of erysipelas may cause elephantiasis nostra, with increase of volume of the affected place due to a persistent and hard edema, the skin acquiring a verrucose aspect. Erysipelas is most commonly located in the skin of the face or in the scalp, but, according to D'Elia (1926), it may attack other parts of the body, including the meninges. It is clinically characterized by strong fever, inflammation of the skin, with heat, redness and swelling of the skin and the nearby lymphatic glands, abundant serous sweat deposited in the skin tissue and in the subcutaneous connective tissue, ending in suppuration. Patients may show loss of appetite, agitation and pains in their joints. Treatment mainly consists of the use of penicillin and sulfas. Ancient sources attribute the disease to Streptococcus erysipelatis, qualified by D'Elia (1926) as a facultatively anaerobic micrococcus normally found in the air, water and soil and on the skin, mouth and duodenum. Epidemics of erysipelas, very common in the past, became rare due to the processes of sanitation and the appearance of antibiotics. However, more recently, and for reasons not yet clear, there has been a resurgence of severe infections by Streptococcus pyogenes, sometimes leaving serious sequels.

(See Streptococcus).

Sources: D'Elia, 1926; Ferreira, 1999; Houaiss, 2001; Koogan-Houaiss, 2004; Stedman, 1979.

Erythema ou erythematous dermatitis: skin redness due to the dilatation of the cutaneous capillary vessels for several causes. As a rule, it is temporary, and momentarily disappears under the pressure of a finger.

Sources: Ferreira, 1999; Larousse, 1971.

Erythematous lupus: also called lupus, systemic erythematous lupus, disseminate erythematous lupus, superficial lupus, centrifugal ulerythema, Biett's disease, Cazenave's disease or centrifugal erythema. A chronic inflammatory disease of the skin of spectral nature, characterized by ulcerations or spots varying according to the specific type. Of slow evolution, it provokes fever, loss of appetite, articular and cutaneous manifestations, especially spots on the face similar to butterfly wings, that may spread and reach other organs. Lupus is a self-immune infirmity: the immune system attacks the cells themselves and the healthy tissues, by reasons unknown up to day. The disease presents three main forms: the chronic one there are only cutaneous lesions; the subacute form is characterized by more disseminated cutaneous lesions and by more acute clinical and histological aspects than those observed in the chronic discoidal phase; in the systemic or disseminated form there is commitment of vital structures. The disease attacks principally young women, from the end of adolescence to the age of 30, and affects each person in a distinct form. Studies on erythematous lupus comprise three periods. During the classic period, descriptions of the cutaneous disorders that characterize the disease were made, by Thomas Bateman (17781821), disciple of the English dermatologist Robert Willan, in the beginning of the 19 th century; by Ferdinand von Hebra and by Pierre Louis Alphée Cazenave (disciple of the French dermatologist Laurent Theodore Biett, 1781-1840) in the middle of the same century. The lesions of the form now called discoid lupus were described in 1833 by Cazenave, who employed the expression centrifugal erythema; the butterfly-wing-shaped facial lesions were studied in 1846 by Hebra, author of the first illustrated publication about erythematous lupus and other dermatological diseases, Atlas der Hautkrankheiten (Atlas of skin diseases, 1856-1876). The neoclassic period had its beginning in 1872, when Moritz Kohn Kaposi, Hungarian dermatologist (1837-1902), son-in-law and successor to the Austrian dermatologist Ferdinand von Hebra, described the systemic nature of erythematous lupus, distinguishing the discoid and the disseminated types. In his "Neue Beiträge zur Kentniss des Lupus erythematosus" (New contributions to the knowledge of erythematous lupus, Archives of Dermatology and Syphilology, 1872, v.4, n.36), Kaposi analyzed the various symptoms characterizing the latter form: subcutaneous nodules, arthritis with hypertrophy of the large and small joints, lymphadenopathy, fever, loss of weight, anemia and involvement of the central nervous system. The works undertaken by Sir William Osler (Canadian doctor, 1849-1919, Oxford), in Baltimore ("On the visceral manifestations of the erythema group of skin diseases - third paper", American Journal of Medical Sciences, 1904, v.127, n.1), and Josef Jadassohn (German dermatologist, 1863-1936) in Vienna ("Lupus erythematodes" in Mracek F., Ed., Handbuch der Hautkrakheiten, Wien: Alfred Holder, 1904, p.298-404), during the turn of the 19 th to the 20th century, consolidated the knowledge about disseminated or systemic lupus. The modern period is inaugurated with the application of immunology to studies of erythematous lupus and the discovery, in 1947, of LE (lupus erythematosus) cells by R. J. Morton. In the following years, Malcolm McCallum Hargraves, a North American doctor, born in 1903, and his collaborators recognized those cells in the bone marrow of their patients with acute dissemination of erythematous lupus and affirmed that they were the result of phagocytosis of the free nuclear material. Other important advances in the study of lupus were the development of animal models and the recognition of the role of genetic predispositions for the development of the disease. Its prevalence amidst certain families was initially investigated by Johann Otto Leonhardt Heubner (German doctor, 1843-1926) in 1954 and later by Frank Cheryl Arnett (professor and head of internal medicine and director of the area or rheumatology at the University of Texas Medical School, in Houston), and Lawrence Edward Shulman (North American rheumatologist born in 1919), who published together "Studies in familial systemic lupus erythematosus" (Medicine, 1976, v.55, n.313). Nowadays molecular biology is revolutionizing the knowledge of the disease and it is hoped that researchers may identify its etiological factors. Up to the end of the 19th century treatment of lupus consisted in the use of quinine, sometimes combined with salicillates. The treatment of systemic lupus was revolutionized by the discovery made by Philip Showalter Hench (North American doctor, 1895-1965) in the middle of the 20th century, that the adrenocorticotropic hormone - ACTH, and cortisone were effective drugs. Nowadays, corticosteroids are the basic drug in the treatment of the disease, and studies of new biological agents are under way, to try to obtain the cure for lupus. (See Tuberculous Lupus). Sources: Houaiss, 2001; Stedman, 1979; www.1; www.2; www.35; www.67; www.69; www.73; www.74; www.75; www.76.

Ether: organic compound constituted by two hydrocarbon groups bound to the same oxygen atom. It results from the combination of an alcohol with an acid or other alcohol, with elimination of water. Under heat, sulphuric acid produces, with alcohol, sulphuric ether, also called ethyl oxyde, ethylic ether or common ether, whose formula is (C H ) O. It is a colorless liquid with characteristic odor, 2 5 2

light and volatile, very inflammable, boiling at 34º C. The paralyzing action upon the nervous system has conferred it anesthetic properties. Ether inaugurated modern anesthetics, together with nitrogen protoxyde, when it was employed in the United States around 1840, first in dental, and then in general surgeries. Once inhaled, ether provokes an accentuated muscular relaxation and allows ample oxygenation. The inconveniences of its use are its irritant action upon respiratory ways and kidneys, as well as the increase of intracranial pressure, rendering it counter indicated in neurosurgery. It is used as solvent and for other industrial purposes.

Sources: Ferreira, 1999; Larousse, 1971; Koogan-Houaiss, 2004.

European blastomycosis: name used in the past to designate cryptococcosis. (See Cryptococcosis).

Fonte: www.17.

 

F

Faradization: therapy that uses electric current as inductor or stimulator of nerves and muscles. The Frenh doctor Guillaume Benjamin Amand Duchenne, called Duchenne de Boulogne, is considered the introducer of electricity in the diagnostic and treatment of neurological affections, with whose help he described and treated progressive locomotory ataxy (tabes), progressive muscular paralisies and other pathologies of the nervous system. The term faradization derives from Michael Faraday, English physicist and chemist (1791-1867), who created the theory of electrostatic induction and discovered electromagnetic induction (1831), providing the bases for James Clerk Maxwell's (1831-1879) theory of electromagnetism. According to D'Elia (1926), induced electric current acted in a special way upon muscular contractility and nervous excitation, giving results considered excellent in paralyses by central lesion.

Sources: D'Elia, 1926; Ferreira, 1999; Larousse, 1971; Houaiss, 2001.

Favus: mycotic infection of the scalp caused by Trichophyton schoenleinii, sometimes also attacking nails and glabrous regions of the skin. Characterized by the formation of small purulent crusts similar to honey-combs, in whose center is found the parasitized hair. The infected hairs are easily breakable, atrophied and fall down very easily. The disease has been known since the Middle Ages. Its best description was made by Raymond Sabouraud (1864-1938). The etiological agent was discovered by the German doctor Johann Lukas Schoenlein (17931864), in 1839, for this reason being called Achorion schoenleinii by Robert Remak (1815-1865). Later on, a new classification of the fungi places Achorion as a junior synonym of Trichophyton, a genus related to Microsporum and Epidermopphyton. Also called in Portuguese "tinha favosa" or simply "favosa".

Sources: D'Elia, 1926; Fitzpatrick, 1971; Larousse, 1971; Houaiss, 2001; Landouzy & Jayle, 1902; Littré & Gilbert, 1908; Stedman, 1979; Veronesi, 1982; Weitzman & Summerbell, 1995; www.159.

Foliaceous pemphigus: a peculiar form of pemphigus characterized by a vesicular cutaneous eruption accompanied by descaling, with imperceptible pustulation. A crusty superficial epidermic lesion normally appears replacing ruptured blisters. Foliaceous pemphigus was described by Pierre Louis Alphée Cazenave (17951877) in 1844, being for this reason, it is also known as Cazenave's disease. Previously, two probable cases of the same infirmity had been described, the first of them by de la Motte, in 1772. (See Pemphigus).

Sources: Cardenal, 1960; D'Elia, 1926; Ferreira, 1999; Larousse, 1971; Houaiss, 2001; Littré & Gilbert, 1908; Murray, 1910; Stedman, 1979; www.187; www.188.

Fowler's liquor, Fowler's arsenical liquor or, yet, Fowler's solution: a remedy conceived by the English doctor Thomas Fowler (1736-1801), constituted by arsenic acid, pure potassium carbonate (5 g), distilled water (500 g) and compound Melissa alcoholate (15 g). According to Littré & Gilbert (1908), the liquor contained the hundredth part of its weight in arsenic acid, or 0.01 grams of acid per gram of liquor. The posology was from 2 to 12 drops, several times a day. Fowler's liquor was used as tonic and in the treatment of infectious processes and cutaneous affections such as lichen ruber and psoriasis. Up to the first decades of the 20th century it was also employed in the treatment of leukemia. (See Lichen ruber).

Sources: D'Elia, 1926; Littré & Gilbert, 1908; Paulier, 1882; www.149; www.150; www.151.

Fowler's solution: See Fowler's liquor.

Framboesia tropica: See Yaws.

Fuchsin [C H CIN ]: a variety of rosanilin-red dye, which 20 20 3

electively fixes itself in certain elements, rendering easier their observation. It is employed in bacteriology and histology, especially under its ammoniacal form (Gram's method), which divides the bacteria into Gram-positive and Gram-negative, according to the greater or lesser fixation of the dye. It is also used in the textile industry for staining hides. (See Staining; Gram's method).

Sources: Dorland, 1947; Houaiss, 2001; Stedman, 1979.

Fungi: common designation for organisms belonging to the Kingdom Fungi, heterotrophic beings, especially saprophytic or parasitic, without chlorophyll, whose nutrition is effectuated by absorption. They grow in irregular masses, are devoid of roots, stem and leaves, reproducing sexually or asexually. They may exist as a simple cell, as in the case of yeasts, or form a multicellular vegetative structure called mycelium, constituted by ramified threads called hyphae. Fungi are usually encountered in moist environments or as parasites of plants, animals, and even man. The most widely known examples are molds and mushrooms. Some form are pathogenic, while others are used as food and in the production of antibiotics. During a long time fungi have been included in the group of lower plants and, in this condition, close to bacteria. By the end of the 19th century, both terms were practically considered equivalent, as well as the denominations microbe, germ and Schizomycetes. Notwithstanding this classification, fungi present a set of particular characteristics allowing their separation from plants: they do not synthesize chlorophyll, do not show cellulose in their cell wall (except for some aquatic fungi) and do not store starch as a reserve substance. Besides, their cell wall is formed by chitin, the same substance enveloping the body of arthropods. Because of these and other differences, in 1969 they passed to be classified as a Kingdom apart. The Kingdom Fungi is constituted by six divisions, four of them having medical interest: Zygomycota, Ascomycota, Basidiomycota and Deuteromycota. In the last years, the introduction of new methods of analysis, particularly biotechnological techniques, produced many modifications in the classificatory system of fungi. The 1995 edition of the Dictionary of Fungi, a reference work for students of that subject, considers them distributed into three distinct kingdoms: Protozoa, where some pathogens are included, such as, for instance, species of the genera Plasmodiophora and Spongospora; Chromista, containing the Oomycota fungi; and the Kingdom Fungi itself, constituted by the so-called true fungi. One of the most significant changes was the transference of Oomycetes from the Fungi Kingdom to the Kingdom Chromista. According to specialists, the Oomycetes differ from true fungi by several structural, biochemical, physiological and molecular characters. Another important change was the extinction of the Class Deuteromycetes, formed by the so-called imperfect fungi (those whose sexual stage has not been identified). The recent modifications in the taxonomy of the fungi are still matter of dispute among specialists and new changes may occur with the introduction of more advanced techniques. (See Bacteria; Mushroom; Hypha).

Sources: Cardenal, 1960; Dorland, 1947; Ferreira, 1999; Houaiss, 2001; Koogan-Houaiss, 2004; Littré & Gilbert, 1908; Murray, 1910; Stedman, 1979; www.144; www.145.

Fungoid mycosis: also called fungoid granuloma, ulcerating scrofuloderma, Alibert's disease, Alibert-Bazin's syndrome, fungoid fibroma, granulosarcoid, granulosarcoma and sarcomatoid granuloma. A rare and fatal disease, characterized by progressive and chronic reticulosis of the dermis, with proliferation of abnormal cellular elements, necrosis of liquefaction and invasion of the epidermis, with the formation of clear spaces containing mononucleate cells (Pautrier's abscesses). The commonest of limphomatous diseases attacking the skin, fungoid mycosis is characterized by the development of lichenoid plates, which become painful red and mild tumors, with a tendency to ulceration and expansion. It was first described by Jean-Louis-Marc Alibert (1768-1837), French dermatologist who, in 1835, called it fungoid mycosis due to the shape of the tumors, which resemble mushrooms, and not at all due to his intention of stressing a fungal etiology whatsoever. Though unfit, the name is maintained due to its historical antecedents. (See Bacteria; Mushroom; Hypha).

Sources: Cardenal, 1947; Houaiss, 2001; Stedman, 1979; www.59.

Furunculosis: staphylococcal abscess caused by Staphylococcus aureus, characterized by the synchronic and consecutive appearance of furuncles. An extremely acute and painful infection, limited to the sebaceous hair follicles, assuming the shape of an abscess in the central part of the swollen region, which disappears at variable intervals. It habitually occurs in the armpits, the buttocks and the nose.

Sources: D'Elia, 1926; Houaiss, 2001; www156.

G

Goa powder: See Chrysarobin.

Gieson, Ira van: histologist and bacteriologist from Nova York (1865-1913). (See van Gieson's staining).

Source: Stedman, 1979.

Gilchrist, Thomas C.: North American doctor (1862-1927). (See North American blastomycosis).

Source: Stedman, 1979.

Glossy skin or atrophoderma neuriticum: a condition following the inflammation and lesion of trophic nerves, in which the skin, generally of the hands, presents erythemas and assumes a glossy, grayish color. It may manifest itself in association with alopecia, fissures and ulcerations of the skin. Also known as glossy skin, atrophoderma neuriticum or glossy atrophy of the skin.

Sources: Dorland, 1947; Stedman, 1979; www.71; www.72.

Gougerot, Henri: French doctor (Saint-Ouen, Seine, 1881 - Paris, 1955), professor of cutaneous and syphilitic diseases at Saint-Louis Hospital from 1928 a 1952. Author of important papers on cutaneous mycoses (sporotrichosis), microbial dermoepidermites, allergy, and syphilis treatment and prevention. (See Sporotrichosis; Syphilis).

Source: Larousse, 1971.

Gram's method: a technique of histological coloration developed by the Danish doctor Hans Christian Joachim Gram (1853-1938). Employed in the study of pathogenic microorganisms, it is the most popular method for the classification and identification of bacteria. It is based upon the greater or lesser retention of certain dyes in the interior of the bacterial cell due to the structure and chemical composition of its cellular wall. In the beginning of the process, bacteria are submitted to a staining by gentian-violet and afterwards to a solution of lugol. After discoloration in alcohol, the microorganisms are rinsed, counter-stained with safranin, again rinsed and then dried. Those that retain the acquired coloration are classified as Gram-positive, those which do not are called Gram-negative. (See Fuchsin; Staining).

Sources: D'Elia, 1926; Dorland, 1947; Nosso Século, 2002; Houaiss, 2001; Landouzy & Jayle, 1902; Littré & Gilbert, 1908; Stedman, 1979.

Guayacol: a substance derived from creosote, which in turn is extracted from beech trees (common designation for trees of the genera Fagus and Nothofagus, family Fagaceae), used in a large measure in the treatment of pulmonary tuberculosis and local antiseptic. Some of its derivates were also used in the treatment of typhoid fever (guayacol carbonate), rheumatism and intestinal affections (guayacol salicilate). It also served as an expectorant.

(See Creosote).

Sources: Dorland, 1947; Houaiss, 2001; Stedman, 1979.

Gummatous lymphagitic sporotrichosis: the same as Schenck's disease. (See Sporotrichosis).

Source: Stedman, 1979.

Gynocardic acid: substance constituted by the mixture of fat acids extracted by saponification from chalmoogra oil. Of a pasty and crystalline aspect and yellow color, it is soluble in alcohol, ether, chloroform, benzine, etc. It was employed in the beginning of the 20 th century in the treatment of leprosy, psoriasis, eczema and lupus. Applied by means of subcutaneous injections, it seemed to be more efficient than the oil and better tolerated by patients. According to Cardenal, it is the oil extracted from Gynocardia odorata, a plant belonging to the family Bixaceae. Hackh, by his turn, presents it as the product of a mixture of acids from chalmoogra oil with non-saturated acid extracted from Gynocardia odorata seeds.

Sources: Cardenal, 1954; Grant, 1944; Littré & Gilbert, 1908; Parascandola, 2003.

 

H

Hard chancre: typical lesion due to primary syphilis, characterized by hard and painless ulceration, generally located on the genital region. It starts developing during the first phase of the disease, which goes from the development of the chancre itself up to the surging of the eruption. It generally begins about a month after contagion and abates spontaneously within three to five weeks. For a long time, clinical manifestations of syphilis were identified with those of gonorrhea. In 1838, French dermatologist Phillippe Ricord (1800-1889) established the differences between the two diseases and defined the primary, secondary and tertiary stages of syphilis. Also called syphilitic chancre or primary lesion. (See Syphilis).

Sources: Bier, 1957; Houaiss, 2001; Landouzy & Jayle, 1902; Littré & Gilbert, 1908; Stedman, 1979; Veronesi, 1982; Wyngaarden, 1992; www.164.

Hebra, Ferdinand Ritter von: born in Brünn, now in the Czech Republic, on September 7, 1816, he graduated in Medicine at the University of Vienna in 1841 and became assistant of Josef Skoda (1905-1881), one of the masters of Viennese clinical medicine and responsible for the section of thoracic diseases at the Allgemeines Krankenhaus (General Hospital), a section that, curiously enough, had an infirmary for skin diseases. Hebra dedicated himself initially to the study of mange. He supposed at first that it was a systemic disease, but soon verified that it was caused by a mite. He published his discovery in Über die Krätze (1844). Making experiments with irritants, such as croton oil, which, rubbed upon the skin, gave place to an eczema, Hebra observed that any inflammatory process could be produced by external factors, a fact proving the existence of specific pathological alterations of the skin, unexplainable at the light of general pathology. Without denying the existence of systemic diseases, he started to grant a great importance to local factors in the production of cutaneous diseases, deviating from the constitutionalist theories maintained by the French school. He thus denied the humoral theory to explain the cause of those infirmities, calling attention to the role played by microorganisms. Hebra had been a student of Karl von Rokitansky (1804-1878), one of the founders of modern pathological anatomy, whom he succeeded in the presidency of Wiener Akademie der Wissenschften (Vienna Academy of Sciences). He applied Rokitansky's methodology in dermatological studies and in 1845 proposed a new classification of skin diseases, distributing them in 12 main categories. The system he created became an obligatory reference among dermatologists and was kept in use for almost a century. Notwithstanding the importance of his studies of pathological anatomy, it was in clinic that he left his greatest contributions. Hebra was the first to describe rhinoscleroma (1872), herpetiform impetigo (1872), lichen acuminatus, lichen scofulosorum and the itch bearing his name (Hebra's itch). He contributed to a better characterization of several other diseases, among them eczema marginatum and various types of xanthomas and pemphigus. He also established the nature of urticary and itchings as internal diseases. The two most important works of Hebra were the monumental Atlas der Hautkrankheiten (Atlas of skin diseases), with plates prepared by Anton Elfinger, and the Lehrbuch der Haurkrankheiteb (Manual of skin diseases), completed by Hungarian Moritz Kaposi, a work consecrating his reputation and considered by many as the bible of dermatology. In a time when this specialty was beginning to be constituted, Hebra helped to consolidate the Vienna University into the foremost center of dermatological studies in the world. Thanks to the course he taught at the Faculty of Medicine and also in his own clinic, a new generation of dermatologists arose, under the leadership of equally brilliant doctors such as Moritz Kaposi (18371902), his son-in-law and successor at the chair of dermatology in Vienna; Heinrich Auspitz (1835-1886); Isidor Neumann (1832-1906); Filip Joseph Pick (1834-1910) and Paul Gerson Unna. His son, Hans von Hebra, was also professor of dermatology and one of the founders, together with Oscar Lassar and Unna, of Monatshefte für praktische Dermatologie, the first dermatological journal of Germany, and, for a long time, one of the main divulgers of that specialty in the world. Ferdinand Hebra died in Vienna on August 5, 1880.

(See Lichen; Lichen Acuminatus; Lichen ruber; Scabies; Rhinoscleroma).

Sources: Carneiro, 2002; Freedberg, 1999; Olpp, 1932; www.31; www.57.

Hektoen, Ludwig: North American pathologist, born in Westby, Wisconsin, on July 2, 1863. He graduated in 1882 at the Faculty of Physicians and Surgeons of Chicago, of which he was a professor from 1892 to 1894. He also taught at Rush Medical College (18951933) and headed the Department of Pathology of Chicago University, in which he worked from 1901 to 1932. Hektoen was the first to produce blood cultures from living patients. He suggested that the reaction to blood transfusions could be avoided if the donator and the receptor had compatible blood types. He dedicated many years of research to cancer. He was a member of several national and international medical societies and the editor of medical journals, including Journal of Infectious Diseases and Archives of Pathology. He was also president of Chicago Societies of Medicine (1919-1921) and Pathology (1898-1902). In 1915 he founded the Chicago Medicament Institute, and died in that city on July 5, 1951.

Sources: www.36; www.146.

Herpes: from the Greek verb herpo: to reptate, to move laboriously. It designates, in a general way, several inflammatory dermatoses caused by Herpesvirus, characterized by the eruption of vesicles on the skin and mucous membranes, which, when ruptured, provoke pain. There are two kinds of simple herpes virus: types 1 and 2. Type 1 produces small vesicles generally appearing near the mouth, called labial herpes of fever blisters. Type 2 is associated to a sexually transmissible disease producing painful ulcerations in the sexual organs. The herpes zoster, commonly known as shingles, is caused by the same virus of chickenpox (varicella), the Herpesvirus varicellae. The lesions caused by herpes virus dry out and disappear in about two weeks, but the virus keeps housed in the nervous cells and may cause a relapse of the disease in occasions of physical or emotional stress. Before Robert Willan (1757-1812), an English doctor considered as one of the founders of dermatology, the term herpes was used to designate noncontagious and hereditary, chronic skin diseases, distinguished either by their persistence or the reptating course over the skin, or yet by the sensation of itching. Willan himself gave the name herpes to a benign skin disease with acute course, manifested through great groups of vesicles in the shape of corn grains or lentils, filled with a clear liquid. According to Willan, the disease never attacked large tracts of the body, localizing itself at certain points and ended up spontaneously with the cure, leaving or not scars after the drying up of the vesicles and the fall of the crust. In the 1920's this concept was generally accepted, except for the different way of aggregating the several types of herpes. In that time, labial and febrile facial herpes, genital or pro-genital herpes and herpes iris were already distinguished.

Sources: Carneiro, 2002; Houaiss, 2001; Landouzy & Jayle, 1902.

Herpes tonsurans: also known as tinea, tinea descalvans, tinea tonsurans, SaintAignan's disease, serpigo and head trichophytosis. Herpes tonsurans is a part of a group of diseases generically known as tinea, caused by parasitic fungi and characterized by the infection of the skin of the scalp and its appendices. The disease habitually presents itself under the form of scaly areas and alopecia (total or partial loss of hair) with black dots indicating the break of hairs, which is a consequence of an affection of the intrafollicular part of hairs, which break up at the point of emergence. Then, circular plates, sometimes confluently organized, take place. They come in variable numbers and sizes, pinkish at first, grayish-white afterwards, scaly, rarely pustular or crusty. The dotted region of broken hair stumps is sometimes intermingled with apparently normal hair tufts, giving the impression of tonsured areas. Among the common genera of fungi that cause this kind of infection are to be mentioned Microsporum, Trichophyton, Epidermophyton and Keratinomyces. Tinea tonsurans is also called trichophytic when caused by fungi of the genus Trichophyton (species tonsurans, mentagrophytes, and, more rarely, violaceum and verrucosum). It is microsporic when caused by species canis and gypseum of the genus Microsporum. Microsporum audouini, which only attacks humans, is common in cold and temperate countries and may sometimes be found in the southern states of Brazil. Microsporic tinea tonsurans disappears spontaneously when the child reaches puberty, but the trichophytic one, especially that produced by T. violaceum, may persist up to the age of fifteen to twenty, or more. The increase of fungistatic fat acids of the sebaceous secretion of the scalp, as a suit of endocrine modifications, explains why the affected regions are rendered inhabitable for these species. Treatment of tinea is made with microcrystalline griseofulvin, in pills or suspension. Topical treatment is almost unnecessary, but may help cure and prevent infections during treatment. Since the beginning of the 20th century, the name "tinea" came to designate several affections of the scalp: eczema, psoriasis, herpes tonsurans, etc. Nowadays, herpes (having nothing to do with herpes tonsurans) generically designates several inflammatory dermatoses caused by herpesvirus. The expression herpes tonsurans maculosus et squamosus has been used by Hebra as a denomination for the disease now known as pityriasis rosea. (See Herpes; Pityriasis circinata marginata; Microsporum).

Sources: D'Elia, 1926; Freedberg, 1999; Houaiss, 2001; Veronesi, 1982; Wyngaarden, 1992.

Herrick, James Bryan: North American doctor born in 1861, in Oak Park, Illinois, died in 1954, in Chicago. He concluded his studies in 1888, at Rush Medical College, where he was professor from 1900 to 1927. He also worked at Cook County Hospital and at the Presbyterian Hospital of Chicago. He began his practice as general clinic, but soon developed an interest in internal medicine, particularly in cardiovascular diseases. Herrick was the first to describe coronary thrombosis and to identify it as the origin of many heart attacks. He discovered sickle-shaped anemia in 1910 and carried out many important studies in this area. President of several medical associations, he was awarded the American Medical Association's Distinguished Cross.

Sources: www.36; www.37; www.38.

Hirsch, August: doctor and historian of medicine born in Danzig, at that time in Prussia, on October 4, 1817. Recognized as one of the great names of medical geography, he took part in several expeditions to study, from a global perspective, the distribution of various diseases, such as plague, cholera and cerebrospinal meningitis. In his studies about rachitism, for instance, he established its relation with cold and wet climate, affirming that the disease could not exist under tropical and subtropical climates. Among his main works are to be mentioned Handbuch der historisch-geographischen Pathologie (1881-1886, Manual of historico-geographic pathology, 3 volumes), Geschichte der medizinischen Wissenschaften in Deutschland (1893, History of medical sciences in Germany) and Biographisches Lexikon der hervorragenden Ärzte aller Zeiten (1884-1888; 1929-1935, Biographical encyclopædia of illustrious doctors from all times, 6 volumes), of which he was the editor. He died in Berlin, where he still taught, on January 28, 1894.

Sources: Lello, 1942.

Hydrated Chloral or Chloral Hydrate [Cl CHO(OH) ]: an 3 2 extremely toxic substance, irritant to mucous membranes, employed in the production of dichlorophenyltrichloretane, the insecticide more commonly known as DDT. Discovered in 1832, it is obtained from the combination of chloride with alcohol. When water is added, it changes into choral hydrate, used as soporific.

Sources: www.82; www.88; www.89.

Hydrochloric acid [HCl]: hydrogen chloride or yet muriatic acid, it is used in medicine as a caustic agent and in cases of achlorydria (absence of hydrochloric acid in the gastric juice). By the end of the 19 th century, it was often used in the treatment of skin ulcers, in cases of stomatitis resulting from mercurial treatment, aphtha, candidiasis, dyspepsia, stomach atony, tuberculosis and liver affections.

Sources: Houaiss, 2001; Paulier, 1882; Stedman, 1979.

Hypha: structural unity of the vegetative body or mycelium of most fungi, forming simple or ramified filaments, divided or not by transversal septa. In many types of fungi the mycelium grows below the surface of the matter from which they feed. (See Fungi).

Sources: Houaiss, 2001; Koogan-Houaiss, 2004; Silveira, 1981.

Hyphomycetes: a class of imperfect fungi found in aquatic or terrestrial habitats, provided with well developed mycelia, among which are included molds, some of them pathogenic. (See Fungi).

Sources: Cardenal, 1960; Houaiss, 2001.

 

I

Ichthyosis: hereditary dermatosis characterized by hypertrophy of the horny layer of the skin, which provokes a desiccation of epidermis, which then loosens scales similar to those of fish. Since the end of the 19th century, distinct forms of ichthyoses are known, among them the simple, the serpentine and the hystrix ichthyoses. The first description of the disease was made by Robert Willan (1757-1812), in 1808.

Sources: D'Elia, 1926; Fitzpatrick, 1971; Houaiss, 2001; Landouzy & Jayle, 1902; Littré & Gilbert, 1908; Stedman, 1979; www.211.

Iodine: a solid and scintillating chemical substance from the family of halogens, atomic number 53, symbol "I" and electronic configuration [Kr]4d 10 2 5 5s 5p, volatile when heated. It was accidentally discovered in 1811 by the French chemist Bernard Courtois (1777-1838), in charge of the production of potassium nitrate for the armies of Napoleon Bonaparte. His process was based upon the transformation of calcium nitrate original from saltpeter mines into potassium nitrate, through the potash obtained from the ashes of marine algae. Using sulphuric acid to extract the impurities of those ashes, Courtois detected the presence of a tenuous smoke that condensed itself and corroded copper objects. Later on, Joseph Louis Gay-Lussac (1778-1850) identified such a substance as a new chemical element, which he called iodine, a word derived from the Greek iodès, meaning "violet". Iodine is amply found in nature, associated to sodium in seawater residues, in sponges and marine plants. It is also present in the flesh of fishes, vegetables and fruits (pineapple, watercress, leek, prune and onion, for instance), and a few minerals such as laurite and calcium iodide, principally extracted from Chilean deposits of nitrates. In man, iodine is deposited in the thyroid gland. Its foremost application in medicine is as topical antiseptic, more commonly known as "iodine tincture" (2% iodine with 2.4% sodium iodide in alcohol at 50%). It is used internally in cases of scrofulism (lymphatic tuberculosis), ganglionic hypertrophy, rachitis, syphilis and problems in both serous and mucous membranes. [F1]. There is yet radioactive iodine (isotope I 131), most efficient in the diagnostic of thyroid cancer. Other applications of iodine and its sub-products are: contrast material for photography, for X-rays, alcoholic iodides, iodoform, machine oils, and yet as raw material in the production of metals such as hafnium, silicon, titanium and zirconium. Researches on iodine action upon animal organism became particularly important from 1895 on, when its relation with the thyroid was revealed. It did not take long to verify that the cause of goiter was related to problems of absorption and fixation of iodine in that gland, leading to an abnormal functioning of it (hyperthryroidism). Because of that, in mountainous regions of Europe far from the sea, where the incidence of goiter is common, it is regular practice to add a small portion of iodine to kitchen salt to compensate for this insufficiency in the alimentary diet. Indispensable to global metabolic functioning, iodine is influential in the composition of thyroxin and triiodothyroxin, hormones of the thyroid gland that act upon renal and respiratory functions, muscles and bones, the cardiovascular system and nervous system (thermogenesis). The lack of iodine in childhood and adolescence may interrupt or retard osseous development (rachitis). In that phase, the reduction of the thyroidean activity may also provoke severe physical and intellectual disturbances known as cretinism. The slightest effects of hyperthyroidism are cutaneous (swollen eyelids, dried integument), muscular (anenergy and cramps), neuropsychic (apathy, slowness in thinking), as well as amenorrhea, anorexia, dyspepsia, hypothermia and sexual impotence. The use of iodine in medications must be extremely careful, as its prolonged use or its use in excessive doses cause poisoning (iodism). Iodized substances used for contrast in clinical analyses may provoke skin rash and other allergies. As a preventive measure against anaphylactic shocks due to intravenous urographies, all the necessary tests of sensibility to iodine should be made. Several types of medication have iodine in their formulation: antialgics, antiarrhythmics, antiasthmatics, antigouts, antihypertensors, external and intestinal antiseptics, bronchial dilators etc.