oisr 
THE USE OF WATER 
IN THE TREATMENT 
OF 
Diseases of the Skin. 
BY 
L DUNCAN BUCKLEY, A. M.. M. D. 
Physician to the Skin Department, Demilt Dispensary. New York; Attending 
Physician for Skin and Venereal Diseases at the Out-Patient 
Department of the New York Hospital; Consulting 
Dermatologist to the Hospital for 
liuptured and Crippled, 
New York, etc. 
REPRINTED FROM THE CHICAGO MEDICAL JOURNAL AND EXAMlNtfk ' 
1 ( 
Fob January, 1880. 
3ST JE2 W Y O ]R. K = 
1880. ojnt 
THE USE OF WATER 
IN THE TREATMENT 
OF 
Diseases of the Skin. 
by 
L DUNCAN BUCKLEY, A. M„ M. D„ 
Physician to the Skin Department, Demilt Dispensary, New York; Attending1 
Physician for Skin and Venereal Diseases at the Out-Patient 
Department of the New York Hospital; Consulting 
Dermatologist to the Hospital for 
lluptured and Crippled, 
New York, etc. 
REPRINTED FROM THE CHICAGO MEDICAL JOURNAL AND EXAMINER 
For January, 1880. 
3sr b -w ~5r o k u: = 
1880. ON THE USE OF WATER 
IN THE TREATMENT OF 
Diseases of tieeie Sfeitst. 
Water is by no means an indifferent agent as regards its influ- 
ence upon the skin, either in health or disease; its right use is 
•capable of thuch good, its abuse is equally capable of much evil. 
As it is an agent which is ever at hand, and one which instinct 
suggests the employment of, it is pretty certain to be used in 
most diseases of the skin by the laity as well as by the physician, 
and it is well therefore for the latter to have definite views in 
regard to its value when properly employed and its harm when 
wrongly applied. 
The employment of water to the cutaneous surface may be 
considered in reference to its use in health as preventive of dis- 
ease, and its use when the skin is the subject of disease; in the 
latter case it may be studied both in regard to its general use to 
the healthy parts and its employment upon parts affected. 
In regard to the application of water in health there is little 
question in my mind that abundant bathing serves as a great pre- 
ventive, both of cutaneous diseases and of systemic disorders, 
although Hebra not long ago gave quite the contrary impression 
in his article upon the use of baths. The skin whose dried excre- 
tions are frequently removed and whose circulation is quickened 
by reasonable bathing, undoubtedly is in a more healthy state and 
is better capable of performing its functions than one whose slug- 
gish action is favored by neglect, and whose epidermal covering 
is allowed to adhere until rubbed off in a dry state by the cloth- 
ing, even though Hebra does argue that skin diseases are no more 
common among those who may be truly said never to bathe th& 
whole body, as is seen among some eastern peoples, than among 
bathers. \ 4 
In health then, I regard the daily use of the cold or tepid sponge- 
bath, followed by active friction, as one of the greatest safeguards 
against disease, both of the integument itself and of the system 
at large. In regard to warm baths, they have their function, and 
as a nervous sedative they may be of real service to certain per- 
sons, and when the daily tepid or cold ablution of the entire sur- 
face is not performed, they should be employed at stated intervals 
for the removal of effete matter from the skin ; once a week, as is 
so commonly practiced, usually suffices. After a warm bath, a 
cold douche, as with a shower, or with a sponge in a pail of cold 
water, greatly enhances the power of the bath as a quickener of 
cutaneous circulation, and diminishes the danger of catching cold. 
The subject of the use of the Turkish and Ilussian baths and 
their modifications in health, is too large an one to enter upon at 
the present time, and in a measure foreign to the subject of the 
paper. Suffice to say, they are continually abused in health, not 
only as relates to any sudden accidents which may and occasionally 
do result to those in peculiar conditions, but also as to their 
repeated use, which, like any powerful stimulant, may be and 
constantly is followed by a reaction whose ultimate effect may be 
very bad. They are not the panacea for all bodily ills, they are 
not the balm of life, securing immunity from disease, indeed, no 
small share of cases of diseases of the skin in private practice 
occur in those who have previously employed these steam or hot 
air baths to a greater or less degree. Their proper use in certain 
diseased conditions of the skin will be referred to later. 
The use of water to the skin in its diseased state, may be con- 
sidered under several heads, as follows : 
1. Common water baths, including river and sea bathing. 
2. Ablutions, bathings or soakings, with hot and cold water.. 
3. Cold and hot packing : water cure. 
4. Yapor and hot air baths. 
5. Medicated water baths. 
6. Natural mineral springs. 
1. The ordinary warm bath, as before mentioned, has for its 
function the removing of effete matter and softening the skin, 
and equalizing the circulation. It may thus have a favorable 
action in disease and may be used with advantage in chronic; 5 
scaly eczema, psoriasis, ichthyosis, also in lupus and in obsti- 
nate ulcerative syphilis. This warm bath has been long used by 
Hebra continuously in certain cases, that is the patient remain- 
ing in the water for weeks or even months, the temperature being 
maintained by steam or a current of hot water, the water being 
also changed more or less continuously. In these the patient 
eats and sleeps in the hath upon a proper mattrass, only leaving 
the bath to empty the bowels. These have been found to be of 
principal service in burns, pemphigus foliaceus, phagedmna, etc., 
as 1 have myself witnessed, and are of really great value. In 
some instances patients have remained in them for many months 
consecutively. 
But ordinary warm water baths cannot always be advised with 
impunity in all diseases of the skin ; acute eczema, or even more 
sub-acute, exuding forms of this disease will be found to be 
aggravated by the contact of simple water. Urticaria will also 
be rather irritated, as will indeed most of the inflammatory 
affections of the skin. It is well to remember when baths are 
gi\;en to a patient with a pruritic skin, to give a caution against 
too great friction afterwards, as this not infrequently more than 
balances any soothing effect of the bath, and the irritation after- 
wards may be very great. 
In regard to river and lake bathing, the reaction and the 
exposure to the air will aggravate most skin diseases. Sea bath- 
ing is of service in psoriasis, and warm baths of sea water have 
been followed, in my experience, with very beneficial results in 
this disease; it is a remedy which I resort to a good deal during 
the summer months. But sea bathing is decidedly harmful in 
most cases of eczema, as I have repeatedly witnessed, although 
I have heard of a few instances where the disease was very chrbnic 
and the eruption very indolent, in which sea bathing was said to 
have cured the cases. But I am very cautious about allowing 
eczema patients either to bathe in the sea or to spend much time 
at the sea shore. The same is true of acne, and every autumn I 
see many, many cases where the sea influence has greatly aggra- 
vated the eruption, and many where the eruption has appeared 
for the first time while by the sea side ; sea voyages generally act 
unfavorably in acne. Sea bathing sometimes is of much service 6 
in chronic urticaria, but in most of the acute inflammatory affec- 
tions of the skin its use is to be prohibited. 
2. In regard to ablutions or washings and bathings or soak- 
ings with hot and cold water, much may be said. The general 
tendency is to bathe or wash a diseased part for the sake of clean- 
liness, and this will pretty certainly be done, whether the physi- 
cian directs it or not, and often in a manner greatly injurious to 
the lesion. It is a most common practice to wash eczema, and 
especially do we often see the eczema of children washed dili- 
gently, often several times daily, the mothers saying that they 
find it “impossible to keep it clean.” Now, in my opinion, an 
eczematous surface should be washed very seldom and that only 
by special direction from the physician. Nature seeks to make a 
protective covering with the exudate ; this is continually removed 
by washing, the process is repeated and cure is most certainly 
retarded. If more time be now given for the formation of a 
more resisting epidermal covering, occasional washings, serving 
to remove superfluous exudation and thus to allow the astringent 
used to come into contact with the diseased surface, repair will 
take place more speedily. I have repeatedly witnessed eczema 
in children get well under the same treatment previously em- 
ployed by the physician calling the consultation, when only the 
frequent washings were omitted. 
The same is true of eczema in the adult; as an instance of the 
effect of water in causing and prolonging an eczema, we may 
mention the case of the eruption when it occurs on the hands of 
wash-women, or those whose occupation compels frequent wetting 
of the hands. It is next to impossible to cure some of these 
cases, as in bar-tenders, waiters in hotels, as well as wash-women 
without a cessation of the occupation, and just so impossible is it 
to cure certain cases of eczema while frequent washing is prac- 
ticed voluntarily. 
But washing is indicated at times, and some judgment is neces- 
sary to determine just when this should be practiced. In eczema 
of the scalp it is rarely best to wash the head more than once or 
twice a week, and here, even more than elsewhere, it is specially 
necessary to reapply the ointment or other dressing immediately 
after the cleansing, before the denuded surface has had time to 7 
become again covered with the impenetrable coating which 
quickly forms. 
Proper use of water is also of much service in certain patches 
of chronic eczema, when there is much thickening of the skin, 
with oft-times desperate itching. Such patches may be washed 
daily with advantage, and sometimes they will bear very great 
stimulation. Thus, taking the sapo-viridis and a bit of flannel 
and water, very sharp friction may be made for several minutes, 
after which the part is to be washed off clean with warm water 
and immediately covered with the appropriate dressing ; the stim- 
ulation may even be carried so far as to use a brush, and I well 
remember a plasterer at Demilt Dispensary, who scrubbed the 
backs of the hands with a common floor scrubbing-brush and 
soft-soap and water until they bled. The result of this active 
treatment was to remove a greatly thickened eczema of many 
years standing, so effectually that, although he has continued his 
occupation and I have seen him repeatedly during the past four 
years with eczema on the sides of the hands and fingers, the 
backs of his hands, which were the seat of his severe attack and 
energetic treatment, have remained perfectly smooth and healthy. 
Hot water is sometimes of the very greatest value in eczema. 
In eczema of the anus often nothing gives so much relief as 
holding a cloth dipped in water, as hot as can be borne, against 
the parts and repeating the application two or three times; the 
part being then covered with the dressing appropriate to the 
case; the same is of service in eczema of the vulva. In eczema 
of the scrotum I frequently direct that the part shall be suspended 
for a few moments in a cup of very hot water before other appli- 
cation is made. Simple pruritus of these parts is also often 
greatly relieved by these hot applications. 
Chronic eczema of the palms of the hands, where the surface 
is hard, dry, fissured, often shiny, and the hands well nigh useless, 
will sometimes seem almost to melt away under the daily soaking 
of the palms on the surface of a basin of scalding hot water, 
followed by diachylon or other ointment. Eczema of the ends of 
the fingers and of the nails sometimes yields to this after all other 
measures have failed. 
Onychia, both where there is and where there is not an appa- 8 
rent eczematous element, is also ver}7 greatly benefited by these 
soakings in very hot water, accompanied and followed by other 
appropriate measures. 
Indolent ulcers of the legs take on active changes and often 
cicatrize rapidly under the powerful stimulation of the alternate 
application of a cloth dipped in very hot water, followed instantly 
by one taken out of a vessel of very cold water. 
Very striking results are often obtained from the use of hot 
water in some of the forms of acne. It is applied by means of a 
cloth, as a handkerchief, dipped in the hot water and held to the 
face until the heat of the cloth has passed oft, when the perform- 
ance is repeated two or three times for a period of not over three 
minutes to five altogether; a long soaking of the face in water 
which is not hot enough will aggravate the eruption, but the 
reaction following the brief application of very hot water, is often 
very remarkable. After multiple scarification of the pustules 
and papules of acne, prolonged bathing with tepid water is of 
service in encouraging the bleeding, which otherwise always tends 
to cease sooner than is desired. 
In certain cases of chronic erythema, where the congestion 
resists other measures, the alternate application of cloths dipped 
in very hot and very cold water, serves to break up the capillary 
stasis. On the other hand, repeated washing of ulcerative sur- 
faces will often be quite sufficient to prevent their healing ; this 
is often seen in ulcerative svphilides, which will sometimes resist 
the proper internal medication as long as repeated washings are 
persisted in, and yields to it almost immediately when cotton 
batting is applied and left undisturbed. Varicose ulcers of the 
leg are not infrequently kept from healing by the too diligent 
cleansing which patients are ever ready to bestow. 
3. Cold and hot packing in wet sheets, as practiced in the 
water cures, is of a certain value as a remedy in diseases of the 
skin. The results which sometimes occur, as boils on the sur- 
face, are to be deprecated, and are not, as is popularly supposed, 
either a good sign, or a good element in the treatment; we of 
course no longer believe that there is a “ materies peccans ” 
which needs to be eliminated. But the wet pack has served well 
in the hands of Hebra in the treatment of acute psoriasis, also in 9 
acute general eczema. The packing is made twice daily, for 
for several hours, morning and evening. 
This is most conveniently accomplished by placing two blank- 
ets lengthwise upon a bed, and over them a sheet dipped in cold 
water. The patient then lies naked upon this, which is closely 
folded over him up to the chin, and the blankets are then 
wrapped closely around, and the whole done up with bands, so 
that the patient is immovably fixed, helpless indeed. The first 
sensation is that of a pleasant glow, and before long perspiration 
ensues, which should be encouraged by draughts of water fre- 
quently given ; the packing lasts from two to five hours. It 
should never be forgotten to place an urinal between the thighs 
of the patient before envelopment. 
Under this treatment the scales of psoriasis disappear, and the 
red patches daily become less visible. Few patients in this coun- 
try will submit to this treatment, but when it is desired to remove 
the existing eruption in the shortest possible time, it is of value. 
Packing is not of service in many affections of the skin, and 
should seldom be prescribed ; although in the water-cure estab- 
lishments all eruptions are submitted to this course. The pro- 
fession need more accurate scientific information in regard to the 
precise effects and the therapeutic indications of this powerful 
remedy. 
4. Vapor and hot air baths, and their modifications, may play 
a not inconsiderable part in the treatment of certain cutaneous 
diseases, although from their expense and the difficulty of their 
application at home, and from the fact that most of the estab- 
lishments where they are administered are in the hands of igno- 
rant, unprofessional persons, they are not employed to the extent 
which their real value would indicate. 
While there are undoubtedly differences in the mode of action 
and in the results obtained from the Russian or vapor and the 
Turkish or hot air baths, I am not aware that any distinctive 
therapeutical indications between them, or effects from one more 
than the other have been scientifically noted in diseases of the 
skin. The Turkish or hot air bath, with the subsequent cold 
douche, is that generally preferred and undoubtedly is the safer. 
It is of a certain value in psoriasis, and of some service in chronic 10 
eczema, also in chronic urticaria, lichen and ichthyosis, but the 
results obtained are generally rather disappointing, and I must 
acknowledge that I use them comparatively seldom. 
Certain modifications of the steam or vapor bath are, however, 
oftimes of considerable aid in treating diseases of the skin. Under 
this head come the sulphur vapor and mercurial vapor baths, 
which, as is well known, have great repute in this line of practice. 
They consist in a steam bath to all the body, save the head, com- 
bined with sulphur or mercury volatilized by heat. The value 
of the mercurial bath, in many cases of syphilis, need not be 
dwelt upon ; its use should be strictly confined to cases where 
this diagnosis is certain. The indiscriminate use of a mercurial or 
sulphur vapor bath when the skin is affected is highly reprehen- 
sible. 
The real utility of sulphur vapor baths in diseases of the skin 
is in a measure still sub judice. Their anti-parasitic value is 
fairly positive. If well used they will cure scabies, phtheiriasis and 
the vegetable parasitic diseases. But even in these the irritation 
occasioned by them is sometimes so great that the artificial erup- 
tion produced quite masks that of the disease proper and prevents 
their continuance. Sulphur vapor baths are also of some value 
in psoriasis, and occasionally the eruption will seem to yield to 
them, but quite as often they are powerless, as I have frequently 
witnessed. Chronic, more or less generalized papular eczema, 
may be much benefited tby sulphur vapor baths, given every other 
day or so; but here care must be exercised, for this very con- 
dition may be entirely caused by their use. 
Mr. J. L. Milton, of London, has arranged a convenient appa- 
ratus by means of which vapor baths, with or without the addition 
of sulphur or mercury vapor, may be administered at the patient’s 
house with comparatively little expense. It consists of a series 
of hoops over which a thin rubber or gutta percha covering is 
stretched, which, when the patient is seated on a chair is gathered 
around the neck and reaches to the ground ; a second cloak of 
coarse flannel is placed within the rubber and over the hoops. 
The patient sitting naked on the chair, with the Mackintosh closely 
drawn around the neck, a lamp with a steam generator is placed 
on the floor beneath the chair; after the body has been submitted 11 
to the steam for some minutes, if it is so desired, the sulphur or 
mercury is introduced on a receptacle over the lamp, placed in the 
centre of the pan of boiling water, and continued for a few minutes 
longer. By means of this apparatus steam baths may be given 
with advantage in a number of cutaneous affections ; acne, chronic 
eczema, lichen, psoriasis, etc., and when it is desired, a cold dash 
afterward makes of it a very decent substitute for the ordinary 
Turkish or Russian bath, according as steam is used or simply 
hot air; this can, moreover, be employed in localities where 
these are not accessible, or in cases where it is not desirable to 
have the patient leave the house. I have also had used a wooden 
box, constructed at home, somewhat like those employed at the 
establishments, in which the patient sits with the heat, which may 
be given by an ordinary low gas stove, beneath the chair. This 
can be made by any carpenter and is very inexpensive. 
Mention must be made here of the vapor bath or douche applied 
locally in acne, as recommended so largely by French writers. 
It consists in holding the face over a basin of standing water, 
with the head and basin enveloped in a blanket or other covering. 
This plan answers very well in many cases, and greatly relieves 
the congestion, but the indications for it are better fulfilled, I 
think, in the method of soaking the face with hot water as pre- 
viously described. 
5. Medicated water baths. This is a very important division 
of our subject, and should always be considered in dealing with 
diseases of the skin. Not only is this an important matter in 
reference to the direct action of the bath upon the diseased skin, 
but the general medicated bath is to be considered in regard to 
its effect upon the general health, which may be very considerably 
modified thereby. Experimental investigations have shown very 
conclusively that under the frequent use of water to the whole 
surface, assimilation and disintegration proceed more rapidly than 
without it. In certain skin diseases, therefore, where these pro- 
cesses are slowly or imperfectly performed, the warm bath, especi- 
ally when holding alkalies in solution, does much to improve the 
general health and to remove diseases of the skin, even from loca- 
tions which are not submitted to the bath. Thus I have found 
many cases of acne to make much greater and more rapid improve- 12 
merit when alkaline baths were added to the measures previously 
-employed; the same is true of some cases of ‘eczema of the face 
or scalp. 
Many ways of medicating the water to be employed in the bath 
have been suggested which need not be mentioned here, inasmuch 
as practically but few are employed in daily practice, and the 
indications for the use of the various kinds of baths have never 
been laid down with any clearness or precision ; and I regret that 
time forbids my entering more deeply into the subject at this time. 
My most common medication for baths consists of carbon- 
ate of potassa, carbonate of soda, and powdered borax, four, 
two and one, ounces of each, respectively, together with from 
one-quarter to one-half pound of starch to a bath of thirty gallons. 
This is a mild alkaline bath, is decidedly soothing to most skins, 
and acts very favorably on sub-acute eczema and urticaria; it 
may be used much stronger, as in psoriasis, ichthyosis, prurigo, 
etc. The bath is to be given at bed time, at a temperature of 
from 87° to 95° Fahrenheit, the patient remaining in the water 
fifteen or twenty minutes. On coming out, if the skin is pruritic 
it is not to be rubbed, but dried with a heated sheet, and all dis- 
eased surfaces are to be covered at once with a suitable ointment. 
I find it very grateful to the patient to have the entire surface 
lightly annointed with the glycerite of starch, or eosmoline, to 
which a small quantity of carbolic acid, five to ten grains to the 
ounce, may be added, if there is fnuch general itching. 
Such medication of the bath may be modified to suit certain 
circumstances; thus, the starch may sometimes be replaced by 
gelatin, a half a pound to the bath, well boiled ; or glycerine, four 
to ten ounces to the bath, will make it more soothing to some 
skins. Sometimes the soda and potash prove too drying,and the 
quantity of borax may be increased and these diminished. 
It is difficult to give in a few words the exact indications for the 
use of these alkaline and starch baths, but in general I may repeat 
that they are soothing to a pruritic skin and serve admirably to 
promote the processes of life. Sub-acute and chronic eczema are 
almost always greatly benefited by such a bath, taken at bed time, 
twice or three times a week, or even every night, if not to® debili- 
tating. 13 
Sulphuret of potassium has been frequently used in bathsr 
especially to relieve itching, but I do not employ it except as 
used in the artificial Bareges baths, which may be obtained at 
some of the bathing establishments; baths made with sulphuret 
of potassium should be given in a wooden tub, as the salt rapidly 
attacks metal lined tubs, if in a strong solution, i have seen a 
number of instances of cutaneous eruptions where sulphuret of 
potassium baths had been used to the great aggravation of the 
disease, and cannot give any indications for the employment of 
this kind of bath, although the books mention it as valuable. 
Occasionally benefit will be derived from the use of other sub- 
stances in solution in baths. Thus, Hebra makes very consider- 
able use of a bi-chloride of mercury bath, in syphilis, lupus and 
prurigo; nitric acid, or nitro-muriatic acid baths have been used 
with advantage in jaundice, and also in other diseases, especially 
to relieve itching, and to promote cutaneous action. Sometimes 
vegetable substances may be added to a bath, in certain diseases 
of the skin, as conium, opium, etc., for a sedative effect and the 
relief of pain ; or astringents, as oak bark or tannin, for their 
particular effects. 
The common warm, or an alkaline bath is sometimes given 
with much effect after the application of tar ; thus, in chronic and 
much thickened eczema, the part is tarred over, and the patient 
enters a bath, remaining there 15 or 20 minutes; this is a favo- 
rite plan with Ilebra. 
6. Finally, the natural mineral springs should never be for- 
gotten in the treatment of the obstinate cutaneous affections, 
although their efficacy is, in my opinion, greatly over-rated. 
The subject is too large an one to enter upon on the present occasion 
and will be deferred to another opportunity. Suffice it to say 
here, that while mineral springs are of much real service in many 
diseases of the skin, their use is not to he rashly advised without 
a definite knowledge of what is to be accomplished; they are to- 
be prescribed, as any other remedy, to fulfill definite indications; 
certain springs, while beneficial to certain eruptions, are just as- 
surely harmless or inefficatious in others. The habit, therefore, 
of sending a patient to particular mineral springs simply because- 
affected with a disease of the cutaneous surface, is as irrational 14 
as it would be to send one indifferently to Florida, Colorado, 
Minnesota or the Adirondacks, because some organ within the 
chest happened to be diseased, without any idea of the nature of 
the malady or the object to be effected by the particular climate 
in question ; or one could quite as reasonably send one’to a drug- 
shop because sick, without giving a prescription for the remedy 
required. 
There is certainly great need of more definite and reliable 
scientific information, based on recorded facts, in reference to the 
vast resources of our wide country in the matter of natural min- 
eral waters, and I cannot forbear the hope that a hydrological 
committee may be formed in this Association for such investigation. 
A not inconsiderable amount of information on the subject has 
come to my knowledge within the past ten years and I shall hope 
on another occasion to collect it from my notes of cases and to 
present it before you. I can premise in regard to it, however, 
that much of it is of a negative character, for I see multitudes 
of patients who have received but slight or temporary improve- 
ment or have failed entirely of benefit from a wrong use of 
mineral waters in diseases of the skin. Notice to Contributors. 
W15 are glad to receive contributions from 
every one who knows anything of interest 
to the profession. Articles designed for 
publication in the Journal and Examiner should be handed in before the fifteenth of the 
month in order to give the editors time for careful perusal. A limited number of EXTRA 
COPIES or reprints (not exceeding fifty) will be given the authors of accepted articles or, reviews 
providing they are ordered when the copy is forwarded to us. 
THE CHICAGO 
Medical Journal &, Examiner 
(established 1844.) 
EDITORS: 
JAS. NEVINS HYDE, A.M., M.D., N. S. DAVIS, AM., M.D. 
DANIEL R. BROWER, M.D. 
This is one of the oldest medical journals in the United 
States. It is published monthly and forms each year two large 
volumes, which begin with the January and July numbers. 
This journal has no connection whatever with any cliques, 
medical schools or mercantile houses, but is owned by a large 
number of the representative men of this city, who, under the 
name of The Medical Press Association, publish it wholly for 
the benefit of the Chicago Medical Library. Since the journal was 
purchased by the Medical Press Association in 1875, its liberal 
policy, the indefatigable work of its editors, and the generous 
support of the profession, have gained for it, both at home and 
abroad, a recognition as one of the best journals in this country. 
Its original articles are from the best talent of the land ; its notes 
from private and hospital practice are a true picture of practice 
in this country ; its foreign correspondence furnishes accurate 
descriptions of the practice abroad; and its summary gives the 
• advanced thought of the profession throughout the world. No 
physician who intends to stand in the first rank of the profession 
can afford to be without this journal. 
The Journal will be sent free of postage on receipt of the 
regular subscription price. 
Terms— $4.00 per annum in advance. 6 Months $2.00 . 3 Months $1.00: 
Single Copies, 40 cents. 
Journal of Nervous and Mental diseases, per Annum $5.00 
The Chicago Medical .Journal and Examiner and the Journal of 
Nervous and Mental Diseases, per annum $7.50 
Specimen pages sent free of charge. 
Address Dr. Daniel R. Brower, 
188 flARK STREET, EHIEAWO,