- __^ FROM — -^ WESTERN lomffiopathic Pharmacy W.F. BOCKSTRUCK.Pror — 4-11 LOCUST ST — ST.LOriS,MO.~ NL" oos?tsm fa SURGEON GENERAL'S OFFICE LIBRARY. Section, ... JVo. / 3—1639 NLM005765416 ^^^^E*S3^S^;^ ■: "\? iit^Pl & General view of the skin and its appendages-(after Heitzmann). HAND-BOOK OF DISEASES OF THE SKIN THEIR HOMEOPATHIC TREATMENT. BY JOHI\T K. KIPPAX, M. D., LL. B., Professor of Principles and Practice of Medicine and Medical Jurisprudence in the Chicago Homoeopathic Medical College' Clinical Lecturer and Visiting Physician to Cook County Hospital; Author of Lectures on Fevers, etc. fifth edition; revised £.nd EiJjAilijEfi f> A fy\? UU1CAUW. in ) ( O 1 GROSS & DELBRIDGE.' / / V^ O / . COPYRIGHTED BT GROSS & DELBRIDGB 1890. To ALL PRACTITIONERS AND STUDENTS OP HOMCEOPATHY, TRUSTING IT WILL MEBT THEIR APPROVAL, THIS VOLUME as Respectfully Dedicated. i PREFACE Do THE FOURTH EDITION. The respectable success of this Hand-Book, as evi- denced by the rapid sale of three large editions justifies the author in allowing a fourth edition of the work to be given to the professional public. Advantage has been taken of the opportunity afforded by the call for another impression to introduce a chapter on diet and hygiene and make such changes in the text as the continued advance in dermatology demands. Chicago, March, 1890. PREFACE TO THE SECOND EDITION. In preparing this edition for the press, the entire text has been thoroughly and carefully revised. Owing to the unprecedentedly rapid advance in derma- tological science, many portions of the book have been entirely re-written, and much new matter has been added. It is hoped that the work, as revised, will merit a continuance of the favorable recognition extended to the previous edition by the profession. ChxoaC4*. Nove^ter, 1883. PREFACE TO THE FIRST EDITION. The design of the present Hand-book is to furnish such a digest of the essentials of practical derma- tology, as will be serviceable alike to students and practitioners. In preparing the manuscript I have steadily kept one purpose in view, to make it as thorough and practical as possible. To this end con- densation has been more or lees necessary, and if at times statements appear too absolute, it must be remembered that conciseness and the limits of the book, prevented any lengthy discussion. The text consists of short general observations on the anatomy, physiology, and pathology of the skin, and on the symptomatology, etiology, diagnosis and classification of cutaneous diseases: followed by a de- tailed description of each individual affection, giving its clinical history and treatment. To this is added a chart, with diagnostic, therapeutic and dietetic hints, which it is believed will be found extremely useful. 7 8 FftEfrAOE. Another feature in the work is thd pronunciation of the various medical words used, and the introduc- tion of definitions. ********** In regard to nomenclature, I believe matters have been simplified very materially, although originality is by no means claimed for the classification presented. • This Hand-book is virtually condensed from notes originally intended for a larger work, and is the result of careful study of dermatological literature * * * * * * combined with extensive clinical expe- rience. Every effort, within the limits assigned in the original plan, has been made to lay before the pro- fession a satisfactory compendium of dermatology in its present stage. ******* With these prefatory remarks I give this work to the profession, trusting it may, to a certain extent at least, supply the present want for a concise and prac- tical exposition of cutaneous affections and their homoeopathic treatment. Chicago, May, 1888. CONTENTS. PART FIRST. Page. General Observations,.....• 17 SECTION I. 1 he Anatomy and Pathology of the Skin, . . 17 SECTION II. Symptomatology, ........ 29 SECTION III. Etiology, ..........35 SECTION IV. Diagnosis,..........38 SECTION V. Classification, . ......^ 9 10 CONTENTS. PART SECOND. The Description and Treatment of Skin Diseases, 45 Acne,............45 Alopecia,............56 Alopecia areata,.........56 Anaesthesia,..........69 7 Anidrosis,..........59 Anthrax, . . .........60 Atrophy of the Skin,. Linear, ....... • • • .63 Atrophy of the Nail.........64 Baker's Itch,......... 65 Baldness. See Alopecia, . . . . • . .56 Barber's Itch. See Tinea Tricophytiua, ... 220 Boil. See Furuncle,........123 Bottle Nose. See Rosacea, . . . . . 189 Bricklayer's Itch, .........65 y Brotnidrosis,..........65 Callositas,...........68 Cancer, . . . ........69 Carbuncle. See Anthrax, . . .. -,.j Chloasma,...........69 Chromidrosis,..........71 Clavus, or Corn, ....,.••• 71 Comedo,...........73 Condylomata,..........™ Cornu cutaneum,.........76 Dermatalgia,..........76 Dermatitis contusiformis,.......77 Dermatitis exfoliativa,........79 Dermatolysis,..........80 Dysidrosis, ..........80 Ecthyma,...........81 Eczema,...........84 Elephantiasis,..........108 Ephelis, . ,........110 Epithelioma...........11! 117 Erysipelas,.......... Erythema,..........114 Erythema nodosum. See Dermatitis contusiformis, . 77 Favus. See Tinea Favosa,......215 Fibroma........• • • • 122 Fish-skin Disease. See Ichthyosis, ... .138 ^ " ,. ■ .122 Framboasia, . ...... Freckles. See Lentigo........146 12 CONTENTS. Furuncle,........<;* '*8 Grocer's Itch, . ....*.«• I28 Guinea-worm Disease,........128 Herpes,...........129 Hirsuties,.....„ ..... 132 Hydroa............134 Hydro-adenitis, . . . . o . o . . • 134 Hypersesthesia,.........135 f> $/0 •) ✓ Hyperidrosis, . ......I35 Ichthyosis,..........I38 Impetigo contagiosa, ......... 141 Intertrigo, . .......* 144 Itch. See Scabies.........193 Keloid............145 Lentigo............146 Leprosy,...........147 Ltucoderma,..........152 Lichen planus, „.........153 Lichen simplex, . .......156 * Lupus erythematosus,.......158 Lupus vulgaris,.........160 Miliara,........... 163 . Milium,...........164 CONTENTS, 13 Mite Disease,..........165 Moles. See Verruca, . 235 Molluscum sebaceum,........165 Morphcea,..........166 Nrevus, or Mother's-mark........ 167 Nails, Diseases of. See Onychia, etc., .... 169 Nettle Rash. See Urticaria,.......227 Onychauxis..........169 Onychia,...........169 Onychogryphosis,.........169 Onycho-mycosis. See Tinea Tricophytina, . . .220 Paronychia...........170 Pemphigus,........ . .171 Pernio,...........173 Phthiriasis,...........176 Pityriasis,..........171 Pityriasis rubra. See Dermatitis exfoliativa, . .79 Polypus of the Skin. See Fibroma, .... 122 Prairie Itch,..........178 Prickly Heat. See Miliaria,......163 Prurigo,...........178 Pruritus,...........180 Psoriasis,...........181 14 contents. Purpura,....... ... 186 Ringworm. See Tinea Tricophytina, .... 220 Rhino-scleroma,.........189 Rodent ulcer,..........HI Rosacea,........... 189 Roseola,...........114 Rupia,............193 Salt Rheum. See Eczema,.......84 Sarcoma cutis........... 193 Scabies,......... . 193 Scleroderma,..........197 Scleriasis,.......... 198 Scrofuloderma,..........199 Sebaceous Cyst..........200 Srthorrhcea,..........200 Shingles. See Zoster,........238 Stone-pock. See Acne, . . . . . . . 45 Strophulus,..........203 Sudamina,..........204 Sunburn. See Ephelis,........110 " Sycosis, .... ......204 Syphilides,...........206 Telangiectasis,.........213 CONTENTS. 15 The Tinese,........... 214 Tinea Favosa..........215 Tinea Tricophytina,........220 Tinea Versicolor,.........224 ; Trichiasis, e..........227 j Trichoclasis,..........227- Urticaria,...........227 Verruca or Warts, . . .....235 Washerwoman's Itch, . .... 237 Wen. See Sebaceous Cyst, ....... 200 Xanthoma,......->... 237 Xeroderma. See Ichthyosis, ..... .138 Zoster, ,.......eo.~ 238 16 Contents, PART THIRD. A Chart of Characteristics, with Diagnostic, The- rapeutic, Dietetic, and Hygienic Hints, . . 243 PART FOURTH. Orthoepic Glossary,......, ,280 PART FIFTH, Diet and Hygiene in Diseases op the Skin, . . 285 lNDEX>...........290 DISEASES OF THE SKIN. PART I. GENERAL OBSERVATIONS. SECTION I. THE ANATOMY AND PATHOLOGY OF THE SKIM. The skin is a flexible membrane which invests the body, and joins the mucous surfaces at the various orifices. Its office is to protect the underlying struc- tures from harm, to give shape and symmetry to the human form, to act as a partial respirator, and to per.form the important functions of secretion, absorp- tion, and tactile perception. Upon its surface are found numerous elevations, furrows and depressions. The larger elevations, which take the form of lines or wrinkles, are particularly well defined on the palm of the hand and sole of the foot. The smaller eleva- tions are found upon almost all regions of the body, and are caused b}' the prominence of the papilla?. The furrows correspond tc the larger elevations and lie between them. The minute depressions or pores, are the orifices of glandular ducts and of hair-follicles. 18 DISEASES OF THE SKIN. Like most tissues of the body the skin is composed of fibres and cells. The fibres are of two kinds: white fibrous tissue, and yellow elastic fibres. The white fibres give to the skin strength, and the yellow, elasticity. The cells are of four kinds, namely, the cells of the rete or stratum malpighii; secondly, those of the stratum granulosum; thirdly, those of the stratum lucidum; and fourthly, those of the stratum corneum. The cells of the stratum malpighii are nucleated, polygonal in form, and rich in protoplasm. When isolated they resemble in outline a chestnut burr, and hence are termed "prickle cells." The cells of the stratum granulosum are spindle- shaped, have a distinct, clear nucleus, and are ar- ranged in two rows. Those of the stratum lucidum are flattened, indis- tinctly striated, and contain a staff-shaped, or flattened nucleus. They are formed from the cells of the stratum granulosum, and are airangcd in three rows. And lastly, those of the stratum corneum, or horny epidermis, are flattened, have no nucleus, and are usually larger than the other cells. These six elements, the two kinds of fibres, and the four sorts of cells, constitute the main part of the structure of the skin. Anatomically, the skin may be divided into two main laysrs, termed respectively the corium and epidermis. Anl again, these two may be subdivided; the former, into the reticular and papillary layers, and the latter <3Ei*X&»£ OBSERVATIONS. 19 mto the relfo jnalpighii, the stratum granulosum, the stratum li-cidum, and the strauun corneum or horny layer. The cerium constitutes the larger part of the skin, and is made up by the interlacement of elastic fibres and connective tissue. It contains as organs peculiar to the skin, prominently, sebaceous and sweat glands. At the deepest part of this structure, masses of fat globules are found packed between the fibres of con- nective tissue, constituting the parniiculus adiposus, or adipose tissue. The external surface of the corium pie^onts eleva- tions, or nipple-like prolongations, called papillae. These are largest about the female nipple, and corona glandis, and smallest over the general cutanecus sur- face. They present an average of 60,000 to the square inch and ore the seat of the tactile corpuscles of Meis- sner. According to their internal structure they may be divided into two kinds, vascular and nervous. The reticular layer is looser in texture than ihe papillary layer; and the inter-fascicular spaces are veil marked. An increase of the connective tissue elements js usually found in keloid, fibroma and scleroderma. And a fatty degeneration occasionally takes place in the new growth which destro3rs the connective tissue, as in xanthoma. The papillae may at times become enlarged in psoriasis, and the reticular layer may be- come the seat of such parasites as the Guinea worm, the acarus scabiei and the pediculus. £0 DISEASES OF THE SKIN. Next to the papillary layer of the corium comes the stratum malpighii or rete. The cells of this structure are mainly polyhedral, excepting the lower rows which are fusiform and fill up the interpapular spaces to a level a short distance* beyond the apices of the papillae. The deeper layers of this stratum are the abiding places of cutaneous pigment. A hyper-activity of rete cells exists in psoriasis, and epithelioma is supposed to take its departure from this membrane. Beyond the stratum malpighii is the stratum gran- ulosum, which consists of two layers of nucleated, spindle-shaped cells. It is best seen at the mouths of the hair follicles and near the nails. The stratum lucidum follows it, and is made up of flattened transversely striated cells, arranged in three rows. And after this comes the stratum corneum or horny epidermis. The deeper cells of the latter stratum are polygonal in shape, while the more superficial are flattened. Its cells are increased in amount in con- gested conditions of the skin, as in psoriasis; iu in- flammatory diseases, as in eczema and dermatitis ex- foliativa; and in general hyperplasia, as in elephan- tiasis. They may be congenitally increased as in ichthy-i osis, or become hypertrophied as in callositas. The cell layers of both the stratum corneum, the stratum lucidum, and the stratum granulosum, may be elevated along with portions of the rete, by fluid forcing its way up from beneath; and thus they form GENERAL OBSERVATIONS. 21 the walls of vesicles as in eczema or herpes on the one hand, or those of bullae, as in pemphigus on the other. The organs of the skin are: blood vessels,lymphat- ics, muscular fibres, and nerves, sweat glands, seba- ceous glands, and hair follicles; the appendages are, the hair and nails. The large trunks of botli arteries and veins are sit- uated in the*deeper parts of the subcutaneous tissue, and after supplying the organs form a deep plexus in the deep layers of the corium. Branches from this plexus, ascend to just beneath the papillary layer of the corium, where they form a superficial plexus. A hyperplasia of these vessels exists in telangiecta- sis. The superficial plexus is mainly affected in psor- iasis, lichen and prurigo. Both plexuses may be im- plicated in eczema. The lymphatics also form plexuses, generally one beneath each plexus of blood vessels, and lymph spaces are usually present in the corium. They play an im- portant part in morpheea and are increased, both as to size and number, in elephantiasis. The lymphatic element is also apparent in the glandu- lar swellings of prurigo, and in the enlarged glands ait the back of the neck in eczema of the scalp in children. The muscular fibres of the skin exist in two forms, t^triated and smooth. The former are found princi- pally in the skin of the face. They arise from the deeper seated muscles, and pass upwards to terminate in the corium. The latter appear either as anastomos- ing plexuses running horizontally, as in the scrotum, or 22 DISEASES OF THE SKIN. as fasciculi, as in connection with the glandular appar- atus of the skin. Contractions of the little muscles formed by the aggregation of these fibres, causes the conditions known as cutis anserina or "goose-flesh." Little muscles of the smooth or unstriped variety, called erectores pili (erectors of the hair), arise from the internal sheath of the hair follicles, pass obliquely upwards around the sebaceous glands, and terminate in the upper part of the corium. They are supposed to erect the hair and to favor the exit of sebum from the sebaceous glands. The nerves of the skin are surface branches of the nerve trunks that accompany the larger blood vessels in the subcutaneous tissues. They are composed of both medullated and non-medullated fibres. The medullated fibres terminate as a rule in the Pacinian and tactile corpuscles; while the non-medullated fibres end as a sub-epithelial plexus in the upper layers of the corium and in the rete mueosum, from which fila- ments ascend between the epithelial cells towards th(- stratum lucidum. The Pacinian corpuscles are small, ovoid bodies, found in the subcutaneous connective tissues, upon the nerves of cutaneous supply. They occur in various regions, but arc most numerous in the volar side of the hand and foot. The tactile or touch corpuscles, also called corpus- cles of Meissner or Wagner, are oval bodies found mostly in the papilhe of the corium. They are most GENERAL OBSERVATIONS. 23 numerous upon the last phalanges of the fingers, where they are found in about one ot four of the papillae. Vaso-motor and trophic nerves supplying the vascu- 1 ir, muscular and glandular systems, are also found in the skin. The cutaneous nerves, in addition, give to the skin the sense of touch, and are intimately connected with ti;e physiological and pathological changes going on around them. They undergo organic alterations in zoster, leprosy, dermatalgia, and telangiectasis. The sweat or sudoriparous glands are small reddish- yellow bodies composed of convoluted tubules situated in the deep j arts of the corium, or even in the subcu- taneous adipose tissue. They open on vhe external surface by means of a narrow efferent duct, which presents an oblique valve-like aperture. They are found in all parts of the body, but are most numerous on the palms and soles. According to careful computation there are between two and three millions of them in the human body, represent- ing an average of eight miles of perspiratory tubing. By evaporation they tend to regulate the tempera- ture of the body, and ordinarily throw oft between one and two pints of fluid daily. They also act as auxiliary to the kidneys, in throwing off excrementi- tious matters. The natural perspiration is generally acid in reaction, and is composed of nearly ninety- cio-ht per cent of water and two per cent of solid, mostly organic, materials. It is normally alkaline in the axilla and between the fingers and toes, and after 24 DISEASE8 OF THE SKEST. prolonged sweating. It may become variously colored, as in chromidrosis; or impregnated with organic matters, such as urea, albumen, .^ugar or bile. The sweat glands may become functionally disor- dered, as in hyperidrosis. They may be primarily affected, as in dy&idrosis, or secondarily disordered as in ichthyosis. The sebaceous or sebijjarous glands are small pyriform sacculated organs lodged in the substance of the cor- ium. They are composed of a basement membrane externally, and secreting cells, or their products inter- nally. They are furnished with excretory tubes which open usually in the hair follicles, but occasion- ally upon the cutaneous surface. Generally there are two to each hair, located on opposite sides; at times four or even eight may be found grouped around a single hair-sac. They are to be met with upon all portions of the body, except the palms, soles, dorsum of the third phalanges, and the glans penis. The largest are those of the eyelids, the nose, the lips, the labia externa and the scrotum. The secretion from these glands is of an oily nature, and is known as sebaceous matter or sebum. It contains about fifty per cent of fatty matter, and is perfectly fluid at the ordinary temperature of the body. The office of the sebum is to prevent too rapid evaporation, and to give softness and pliability to the skin and to the hair. The sebaceous glands may be functionally disordered; as in seborrhcea on the one hand, or as in xeroderma 01 the other. They may be primarily affected, as in acne GENERAL OBSERVATIONS. 25 v,r secondarily diseased, as in elephantiasis and lep- rosy. The hairs are peculiar modifications of the epider- mis, and consist of shafts and roots. They are of three classes: (1.) Long and soft hairs, as those of the scalp, pubes, and axillae. (2.) Short hairs, soft as those of the eyebrows, or stiff as upon the lids. (3.) Fine downy hairs, found upon the face and body and called lanugo. The total number of hairs on the scalp has been estimated at from ninety to one hundred and twenty thousand. The cortical portion of the shaft of the hair is made up of firmly adherent, flat horny cells, while the medullary substance consists of a mass of loosely packed epidermal elements. The difference in con- stitution of the cortex and medulla of the hair gives to the structure minuteness, strength and elasticity. A single hair has been known to support a weight of over two ounces ; and it is so very elastic that it may stietch almost one-third of its length, yet return to its former measurements. The color of the hair is mostly given to it by the pigment granules that are found stored in the horny and medullary portions. The root presents a bulbous enlargement which is closely connected with the papilla, a vascular eminence situated ait the base of a finger-of-glove depression in the epidermis and corium, called the hair follicle. The rate of growth of the hair is about a half inch per month. Hairs grow by the multiplication and pushing outwards of the cells of the bulb lying next 26 DISEASES OF THE SKIN. to the hair papilla. They may become either hyper- trophied or atrophied, or even texturally changed. The hair follicle is cylindrical in form and is always placed more or less obliquely in the skin. It consists of a body, neck and mouth. The latter is funnel shaped and opens directly upon the surface. The neck is the narrowest part of the tube and is located just below the level of the papillary layer; while the body, which constitutes the largest part, terminates in a bulbous extremity and contains the hair papilla and the hair bulb. The follicle consists of two parts, an outer, the hair sac, and the inner, the root sheath. The hair sac is made up of three layers, external, middle and internal. The external layer is the thickest and most impor- tant, and is composed of connective tissue fibres which run parallel with the course of the hair, and join the fibres of the papillary layer of the corium. The mid- dle layer is highly contractile and is made up of trans- verse connective tissue fibres, embedded in a homosjen- ecus, slightly granular substance. The internal layer is a homogeneous transparent tissue, and is a direct continuation of the basement membrane of the corium. The hair papilla protrudes into the cavity of the follicle, and consists of connective tissue derived from its middle layer, together with round nuclei and nucleated cells. It is about twice as long as it is broad, and contains arteries, veins and non-medullated GENERAL OBSERVATIONS. 27 nerve fibres. The constricted portion of the papilla is the neck and the thicker part the body. The root-sheath consists of two layers: (1.) The external; (2) the internal. The external root-sheath is a continuation of the rete malpighii, which extends into the level of the papilla. It is thinnest at the neck of the follicle, and thickest at the bulb. The internal root sheath is made up of (a.) an outer or Henle's layer; and (b.) an inner or Huxley's layer. The outer layer is a thin, transparent membrane com- posed of oblong non-nucleated scales which run paral- lel with the shaft of the hair. It commences at the neck of the follicle and terminates at the bulb. The inner layer consists of flattened fusiform nucleated cells containing small refractive granules. As a rule there is only one hair in eaich follicle, but occasionally two are found to occupy a follicle con- jointly. The nails are horny, elastic, concavo-convex, struc- tures imbedded in the skin upon the dorsum of the distal phalanges. They are composed of altered cutic- ular cells derived from the various strata of the epi- dermis. The posterior portion of the nail, situated beneath the skin, is called the root; and the anterior exposed portion is termed the body. The corium upon which the nail rests and to which it is firmly attached is known as the bed or matrix. The whitish disk, situated just in front of the poste- 28 DISEASES OF THE SKIN. rior groove and due to the diminished transparency of the tissues is called the lunula. Nails grow from their roots as do hairs, and simply slide over the matrix. They grow more rapidly in summer than in winter, and in early age than in adult life. They may become structurally changed, as in onychia. Or they may be primarily affected, hyper- trophied, as in onychauxis, or secondarily so, as in psoriasis, syphilis and ichthyosis. Or, again, the vege- table parasites may here take up their habitat, giving rise to the condition termed onycho-mycosis. The subcutaneous tissues are made up of variously sized loose bundles of connective tissue, containing usually an abundance of fat. When the fat cells are arranged in groups to form lobules and lobes, the structure is then called adipose tissue or panniculus adiposus. The beauty of the skin depends upon the activity of its circulation, the shade of the pigment in its rete mu- cosum, and the depth of its epithelial covering. The shade of pigmentation varies with the color of the hair and eyes. A dark skin generally accompanies dark hair and eyes, while a fair skin is found in people with light hair and blue, hazel or gray eyes. As a rule blondes predominate in temperate and brunettes in tropical climates. SYMPTOMATOLOGY. 2d SECTION II. SYMPTOMATOLOGY. The clinical signs, or symptoms, of disease may be '\ ti, a£( .ly+j-^ either objective or subjective. Objective symptoms »//Lj. I • are those appearances which manifest themselves upon / // the surface, and are capable of ocular demonstration. ^ ^ ^^ Subjective symptoms relate solely to sensations which arise from within, and are cognizant only to the patient. ^jL^iL Aw^». 'r -'■•<-' '-'^ The objective symptoms.,of diseases of the skin embrace all the elementary cutaneous lesions, whose physical characters may be roughly outlined as fol- lows : MaCJDJLES, SPOTS OR STAINS, ARE CIRCUMSCRIBED DIS- I COLORATIONS OF SKIN. yrd^t>^ r'.lis-t*Ai.^ or ix}***-■*■"*•) They are usually of a reddish, yellowish, or brown- 5 ish color; and may be either permanent or evanescent. 5 Small clot-like purpuric macules are calledpelechice. ) cVk-*uv Macules may be either primary as in lentigo or sec- cdLrJ *? / ondary as in Addison's disease. Sometimes they are ■'> * - &****■•y> physiological in character, as in pregnancy. They are w> ?'' "'u r met with in chloasma, naevus, purpura, morjphcea, and erythema. ^>^ ^ *^ * ^^* Papules or pimples are small acuminated ele- 1 vations of skin varying ix size from a millet seed 5 TO A SPLIT PEA. i **-», cJ K-^fA. h^ 'j ■ ■> , . v(,^ M They may be either true or false, and are frequently attended with itching. They are seen in acne,(eczema, ttU J scabies, lichen, prurigo and milium. -< - SO DISEASES OF THE SKIN. Macules, Papules, — Tubercles Vesicles, —.—&&'& -M* Pustules, *ri8^h Bullae, Scabs, Scales, g^^S^ ,s4^^£*. t^SZZSZZZZZr ^&Z2ZiZ>&ZSSZ2Z% FlSSUKES, Ulceus, \ V Nf 7__S" Nw/" Wheals. Fio. 2. Diagram of the principal elementary cutaneous lesions—in profile—(after Piffard). h^uy -L„* ~4~S*-¥*' SYMPTOMATOLOGY. 3i Vesicles are small, elevations of the epidermis, \ enclosing a transparent or milky fluid, varying in size from a millet seed to a split pea. j / , / fi They are as a rule inflammatory, and are usually ^ A'Pfi accompanied by burning and itching. There are three "' -"'^■/' kinds, viz.: serous, sweat and lymphatic. The serous ' v^ are present in eczema, herpes, scabies, impetigo con- *>*-"' /*'*' favosa and zoster. The sweat are seen in sudamina W^-— and dysidrosis. And the lymphatic are observed in elephantiasis. Bullae are blisters or large vesicles, varying ) / IN s'lZE FROM A SPLIT PEA TO a GOOSE EGG. f>J .«,*' ■♦>.''« They occur in groups, and are not commonly at- j. . /,£,<•>, tended by marked itching or burning. They may be t) ,\ either primary or secondary. They are primary in" pemphigus, leprosy, and hydroa. And they aie secondary or accidental in dysidrosis, eczema and urticaria. Pustules are small collections of pus covered by epidermis. They are of yellowish,yellowish-green, or brownish- o-rcen color, and are as a rule accompanied with areolae. They may either originate as pustules, or become so by change from vesicles or papules. And they termi- nate either by rupture or by desiccation. They are met with in aicne, eczema, impetigo contagiosa and ecthyma. a£ 32 DISEASES Or THE SKIN. Tubercles are small solid fleshy swellings in the skin, varying in size from a split pea to a hazel NUT. ■/- . They are usually of a reddish color, and are com- monly situated in the deeper layers of the corium or the subcutaneous connective tissue. They are seen in acne, tricophytina, sarcoma, fibroma, syphilis and leprosy. Small wens are tubercles. \ Wheals are red or whitish, transitory elevations ] OF the skin, resembling the sting of the nettle, \ AND ACCOMPANIED BY TINGLING OR PRICKING SENSA- Y TIONS. They are situated in the upper layers of the skin, and are produced by a rapid exudation and tempor- ary incarceration of serum in the meshes of the corium, due to clonic vascular spasm. They are fugi- tive and capricious in character, and may appear either as elongated oval lines or stripes. They are pathog- nomonic of urticaria. Occasionally they result from insect bites and from medicinal poisoning. Scales, are collections of altered cells of the stratum corneum. They are usually whitish or yellowish in color, and have a shilling or glistening aspect. They are ob- served in eczema, pityriasis,psoriasis,ichthyosis, sebor- rhcea, tricophytina, etc./ Z^v C^'3-«-tA (L -?A/ symptomatology. 33 Excoriations, are superficial solutions of con- , tenuity of the skin. !# c , .. They present a variety of forms, and as a rule, heal without leaving scars. They are observed in connec- tion with eczema, scaJMes, phthiriasis; also in con- sequence of bites of insects; and in all disorders of the skin attended with pruritus. 7^ c •*..-■ ) f Cc*.^ ' «~ TISSURES, ARE LINEAR SOLUTIONS OF CONTINUITY OF S . TH :•: SKIN, SITUATED IN THE EPIDERMIS OR CORIUM. J flAy*^*-^-4- They commonly appear about the normal furrows of ' '""* F-^*- the skill especially in the vicinity of the articulations, ) GUy* and are usually attended with pain. They occur in ■'*>*#»"*"" eczema, psoriasis, leprosy, and the syphilides. '> Crusts, are formed by the drying up of discharges. ( They are yellowish in color when formed by desicca- tion of serum; greenish-yellow when composed of dried pus; and brownish or blackish when they con- tain blood. They are found in eczema, ecthyma, impetigo contagiosa, leprosy, sycosis, seborrhoea, syphilis, etc. Ulcers, are" circular solutions of continuity of. the skin, usually followed by cicatrices. They are most frequently met with on the lower extremities, and are usually attended with pain. They are the result of previous disease, and occur in lupus vulgaris, leprosy, scrofuloderma, furuncle, etc. A 84 DISEASES OF THE SKIN. S Scars or cicatrices, are new formations replac- &Uj *..-• J\ ING LOST TISSUE. '*/-*«« h ■■■ ^ne^ are usua% whitish in color, smooth, and ( somewhat depressed. They consist of connective tissue u-^i^ elements, and are devoid of hair follicles, papillae or A-~«~«A ^ Aw, glands. They may follow ulcerative lesions, and are f *^\kI .also seen in acne, favus, sycosis and zoster. Of subjective symptoms, sensations of heat, hurnvng and tingling are most common. They are met with in varied degrees in all hyperaemic and inflammatory cutaneous affections. Pain is a general accompaniment of acute inflam- mation, as in zoster, etc. Ifyperaist/tesia or over-sensitiveness of the skin is frequently met with in dermatalgia, and in the early stages of leprosy. Anaesthesia or loss of sensibility is present in the later stages of leprosy, and in syphilis. Pruritus or itching is one of the most prominent and annoying of the subjective symptoms. It may be due to locaLcauses, or may be entirely dependent on reflex conditions. etiology. 35 SECTION III. etiology. The etiology or causes of diseases of the skin may be conveniently considered under two heads: I. In- ternal or constitutional causes. II. External causes. I. The internal causes which are also the most numerous, admit of arrangement and description as follows: 1. Hereditability.—An inheritable state in which diseases or taints may be handed down from parent to child. As striking examples, syphilis, leprosy, psori- asis, and ichthyosis, may be mentioned. 2. Constitutional Tendencies.—By which is to be understood a disposition either hereditary or acquired, to the development of certain, usually inflammatory, cases under favorable conditions. 3. Orga.nic and Functional Diseases of the Internal Organs.—Their name is legion. A few may be cited. Derangement of the alimentary canal, are frequent causes of cutaneous eruptions, notably of eczema, urti- caria and acne. Uterine diseases may complicate or give rise to the same troubles. Disease of the kidney is a common cause, or aggravating condition in eczema. Derangement of the nervous system plays a promi- nent part in a variety of disorders. Venereal excesses lead to herpes, pruritus, and syphilis. And affections of the liver have considerable influence in shaping the course of a number of cutaneous ailments. 4. Age and Sex are important conditions influen- 36 DISEASES OF THE SKIN. cing disease. Certain affections are found to appear at stated periods of life, and are peculiar to one or the other sex. The congenital syphilide appears during the first months of infant life. Ichthyosis manifests itself in the second year. And impetigo contagiosa is in the majority of cases an affection of childhood. Of the parasitic affections, tricophytina, excepting when it at.acks the beard, is more common in child- ren, while tinea versicolor is oftenest met with in adults. Acne appears about the time of puberty. Epithelioma rarely shows itself before middle life, and is of more frequent occurrence in males; while lupus originates in childhood and is more commonJn females. b. Certain articles of food, may, under peculiar con ditions become essential factors in the causation of cutaneous eruptions. Of these should be noticed: shell-fi&h and strawberries as common causes of urti- caria; cracked wheat, graham bread, oat meal and buckwheat, as giving rise to roughness of the skin and pruritus; stimulating drinks, preserved meats, and highly seasoned food, as aggravating influences in eczema, urticaria and acne. 6. Drug Poisoning.—The overdosing with such drugs as Mercury, the Potassium Bromide and Iodide, Quinine and Fowler's solution, Copaiba and Valerian, Chloral and Salicylate of Soda, is frequently produc- tive, in Old School practice, of cutaneous complications. Notably may be mentioned the eczema mercunale, the urticaria caused by Valerian and Copaiba, the etiology. 37 acne produced by the Potash salts, and the scarlatinal rash induced by Chloral and Salicylate of Soda. II. The External causes, are: 1. Climatic Influences.—Some diseases are aggra- vated in, or peculiar to cold climates, while others flourish in tropical regions. The majority of cutan- eous disorders are aggravated by cold weather. A few as for instance prickly heat, are peculiar to warm seasons. While certain diseases, such as leprosy, elephantiasis, and pellagra, are almost peculiar to certain countries. As a general rule in any locality, temperature will exert an influence, proportionate to the extremes of heat and cold to which the patient is subjected. 2. Irritants.—Want of cleanliness is the exciting cause of many skin affections. The tinea fungus riots v in dirt, amd filth is a condition favorable to the develop- ment of eczema and other cutaneous inflammations. Pruritus is frequently due to the frictional effect of clothing. Traumatism may give rise to excoriations and even infiltrations of the skin. Local irritants are often met with in particular occupations. Grocers, masons and bakers are often troubled with eczema, induced by handling flour or lime. Washerwomen, workers in dyes and the wearers of dyed garments, are also frequently the subjects of the same disease. 3. Parasites.—Of these there are many varieties, both aninml and vegetable, each parasite producing its own characteristic contagious lesion, and only requir- ing a favorable soil on which to fructify and grow. 38 DISEASES OF THE SKIN. SECTION IV. diagnosis. The diagnosis of cutaneous affections is, to the experienced eye, an easier task than that of any other class of diseases. The predominance of objective -symptoms which serve at all times as "key-notes," enables the physician with a little aid from the patient in the way of subjective symptoms, to ascertain positively the extent and nature of the lesion. The examination must in all cases be thoroughly instituted. The family history of the patient should be learned, and the occupation and habits inquired into. The physical characters of the eruption must be closely scrutinized, and the peculiar features of the extending edges of the patches accurately determined. To this end, it is necessary to examine all the affected portions of the skin, special attention being given to the newest developments. The changes, if any, in the character of the eruption from the time of its first appearauice should be carefully noted, and the stages through which the disease has already passed, satisfactorily mapped out. It must be borne in mind that the influences of teniperament, age, sex or social surround- ings may modify the generail characters and aspect of a disease; and that complications may so mask a case as to render it difficult of recognition. The examination is best conducted in day lio-ht, admitted from a northern exposure. A white lio-ht is the best substitute for sunlight. In difficult or DIAGNOSIS. 39 complex cases, where the unaided eye is uuable to solve the problem, a microscope provided with a fifth and half inch objective, may be used with profit. Fig. 3. Skin Grafting Scissors. When necessary, as in affections of the beard or scalp, one or more hairs may be secured for examination by extraction with a pair of epilating forceps, (Fig. 12.) Small slices of other parts to be examined can be easily obtained by the use of the skin-grafting scissors, (Fig. 3.) or, if still thinner sections are needed, the cutisector (Fig. 4.) may be employed. Fig. 4. The Cutisector. The temperature of parts, if desired, is readily taken by Seguin's surface thermometer. (Fig. 5.) 40 DISEASES OF THE SKIN. Very material aid in making a diagnosis is fre- quently derived from remembering the locality Fig. 5. Sequin's Surface Thermometer. attacked. The following table, after Fox, gives the main points: The scalp, is the most common seat of seborrhcea, the tineae, eczema, sebaceous cysts, psoriasis and alo- pecia areata. v The forehead, of acne. v The nose, of lupus and rosacea. The cheeks, of lupus, rosacea and eczema. The upper lip, of herpes and eczema. The lower lip, of epithelioma. The chin, of sycosis and tinea tricophytina. The angle of the mouth, of epithelioma. The ears, of eczema. The front of chest, of keloid and tinea versicolor. Under the clavicle, of sudaxiina. Region of the nipple, of scabies and Paget's disease. The side of chest, of zoster. The elbows and knees, of psoriasis. The interdigits and front of wrists, of scabies. Back of the hands, of lichen amd eczema. The palms, of syphilide. The buttocks inner ankle and toes in children, of scabies. J DIAGNOSIS. , v> 4i *y ■ The dorsum of penis, of scabies. ' , The scrotum, of eczema, psoriasis and chimney-. sweepers' cancer. The front of the leg, of dermatitis contusiformis. The leg, if running around or lengthwise, of zoster. The whole body, of pemphigus foliaceus and derma- titis exfoliativa. And the flexures of joints, of eczema and scabies. I i 42 DISEASES OF THE SKIN. SECTION V. CLASSIFICATION. Classification is generally resorted to in order to simplify the study of disease, and is as important in the department of dermatology as in any other branch of medical science. The arrangement here presented is a modification of that recently adopted by the American Derma- tological Association. CLASS 1. Disorders of the Glands.— (1.) Of the sweat glands: Anidrosis. Bromidrosis. Chromidrosis. Hy- peridrosis. Miliaria. Sudamina. (2.) Of the sebaceous glands: Comedo. Cysts. Milium. Molluscum sebaceum. Seborrhcea. class II. Inflammations.—Erythema. Intertrigo. Derma- titis contusiformis. Erysipelas. Pityriasis. Urtica- ria. Acne. Sycosis. Eczema. Dysidrosis. Pernio. Strophulus. Prairie itch. Herpes. Zoster. Hydroa. Pemphigus. Impetigo contagiosa. Ecthyma. Lichen planus. Prurigo. Lichen simplex. Psoriasis. Der- matitis exfoliativa. Anthrax. Furunculus. Hydro- adenitis. class m. Hemorrhages.—(1.) Of connective tissue: Pur- pura. CLASSIFICATION. 43 CLASS IV. Hypertrophies. — (1.) Of pigment: Chloasma. Lentigo. (2.) Of epidermal and papillary layers: Callositas. Cornu cntaneum. Clavus. Ichthyosis. Verruca. Ony- chia. Paronychia. Hirsuties. (3.) Of connective tissue: Elephantiasis. Fram- bcesia. Rosacea. Scleriasis. Scleroderma. (4.) Of nail: Onychogryphosis. (5.) Of cutis: Dermatolysis. CLASS V. Atrophies.—(1.) Of pigment: Leukoderma. (2.) Of connective tissue: Morphoea. (3.) Of hair: Alopecia. (4.) Of nail: Atrophy of the nail. (5.) Of cutis: Linear atrophy. CLASS VI. Nrw Growths.—(1.) Of connective tissue: Fibroma. Keloid. Xanthoma. Neuroma. (2.) Of vessels: Nievus. Telangiectasis. Lym- phangioma. (3.) Of granulation tissue: Epithelioma. Leprosy. Lupus erythematosus. Lupus vulgaris. Rhino scle- roma. Sarcoma cutis. Scrofuloderma. Syphilides. CLASS VII. Xruroses.—Anaesthesia. Dermatalgia. Hyperaes thesia. 44 DISEASES OF THE SKIN. CLASS VIII. }*arasitic Diseases.—(1.) Vegetable or dermatophy- te: Tinea favosa. Tinea tricophytina. Tinea versi- color. Alopecia areata. Onycho-mycosis. (2.) Animal or dermatozoic: Elephantiasis. Gui- nea worm disease. Mite disease. Phthiriasis. Scabies. DESCRIPTION AND TREATMENT. 45 PART II. THE DESCRIPTION AND TREATMENT OF SKIN DISEASES. ACNE. Definition.—Acne is an inflammatory disease of the sebaceous glands, caused by the retention of sebum, and characterized by the formation of papules, pus- tules and tubercles, which on disappearing may leave cicatrices. Synonyms.—Varus. Ionthus. Stone-pock. Symptomatology.—Acne, from the Greek acme, a point, is, next to eczema, the commonest disease of the skin. It may show itself on any part of the body, except the palms of the hands and soles of the feet, but generally selects as seats, the face and back. It affects both sexes, and is most common, between the * ages of fifteen and forty-five. It occurs mostly in light complexioned }7oung people, at the age of puberty. It is more common at this period of life, because the hair follicles and sebaceous glands are in a state of physiological hyper-activity, and hence more liable to suffer functional derangement, and to take on diseased states. It may appear either as a separate and inde- pendent affection, or exist as a complication of other follicular diseases, 46 DISEASES OF THE SKIN. The eruption usually manifests itself, in the form of pin-head or pea-sized elevations, situated around the glandular orifices, attended by more or less peri-follic- ular and peri-glandular inflammation. The eleva- tions may be either light-red, dull crimson, or viola- ceous in color, and are usually slightly painful and tender. The course of the disease, though at times acute, is usually chronic. When acute, it may run its course in a few d.-vys or weeks, but when chronic it may last for years. Occurring for the most part in early life, it frequently disappears spontaneously as maturity is attained. Varieties.— The two principle varieties of acne are acne vulgaris, and acne indurata. The former vari- ety is most frequently observed in early life, and con- sists of pin-head or split-pea sized, discrete papules, in various degrees of development. The papules and pustules, are seldom surrounded by marked infiltration but are generally interspersed with black points (com- edones). The eruption is usually confined to the face and shoulders. The latter variety of acne, acne indurata, may follow acne vulgaris. It occurs oftenest about the twenty- fifth year, and is frequently generalized over the fore- head, cheeks, chin and back of the neck. It consists of split-pea or small chestnut sized papules, tubercles and pustules, situated on reddened, infiltrated and hard- ened bases, frequently presenting the appearance of conical elevations, and often attended with pain. DESCRIPTION AND TREATMENT. 47 The eruption is usually very chronic, often very indolent, and is apt to be attended with much disfig- urement and scarring. In debilitated states of the system, such as attains in anaemia, chlorosis, marasmus, scrofulosis, and tuber- culosis, a form of the disease, termed cachectic acne, is frequently observed. The eruption appears mostly, on the trunk and extremities, and consists of indolent pin-head or bean sized, livid or violaceous, usually soft papulo-pustules, which on disappearing, leave minute cicatrices. An acneiform eruption, to which the name, artifi- cial acne has been applied, is occasionally produced by the constant or over-use of such substances as tar and the salts of bromine and iodine. It usually con- sists of reddish-brown, pin head or pea-sized papules, and differs from true acne, in that it is frequently attended by more or less inflammation of the whole skin, and by the development of pustular and furun- cular lesions. Etiology.—The causes of acne though often obscure, are frequently found in a lowered vitality, commonly associated with functional or organic derangement of the digestive and sexual systems. Acne vulgaris, which is pre-eminently a disease of youth, is frequently attended with either perverted sexual habits, or a poorly regulated sexual hygiene. Menstrual irregularities, and uterine disease frequently play a not unimportant part. W hile various topical irritants, such as cosmetics, irritating soaps, frizzes, 48 DISEASES OF THE SKTN. dyed veils, etc., in persons having irritable skin, often produce acne. Acne indurata is oftenest met with during and after adult life. In males it is frequently induced by gas- tric and hepatic derangements, or may be due to exces- sive indulgence in alcoholic liquors. In females it may be caused by gastric trouble, or by ovarian or uterine disease. Morbid anatomy.—In acne vulgaris there is first a retention of the secretion of the sebaceous gland, and the formation of a sebaceous plug, which by blocking up the excretory duct, acts as a foreign bod}', and excites inflammatory hyperaemia and exudation in and around the hair follicles and glands. If the plug is not removed, pus formation, associated with painful inflammatory induration of the connective tissue about the gland, takes place. In this way the hard tubercles of acne indurata are formed. It the peri- glandular and peri-follicular inflammation is active, both the gland and the follicle maybe destroyed, leav- ing ultimately a visible cicatrix. Diagnosis.—The differential diagnosis of acne is exceedingly simple, if the chief characteristics and history of the disease are borne in mind. The only affections with which it is liable to be confounded are, a papulo-pustular or tubercular syphilide, rosacea, and eczema in the papular stage. From the papulo-pus- tular syphilide it must be distinguished by its history, by the absence of groupings of eruption and the characteristic crusts, as well as of other signs of gen- DESCRIPTION AND TREATMENT. 49 eral syphilis. From rosacea it may be distinguished by the age of the patieut, by absence of itching and burning sensations, and by the color of the pimples, which are pale red or livid in acne, but brighter, and scattered over a more or less reddened patch in rosacea. In the papular staige of eczema, there is more or less interpapillary infiltration, and a disposition to scaly formation. Treatment.—The treatment is both local and constitu- tional. The diet should be light and unstimulating. Buck- wheat cakes, hot-bread, nuts, cheese, fried substances, exhilarating drinks, and all sweet and rich articles of food should be avoided. In dyspeptic patients, a cup of hot water taken a half hour before meals, will often prove beneficial. The external treatment will vary, according to the extent, obstinacy, and stage in which the disease exists. The plugs of sebum should be removed as earl}' as possible. For this purpose a watch-key or what is perhaps pre- ferable, a comedo extractor (Fig. 6) may be used. In Fig. 6. Comedo Extractor. all inflammatory conditions the greatest benefit is ob- tained from five-minute applications of very hot water, two or three times per day. When the pustules are large and full, the inflammation and congestion is best 50 DISEASES OF THE SKfN. relieved bypassing the point of an acne lance (Fig. 7) into them, and evacuating their contents, and after- wards resorting to the hot water fomentations. In the milder forms, and in all cases after the inflammation and congestion have somewhat subsided, the best results may be obtained from either a resorcin lotion (resorcin one drachm (4.) glycerine one drachm Fig. 7. Acne Lance. (4.) aq. aurant. six drachms (24.) alcohol three ounces (96.); or a sulphur wash (sulphur precip. one drachm (4.) glycerine, one drachm (4.) alcohol four drachms (16.), aq. ros. four ounces (128). Finely powdered sulphur, intimately mixed with three or four times its weight of rice flour or of any simple toilet powder, may be freely dusted over the face. In mild forms of acne vulgaris, this prepared sulphur powder may be used in preference to the lotions. In acne indurata, the inflammation and induration are best relieved by freely incising the papules and pustules with the acne lance (Fig. 7), and applying hot fomentations. After the inflammation has some- what subsided, the sulphur lotion referred to above should be employed. In obstinate cases apply nightly, an unguent made of three drachms (12.) of a five per- cent oleate of mercury, and one ounce (32.) of olive oil. The affected parts should be rubbed with a soft nail- brush and warm soap and water, every night before applying the lotions. DESCRIPTION AND TREATMENT. 51 In indolent papular acne, associaited with comedones the dermal curette (Fig. 9) may be used. Applications of the faradic current every two or three days, and sea salt or sea water (Briggs), baths about twice a week, have occasionally rendered excel- lent service. The soaps that have been found most useful, are notably, sulphur and iodide of sulphur soaps, and the Juniper tar soap. Of internal remedies one of the following may be selected according to the indications: Antimonium crudum.—Small, red pimples about the face, and on the right shoulder,stinging when touched. Acne in drunkards, with gastric derangements, severe thirst, and white coated tongue. Antimonium tart.—In obstinate cases with longing for acids, and when there is a decided tendency to pus- tulation. The pustules are thickest on the neck and shoulders, and after discharging leave bluish-red cica- trices. May be used internally and locally. Arsenicum.—In chronic cases when the skin is dry, rough, and dirty looking, and when the eruption is most marked on the face and extremities. Cachectic acne. Asimina.—Itching red pimples, appearing first en the left, then on the right side. Pustular acne, with itching in the evening when undressing. Aurum.—Red pimples on the face. Disposition to melancholy. In onanists and syphilitics. After over- dosing with potassium iodide. 52 DISEASES OF THE SKIN. Baryta carb.—In obstinate cases, especially when the papules or pustules are interspersed with come- dones. Adapted to scrofulous persons and to wine drinkers. Berberis vulg.—Red, burning, gnawing pimples, sensitive to pressure, surrounded by red areolae, and leaving brown stains. Adapted to indurated acne, associated with urinary or haemorrhoidal troubles. In women with scanty or suppressed menstruation. Belladonna.—Large, bright, red pimples on the face, back, and scapulae, especially in young, full- blooded people. Fine stinging in the tips of the pimples. Worse during menstruation and pregnancy. Bovista.—Large, scattered pimples on the forehead. Hard, red pimples, large as peas, on the chest, worse from scratching. In delicate women, with thick acrid or corrosive, gresnish-yellow leucorrhcea, after the menses. Bromine.—Indurated acne in scrofulous individuals. Aggravated by smoking. Swelling and induration of the glands of the neck. Calcium sulphide.—Painless pimples on the nape of the neck, forehead and chin. Crusty pimples on the face in young people. Swelling and suppuration of glands. Calcarea carb.—Acne on the face and neck, worse before menstruation. After sexual excesses. Espec- ially in scrofulous persons. Carbo veg.—Pimples on the nape of the neck. Red pimples on the face and chin in young persons. DESCRIPTION AND TREATMENT. 53 Aggravated by eating butter or pork. Cachectic acne. Causticum.—Eruption on the face, more felt than seen. Yellow color of the face. Papulous eruption between the eyebrows above the nose. Adapted to dark-haired persons. Chelidonium maj.—Pimples and pustules in groups -of three or four on the face, except the chin. Chiefly on the left side. Acne dependent upon liver derange-. ment. Cimicifuga.—Acne in women, dependent upon gas- tric ovarian or uterine derangement. Conium mac.—In obstinate, indurated acne occurr- ing on the face. After the suppression of the menses. Adapted to scrofulous persons, and old maids. Eugenia jamb.—Pimples on the face which are painful for some distance around. At times useful in the indurated form. Granatum.—Pimples on the forehead and left tem- ple with sore pain. They suppurate and on drying leave nodules. Itching in different parts of the body as if pimples would break out. Graphites—Acne in persons inclined to obesity; particularly females with disposition to delayed men- struation. The skin is very dry, inclined to crack, and easily tends to ulceration. Iodine.—Indurated acne in scrofulous subjects. Adapted to young persons with dark hair and eyes, and rough, dry skin. Kali. bich.—Face covered with a profuse eruption resembling acne. When pustules form they resemble 54 DISEASES OF THE SKIN. small-pox pustules. Especially suitable for fat, light- haired persons. Kali. carb.—Small pimples on the face, chest, and back, with redness and swelling deficient perspiration. Aggravated during suppressed menstruation. In per- sons inclined to pulmonary troubles. Kreasote.—Acne worse after menstruation, or from getting heated. Dry pimples on the forehead. Greasy pimples on the right cheek and chin. Ledum.—Red pimply eruption en the face. Small pimples on the root of the nose. In rheumatic persons and brandy drinkers. Lycopodium.—Red pimples in clusters, betwreen the scapulae and on the nape of the neck. In dyspeptic individuals, inclined to constipation. Mercuriussol.—Indolent bluish-red papules, especi- ally on the lower extremities. Dirty yellow color of the skin, with glandular swellings. In syphilitic and scrofulous persons. Mezereum.—Single pimples on the thighs. Red pustules with inflamed areolae on the outer side of the extremities. In scrofulous individuals, and in persons who have already taken mercury. Nabulus serp.—Pimples on the face, about the nose, upper lip and chin. Natrum mur.—Acne accompanied by seborrhoea, when associated with scorbutic affections or chlorosis. Nitric acid.—Many small pimples on the forehead, just below the hair. Painful pimples on the chin with hard, red areolae. Skin dry and scaly. Brown-red spots on the skin. After the abuse of mercury. Description and treatment. 55 Nux juglans.—Variously sized reddish pimples and pustules on the face, chiefly around the mouth. Large painful blood-boils on the shoulders, and in the hepatic region. Adapted to all stages of acne. Nux vom.—Acne with dyspepsia and constipation. After over-use of coffee, liquors or tobacco. In persons of sedentary habits. Phosphoric acid.—Smooth, red pimples with red areolae on the fore arm, knees and leg. Large, red pimples on the face and scapulae, only sensitive to the touch. Acne in weakly persons, onanists, and victims of spermatorrhoea. Potassium bromide.—Acne on the face, neck and shoulders, with peculiar yellow points which neither coalesce nor burst. Frontal headache at night. Adapted to both the simple and indurated forms. Potassium iodide.—Papulous eruption all over, but especially on the face and the shoulders. Painful sen- sitiveness, worse at night. In mercurial and syphilitic affections. Pulsatilla.—Acne in pale, slender individuals. Gas- tric and bilious disorders. Amenorrhcea. Chlorosis. Aggravated by pastry and fat food. Rhustox.—Acne in drunkards, rheumatic individu- als, and in persons addicted to sexual excesses. Robinia.—Hard pimples which take a great while to suppurate. Great tendency of tumors to become indu- rated. In dyspeptics with sour stomach, worse at night. Nocturnal emissions. Rumex crisp.—Dense rash of small red pimples. 5(5 DISEASES OF THE SKIN. Eruptions aggravated by wearing flannel. Itching oil various parts, worse while undressing. Sabina.—Papular eruptions during pregnancy. Sarsaparilla.—Acne on the nose and face, worse dur- ing the menstrual period. Burning itching eruption. Sepia—Acne on the chin, during pregnancy and nursing. Pimples on the mons veneris, legs and flexures of the joints. Ailments following vaccination and self- abuse. Silicea.—Cachectic acne. Obstinate cases in scrofu- lous persons. Aggravated by wine drinking. Sulphur.—In acne vulgaris with black pores in the face. Red, itching pimples on the nose, lip, around the chin, and on the forearms. Furunculosis. Chronic cases. Sumbul.—Smooth, small, reddish spots on the fore- bead. Black pores on the face. Thuja.—Acne on the alae nasi, worse during men- struation, and after excesses of all kinds. Veratrum alb.—Pimples on the right labium just before menstruation. ALOPECIA. Alopecia or simple baldness, is an absence of hair, either partial or general. It is a symptom rather than a disease, and may exist ais an accompaniment of a variety of affections. ALOPECIA AREATA. Definition.—It is a disease of the hair system, characterized by the more or less sudden appearance of variously sized white, bald patches. DESCRIPTION AND TREATMENT. 57 Synonyms.—Porrigo decalvans. Tinea decalvans. Symptomatology.—It starts usually on the scalp, and generally from the parietal protuberances, but occa- sionally it commences in the beard. At times the whole body becomes affected. The disease is fre- quently unilateral, occurs mostly in young people, and is usually announced by the appearance of one or more nickel-sized, roundish or oval .areas, devoid of hair. These are apt to extend quite rapidly, and in a few days may have attained the size of an inch or more. Other spots soon appear elsewhere, and in a short time the greater part of the side of the head may be bald. The hairs generally come out by the roots leav- ing a perfectly smooth polished surface, and do not break off as in tinea tricophytina. At times little fine lanugo or downy hairs appear on the affected part; these, however, arc seldom more than transients, and soon fall off and disappear. After this manner the disease may run indefinitely. Etiology.__There are probably two varieties of alo- pecia showing a disposition to develop in areas. One variety being contagious and presumably para- sitic; the other often displaying an hereditary predis- position and dependent upon a trophoneurosis or func- tional nerve derangement. Treatment.__The treatment is often parasiticidal, and consists in epilating with a broad-lipped forceps 5 Ax Veratrum alb.—Cold, clammy sweat staining the linen yellow. Worse on the forehead. ICHTHYOSIS. Definition.—Ichthyosis is a congenital chronic dis- ease of the skin, characterized by increased growth of the papillary layer with dryness, roughness and general scaliness. Synonym.—Fish-skin disease. Symptomatology.—The mildest form of this-affection, occurs in children of two years and upwards, and pre- sents a dry harsh dirty looking skin, covered with a variable amount of furfuraceous scales {Xeroderma.) In severer cases, or when further developed the papillae become enlarged, the discoloration grows more marked, and the epidermal scales are lozenge- shaped, and are separated by numerous lines and fis- DESCRIPTION AND TREATMENT. 139 eures {I. simplex.) In more extreme cases still, the scales form dry, hard, brittle plates of a yellowish or greenish hue, separated by white intervening lines, which mark the natural furrows of the skin. ( These plates never overlap one another.) At times the scales become heaped up into black papillary horny projec- tions. To this extreme condition the term ichthyosis hystrix has been applied, from its fancied resemblance to the quills of a porcupine. In ichthyosis the whole surface of the body is usually more or less involved, and the front of the knees espec- ially so. The face and flexures of the elbows and knees, however, generally escape. There is always attend- ing the disease a characteristic diminution or absence of perspiration. It is apt to be much worse in the winter time, so that the face and hands become extensively chapped and painful. Diagnosis.—The diagnosis is generally easy, as pity- riasis is the only disease to which it bears any resem- blance. In pityriasis it should be remembered, the skin is more or less hyperaemic, while in ichthyosis it is not. The scales in pityriasis are "branny" and fall off readily while those of ichthyosis resemble "fish- scales" and are more adherent. Prognosis.—Ichthyosis though very intractable, sel- dom proves fatal. Treatment.—A generous diet should be allowed the patient, and cod liver oil should be a standing order. After every full bath—the Turkish bath being the 140 DISEASES OF THE SKrN. best—the body should be anointed with either olive, chaulmoogra or cod liver oil, well rubbed in. An infusion of quillaya saponaria bark sometimes works well as a local application. Arsenicum iodide is the principal internal remedy. Others may be indicated as follows : Arsenicum iodide.—Dry scaly skin. Itching and burning. In scrofulous subjects with swelling of the lymphatic glands. Clematis.—-When there are fine scales with some itching, worse when getting warm in bed. Painful swelling and induration of the glands. Eruption changes character with the changes of the moon. Graphites.—Skin dry and inclined to crack. Un- healthy skin ; every injury tends to ulceration. Thick and crippled toe nails. Extremities go to sleep. Itching of the genitals. Iodine.—The skin has a brown dingy color. Rav- enous hunger. Swelling and distension of the abdo- men. Emaciation in dark complexioned, scrofulous children. Mercurius.—Dirty, yellow color of the skin. Itch- ing, worse at night when warm in bed. Dry, scaly spots. In syphilitic and scrofulous subjects. Natrum carb.—Skin of the whole body becomes dry, rough and cracked here and there. Frequent empty or sour eructations. Great prostration. Phosphorus.—Skin is dry and wrinkled. Skin of hands is rough and dry. Pains in the chest. Desire for acids and spicy foods. Falling of the hair. Great indisposition. In tall, slender people. DESCRIPTION AND TREATMENT. 141 Potassium iodide.—Skin dried up. Rough, like hog skin. Sensitive swelling of the thyroid gland. (Edematous infiltration of the tissues. After mer- cury or syphilis. Plumbum.—Dry skin. Absolute lack of perspira- tion. Obstinate constipation. Paralytic weakness of the limbs. Thuja.—Dirty gray cadaverous looking skin. Wart- shaped excrescences. Brittle or soft nails. Lymphatic temperament. IMPETIGO CONTAGIOSA. Definition,.—Impetigo contagiosa is an acute inflam- matory contagious affection, occurring mostly in children, and characterized by the presence of one or more discrete vesicles or vesico-pustules, generally umbilicated, varying in size from a split pea to a hazel-nut, and followed by flat, large straw-colored, usually fungoid, crusts. Symptomatology.—This disease is usually ushered in by a period preceding the eruption, characterized by more or less fever and malaise. After two or three days this stage is followed by crops of small vesicles, which gradually develop into vesico-pustules and pustules. The vesicles which are at first small, grow rapidly and may at maturity have reached the size of even a split pea or a hazel-nut. They are generally umbili- cated and contain a lymph-like fluid with granular and subsequently pus cells. Red areqhe more or less extensive usually surround them. 142 DISEASES OF THE SKLN. In five or six days after their first appearance, their fluid contents begin to dry up, and eventually form flat-shaped, straw-colored scabs about the size of split peas or hazel-nuts, looking as if stuck on. In mild cases the eruption may be confined to the skin of the forehead and cheeks, its most usual seat, but quite frequently it extends to the arms and head, and may implicate the mucous membrane of the eyes, mouth and nasal cavity. Impetigo contagiosa was first described by Tilbury Fox in 1864. It generally occurs in children of the poorer classes, though the rich are not exempt. It may be epidemic but is mostly sporadic, and is both contagious and auto-inocnlable. It tends to run a definite course and usually lasts from one to two weeks. At the Central Homoeopathic Dispensary of this city it constitutes about one per cent, of all skin affections. Its most frequent cause is vaccination. It can hardly be considered a parasitic affection, for although a fungus similar to that observed in the vaccine crust has been seen in the scabs of this dis- ease, none have as yet been found in the fluid of the vesicle, or vesico-pustule. Diagnosis.—By bearing in mind that this affection occurs mostly in children and frequently in those who are perfectly healthy, that it is preceded by more or less febrile distur' ance, consists of isolated vesicles usually umbilicated, of split-pea size or larger, seated mostly in the face, following generally in the wake of vaccination, and presenting scabs having the charac- DESCRIPTION AND TREATMENT. 143 turistic appearance as if " stuck on," it can hardly be mistaken for any of the other forms of cutaneous trouble. The diseases with which it is most liable to be confounded are eczema and varicella. It may be distinguished from the former by the fact that the children attacked are usually healthy, while those of eczema are not; that the scabs are light yellow, flat and " look as if stuck on," while those cf eczema are greenish yellow and adherent; that it is generally confined to the face and upper extremities, while eczema may attack any part of the body. From varicella it may be known by the smaller vesicles and different crusts of the latter, together with the almost constant constitutional disturbance and the appearance of vesicles on all parts of the body. Treatment.—The patient should be well nourished, and if there is much inflammation around the vesicles, the soothing applications spoken of in eczema should be used. White precipitate cerate—five grains (.3) of white precipitate, vaseline one ounce (3-.)—is the best local dressing. Antimonium crudum is the principal internal remedy. Aconite may be called for in oft repeated doses, if there is much febrile disturbance. Euphorbium is indicated when there is an irritable skin, with swelling of the face and pea-sized yellow vesicles. Kali bich. stands next to Antimonium crud. Tartar emet., is ihe remedy when the disease is ex- ceedingly pustular. 144 DISEASES OF THE SKIN. Thuja.—After vaccination. Silicea and Kali nitricum are at times indicated. INTERTRIGO. Definition.—Intertrigo is a hyperaemic affection caused by the prolonged contact of two cutaneous surfaces, characterized by heat, redness and an abraded surface with maceration of the epidermis. Synonyms.—Dermatitis traumatica. Erythema in- tertrigo. Eczema intertrigo. Symptomatology.—It is chiefly met with in fat per- sons and in infants. It may occur whenever the skin hangs in folds, and is therefore more commonly seen about the nates, groin and axillae, and in the folds of the neck and beneath the mammae. Treatment.—The local treatment consists in wash- ing with cold water and castile soap, and after drying with a soft towel, in dusting the parts with lyco- podium dust, or oxide of zinc and rice powder equal parts. Attrition of the surfaces should be guarded against. The principal internal remedies are: Borax.—Slight injuries ulcerate. Hot urine in infants. Red, papulous itching eruption. Calcarea carb.—Intertrigo in fat, scrofulous chil- dren during dentition. Sour vomiting. Hard, dis- tended abdomen. Chamoahlla.—In infants aggravated by every cold change of weather. Child is cross and fretful. Graphites.—Intertrigo between the thighs with DESCRIPTION AND TREATMENT. 145 discharge of glutinous fluid. Itching of the genitals. Aversion to animal food. Slight injuries ulcerate. Hydrastis.—Irritation maddening, with intense burning heat. Constipation with haemorrhoids. Mkrcurius.—Rawness with great soreness, worse at night. Soreness between the thighs and genitals. Swelling and inflammation of the glands. Superficial, wide-spread ulceration. Petroleum.—Intertrigo behind the ears. Tips of fingers rough, cracked and fissured. Itching, soreness and moisture of the genitals. Painful sensitiveness of the skin. Psoricum.—Intolerable itching in the evening and at night. Offensive perspiration at the anus and perineum. Arsenicum sulphide, Nux juglans and Lycopodium may be compared in chronic and obstinate cases. itch. Definition.—See Scabies. KELOID. Definition.—Keloid is an affection of the skin, char- acterized by the development of one or more flatfish smooth-surfaced tumors, usually upon the site of cicatrices. Synonyms.—Cheloid. Kelis. Symptomatology.—The form of the tumor is very variable, and somewhat peculiar, in that it is usually made up of a central portion or body, having numerous prolongations or claws. It may vary in size from a 146 DISEASES OF THE SKIN. five-cent piece, to several centimeters in diameter. Its usual seat is the sternum and mammae, though it may appear on other parts. It is a disease mainly of adult life, and is seen oftenest in colored people. The tumors are slightly painful on pressure, but do not tend toward ulceration. Spontaneous evolution occasionally takes place. Treatment.—Excision is not attended by good re- sults, as the tumor is prone to return in the scar. Galvanism by means of surface applications, does more than anything else in the way of local treatment. Fluoric acid, is the principal internal remedy, and the next is Graphites. Nitric acid and Sabina, are occasionally indicated. LENTIGO. Definition.—Lentigo is a skin discoloration due to deposit of pigment in the rete mucosum, and is charac- terized by round yellowish split-pea sized spots. Synonym.—Freckles. Symptomatology.—It appears for the most part on the cheeks and back of the hands, and is seen more in light complexioned, and especially red haired people. Treatment.—The best local application is the oint- ment of the oleate of copper, prepared by dissolving one drachm (4.) of the salt of oleate of copper in suffi- - cient oleo-palmitic acid to make a soft ointment. It may be applied every night on retiring. Night and morning applications of a mercuric bichloride loiion, two grains (.13) to the ounce (32.), are frequently of service. DESCRIPTION AND TREATMENT. 147 The internal remedies are: Ferrum mag.—Spots resembling summer freckles on back of hands and fingers. Kali caub.—Freckles on the face. Lycopodium.—Freckles on the left side of the face and across the nose. Nitric acid.—Freckles on the chest. Dark freckles. Petroleum.—Freckles on the arms. Phosphorus.-—Freckles on the lower limbs. Sepia.—Freckles on the cheeks. Sulphur.—Freckles on the nose. LEPROSY. Definition.—Leprosy is a chronic infectious disease caused be the lepra bacillus, and characterized by the occurrence of cellular deposits in the skin and other tissues, producing changes which usually result in the destruction of the parts, with anaesthesia and great deformity. Synonyms.—Leon^'asis. Lepra. Elephantiasis grae. corum. Symptomatology.—This is supposed to be the leprosy alluded to in the Bible, and was the leprosy of Europe in the middle ages. It is constitutional in its nature, occurs principally in warm climates and is common along the shores of the Mediterranean, and in India, Japan and China, in the Sandwich Islands, Brazil and the West Indies. In the United States it has been seen among the Chinese in California, and in a Norwegian community in Minnesota, and from statistics is certainly on the 148 DISEASES OF THE SKIN. increase. Leprosy exhibits several different phases, and according to the predominance of certain lesions or symptoms, may be divided into three sets, viz: The tubercular the macular and the anaesthetic. A prodromal stage of gradual decline in health, run- ning for weeks, months, or even years, generally pre- cedes the more decided and characteristic features. Faint brownish patches of the size of a nickel or larger, often mistaken for syphilitic maculation, show them- selves. Oftentimes an eruption of bullae followed by slight scars and pigmentation is one of the first symp- toms. The macules as they increase in size peripherally, retain their brownish color at the edges, but gradually fade into dirty gray color in the centre. When first formed the patches are markedly hyperaesthetic, while later they may become completely anaesthetic. They may appear on any part of the body, but are commonly seen on the trunk, and extensor surfaces of the extrem- ities. In connection with the maculae or independently, dull brownish-red tubercles, roundish in form, and varying in size from a pea to a large plum, may make their appearance. These form in greatest numbers on the face, and by obliterating the natural lines, give rise to a peculiar leonine expression. After a time tubercles may appear upon the mucous membrane of the buccal cavity, nares and larynx. Ulceration takes place sooner or later, from the breaking down and softening of the tubercles. The hair and nails fall out. DESCRIPTION AND TREATMENT. 149 The fingers and toes become bent and crooked, caries set in, and one by one the phalanges disintegrate or finally drop off. The average duration of leprosy is about fifteen years. Diagnosis.—Well marked leprosy can hardly be mistaken for any other disease. In the early stage when the macules are small and pinkish, it may be mistaken for a papulo-macular syphilide. Later, when the tubercles are arranged in aggregated patches, it closely resembles lupus. The spots of leprosy are, however, larger, more infiltrated and tender, smoother and change to a darker color than in syphilis. The nodules of leprosy are firmer, tender and more oily than are the tubercles of lupus. Prognosis.—The prognosis is unfavorable. Treatment.—As tending to prevent the spread of leprosy, the sequestration of those attacked in infected districts should be enjoined. A generous diet with plenty of fresh air and out door exercise is of vital importance. Cod liver oil, or what is better, Chaulmoogra oil may be taken in such quantities and as often as the stomach will permit. Locally, warm baths with Gurjun oil are highly recommended. The principal internal remedies are Hydrocotyle, Hoang nan and Piper methysticum. Others may be indicated as follows: Arsenicum alb.—Hyperaesthesia followed soon by 150 DISEASES OF THE SKIN. anaesthesia. General prostration. Burning like fire in parts of the body. Loss of hair and eyebrows. Livid tubercles on any part of the body. Arsenicum iodat.—Pricking sensation in the skin. Loss of the voice. Enlargement.of the glands. Hoarse cough. Falling off of the fingers and toes. Ozaena. Tubercles dirty looking. Aurum.—Melancholy disposition. Discharge from the nares very offensive. Absorption of the bones of the nose. Has no desire to talk about sickness. Calotropis gig.—In tubercular leprosy. Crotalus.—Swelling of the limbs or body. Spots appearing like gangrene. Cuprum.—Leprous eruptions. Cramps. Suffocat- ing spells. Graphites.—Obstruction of the nares. Skin cracks and discharges a sticky fluid. Leprous spots. Coppery annular raised spots on the face, buttocks, legs and feet. Ulcers on the toes. Hydrocotyle.—Well marked cases of tubercular leprosy. Leonine face. Nose flattened and swollen. Lobes of the ears pendulous and swollen. Ulcers in the alae nasi and corners of the mouth. Ears dis- charge. Hands and feet swollen so that fingers and toes spread apart. Itching of any part of body. Feeling of lassitude. Yellowish or reddish spots on the trunk and extremities. Iodum.—Emaciation marked. Swelling of the glands. When mercury has been taken in large quan- tities. Loss of voice and hoarseness. Voracious appetite. Description and treatment. 151 Kalibieh.—Brownish colored spots. Ulcers with an unhealthy look. Blisters on the extremities. Little boils or pustules on any part of body. Thick, tough discharge from nose. Hard plugs in nose. Thick, yellow, putrid discharge from the ears. Ulcers on tongue and on cornea. Kreosot.—Sores on the nose. Swollen gums. Pain- ful ulcers. Wheals like urticaria. Numbness in dif- ferent parts of the body. Lachesis.—Large boils. Bloody serum discharge from the nose, ears and# mouth. Obstinate ulcers with black spot in the granulations. Ulcers on the cornea. Mercurius.—Falling out of the teeth. Absorption of small bones. Swollen gums. Sore tongue. Flat indolent ulcers. Petroleum.—Tubercles on the face. Unhealthy skin with brown spots. Skin dries and forms deep cracks. Falling out of hair. Ulcers on fingers and tibia. Hyperaesthesia of scalp and ears followed by anaesthesia. Ravenous appetite. Numbness of ex- tremities. Phosphorus.—In latter stages. Boils. Hair falls out. Spots like blood blisters on the body. Great debility with increase of sexual desire. Rhus.—Scalp sensitive, cannot bear to have the hair touched. Pulsation in the ears. Loss of smell. Swollen face so that patient is not recognized. Tubercles with sharply defined margins. Bright red skin, vio- 152 Diseases of the skin. lent itching. Hardness and thickening of skin on \.vy part of body. Secale.—Can hardly talk, the tongue will not re- spond to the will. Fingers and toes drop off. Falling out of the hair. Eyes look sunken. Cold, dried up looking skin. Sepia.—Breath offensive. Loss of smell. Redeyes. Falling out of the hair and eyebrows. Brownish spots on face. Skin peels off from hands and feet. Nails look dried up and deformed. Swollen forehead and temples. Face thick and covered with tubercles. Leonine face. Drawing ulcers on fingers and toes. Silicea.—White spots on face. Shortening of ham strings. Induration of nose with ulceration and dis- charge. Woorari.—Obstinate boils that will not heal. Slowly forming and suppurating pimples. Dirty looking skin. Blood oozes through the skin. Tuber- cles on nose. Stoppage of nose with swelling of parts. Falling out of hair. Swelling of the lobes of ears. Falling out of the teeth. Discharge of matter from the ears. Tonsils inflame and suppurate. Hura Braziliensis, Guano and Helleborus foetidus may be compared. LEUCODERMA. Definition.—Leucoderma is a cutaneous disease, characterized by localized loss of pigment. Congenital absence of pigment is called albinism. Synonyms.—Cutis variegata. Piebald skin. DESCRIPTION AND TREATMENT. 153 Symptomatology.—Leucoderma is a rare affection, and seldom appears before adult life. The general health is as a rule good, though the nervous system may at times be implicated. The face, hands and genitals are usually the parts first invaded. The patches are either round or oval, and are of a milk white color. They may either increase in size or re- main stationary, and seldom if ever, regain their normal color. Diagnosis.—Leucoderma is to be distinguished from leprosy, chloasma, tinea versicolor and morphcea. Treatment.—Of the treatment nothing encouraging can be said. Locally, the pigmentation around the patch may be lessened by the use of strong acetic acid. Galvanism may prove serviceable. Internally the Sulphide of Arsenicum will be oftenest used with benefit. Natrum, Nitric acid, Sumbul and the Phosphide of Zinc may be studied. LICHEN PLANUS. Definition.—Lichen planus is a chronic disease characterized by the appearance of dull-red, flat- topped, angular-based pin-head sized glazed papules, running a distinctly papular course, and attended by more or less pruritus. Symptomatology.—It is a rare disease in this coun- try, and is usually associated with a debilitated state of the system, depending upon a faulty nutrition. The eruption generally makes its appearance in the form of solid, millet-seed sized papules, that in the 154 DISEASES OF THE SKIN. early stages have a shiny aspect, but later on are cov- ered with thin micaceous scales. They start abruptly from the skin, are irregular shaped, flattened on the top and frequently present in the center an umbili- cated depression, which is the opening of the hair follicle. They are usually discrete, but may be aggre- gated in patches, and as a rule develop slowly and occur symmetrically. Melasmic stains frequently, and little pits occasionally remain after the disappearance of the papules. The disease may occur at any time of life, attacks women more than men, and selects as seats the front of the forearms and wrrists, the thighs, abdomen, and the legs below the knees. It arises primarily as a disturbance of the trophic nerves of the hair papilla, with resulting hyperaemia and formation of new tissue. Diagnosis.—Lichen planus is to be distinguished from papular eczema and papular syphilide. Prognosis.—The prognosis is usually favorable, except in the diffuse form of the disease, the lichen 7'uber of Hebra, which is commonly associated with marasmus, and may terminate fatally. Treatment.—The patient should be liberally fed and well hygiened. Local treatment may be resorted to mainly to allay the annoying itching. Antimonium crud. is the principal internal remedy. Others are indicated as follows: Agaricus muse.—Eruption of small pimples with red areolae and violent itching. Sensation in various DESCRIPTION AND TREATMENT. 155 parts as if ice cold needles were piercing the skin. In light complexioned persons and drunkards. Arsenicum alb.—In chronic cases. Burning itch- ing, painful after scratching. Great weakness and prostration. Oppression of breathing. Chinium ars.— In the diffused form with threaten- ing marasmus. Chronic intestinal derangements. Iodine.—Small dry, red pimples on the arms, chest and back, with jerking sensation while appearing. Rough, dry skin. Emaciation. Ravenous hunger. Kali bich.—Papular eruptions on the forearms. Rheumatic pains in the limbs. In fat light complex- ioned individuals. Ledum.—Eruption of pimples on the forehead as in brandy drinkers. Eruption of small pimples like red millet seeds over the body. Excessive itching on the backs of both feet, worse after scratching, and by warmth of bed. Relieved after scratching the feet sore. Nux juglans.—Red pimples on face, neck, shoulders and back. Little tubercles with hard scurf on the in- step. Potassium iodide.—Lichen on the face and shoulders. Sensitive swelling of the thyroid gland. Great gen- eral debility. Sarsaparilla.—Red dry pimples. Burning itching with chilliness. Staphysagria.—Itching pimply eruption over the face and behind the ears, with rough skin. Burning of the eruption after scratching. 156 diseases of the skin. Sulphur iodide.—Red pimples on the nose, chin and arms, with itching. In chronic cases. LICHEN SIMPLEX. Definition.—Lichen simplex is a disease charac- terized by round solid millet seed sized flesh colored or reddish papules, running a distinctly papular course, and accompanied by marked itching. Symptomatology.—It is one of the rarer diseases, and appears for the most part in summer time. At the dispensary it constitutes about three per cent, of all skin affections. The papules are usually seen on the outer aspects of the forearm, the neck and the thighs. They last a week or more, and disappear by resorption. Frequently the disease attacks the backs of the hands, which may secondarily become inflamed, and give out a discharge (L. agrius.) When the papules are seated at the hair follicles, it has been termed (L. pilaris.) Treatment.—The lotions recommended in eczema to allay the itching may be used in this disease. Bran baths may also be of service. The indicated internal remedy will generally be one of the following : Alumina.—Red pimples on the face. Pimples on the neck and back. Intolerable itching of the whole body, especially when becoming heated in bed. Ammonium mur.—Pimples on the back of the hands desquamating next day. Anatherium.—Red pimples with itching and burn- ing. Scarlet skin with burning. DESCRIPTION AND TREATMENT. 157 Antimonium crud.—Small red pimples on right shoulder. From digestive derangement. Arsenicum alb.—In chronic cases with burning itching. Belladonna.—Papular eruption on the hands like lichen agrius. Bovista.—Red pimples on the foot. Bryonia.—Pimples on the abdomen and hips. Castanea vesca.—Several small pimples on the right thigh, back of the left ear, and on the left upper lip. Caladium.—Pimples on the mons veneris. Soreness of pimples to the touch. Kreasotum.—Forehead covered with pimples the size of millet seeds. Ledum.—Small pimples like red millet seeds over the whole body. In brandy drinkers. Mercurius.—Pimples on the labia. Voluptuous itching. Itching changes to burning by scratching. Nabulus serpent.—Pimples on the face .about the nose, upper lip and chest with itching. Natrum carb.—Pimples on the face and lips. White pimples on the nose. Nux juglans.—Red pimples on the face and neck. Pricking itching. Plantao-o maj.—Hard white flattened isolated papu- les on the inside of the thigh. Some papules have a red point in the centre. Phytolacca.—Pimples with itching on the left leg. Worse first part of the night. 158 DISEASES OF THE SKIN. Rumex crisp.—Red pimples on calves of the le^i, with itching worse immediately after undressing. Sepia.—Pimples close together on the face. Pim- ples on the legs, and in the bends of the joints. Sulphur.—Pimples on inner parts of the thighs. In simple cases. Sulphur iodide.—Red pimples on the nose, chin and arms. Tilia.—Eruption of small red, rather deeply seated pimples, with violent itching and burning like fire after scratching. LUPUS ERYTHEMATOSUS. Definition.—Lupus erythematosus has been defined as characterized by one or more usually roundish or oval, variably sized reddish patches, covered with fine thin whitish or grayish fatty adherent scales. Synonyms.—Erythematous scrofulide. Lupus seb- aceus. Seborrhcea congestiva. Symptomatology.—The disease appears at the outset as pin-head sized, pale red spots or patches, situated for the most part upon the cheeks and nose. Their centres, occasionally marked by comedo-points of a greenish hue, usually correspond to the orifices of the hair follicles, which are widely distended and patulous. They tend to coalesce and form patches, and are cov- - ered with firmly adherent fatty scales. These patches extend gradually by their peripheries, at times heal- ing in the centre, where the skin presents a whitish sunken, as if thinned, appearance. Lupus erythema- tosus is one of the rarer skin affections, and usually DESCRIPTION AND TREATMENT. 159 tends to become chronic. It seldom occurs before the twentieth year of life, attacks females more than male3 and more especially those who are subject to disorders of the sebaceous glands. It is generally confined to the face, and when fully developed presents a peculiar configuration that has been likened to a bat with out- spread wings. The body of the bat corresponding to, the nose and the wings to the cheeks. Lupus erythematosus is usually regarded as a chronic inflammation of the skin, leading to degeneration and atrophy. Diagnosis.—From lupus vulgaris, it is distinguish- ed by the fact that the tubercles and ulcers of the for- mer are never seen in the latter. The sebaceous glands are disordered in lupus erythematosus, not in lupus vulgaris. Lupus vulgaris appears during childhood ; lupus erythematosus is a disease of adult life. Fig. 9. Dermal Curette. Prognosis.—The prognosis should be guarded, as relapses are liable to occur. Treatment.—The diet should be of the best quality and generous. The most efficient local treatment con- sists in painting the surface with pure carbolic acid. In severe and obstinate cases resort may be had to the curette or scoop (Fig. 9). 160 DISEASES OF THE SKIN. Iodine is the principal internal remedy. Guaraca, Hydrocotyle, Cistus, Sepia, and Apis may be compared. LUPUS VULGARIS. Definition.—Lupus vulgaris is a disease of the skin characterized by variously shaped, pea-sized or larger, yellowish or reddish elevations, which are soft and pulpy and usually terminate in ulceration and cicatri- zation. Synonyms.—Tubercular scrofulide. Lupus exedens. Noli me tangere. Lupus tuberculosus. Symptomatology.—It usually begins in the form of yellowish or reddish solid points, at first disseminated but later tending to aggregate in patches. They are firm and painless, and gradually enlarge to form papules and tubercles that vary in size from a pin's head to a split pea, and are covered with a thin layer of adherent epidermis. (L. tuberculosus). Later the pro- cess may terminate either by insensible absorption of the lupus tissue, commencing with its degeneration and followed, without ulceration, by thinning of the tex- tures with marked scaliness (L. exfoliativus); or ter- minating in a free breaking down of the neoplasm with destruction of the infiltrated structure and resulting ulceration followed by atrophic cicatrices, (L. exedens). Lupus vulgaris, is one of the most chronic and obstinate of skin affections. It occurs mostly about the age of puberty, selects scrofulous subjects, and attacks by preference, the face and extremities. The cartilages, fibrous tissues and mucous membrane are its favorite seats. DESCRIPTION AND TREATMENT. 161 It is a rare disease in this country, though common in Europe. Diagnosis.—It may at times be mistaken for syphilis. The hard rapidly developed tubercles of syphilis, how- ever, differ greatly from the soft slow growing "apple jelly" ones of lupus. The ulcers of syphilis have sharply defined borders, and discharge a copious offen- sive secretion; those of lupus are illy defined, and have a slight and inoffensive discharge. The crusts of syphilis are bulky, and of a greenish color; those of lupus are scanty and of a brownish-red color. The cicatrices of syphilis are soft and whitish; those of lupus are shrunken and yellowish. Lupus may also be confounded with epithelioma. But if it is remembered that the hard everted edges of the latter are never seen in the former, and that the former is a disease of childhood and youth, while the latter is confined mostly to adult life, the mistake will rarely be made. Prognosis.—The prognosis is usually good when the lesion is small, but becomes less favorable as it in- creases in size. Occasionally the disease disappears spontaneously. Treatment.—An abundant supply of fresh air and outdoor exercise, along with a nutritious diet, is of the utmost importance in the treatment of this disease. In the earlier stages the red iodide of mercury oint- ment—red iodide of mercury two drachms (8.) vaseline two drachms (8.)—will be found serviceable as a superficial destructive. 162 DISEASES OF THE SKIN. Later the papules or tubercles may be bored with an irido-platinum needle (Fig. 10) dipped two or three times in Squibb's fused nitrate and allowed to cool. Smaller and less painful punctures can be made with these needles than with any other appliances. Fig. 10. Irido-Platinum Needle. The arsenical mucilage alluded to in the treatment of epithelioma is also useful. At the Dispensary a ten per cent, ointment of pyrogallic acid has been used with very satisfactory results. In severe cases erasion with the curette or scoop (Fig. 9) and multiple scarification are of great service. Arsenicum alb. and Hydrocotyle, are the main internal remedies. Others may be indicated as follows: Aurum mur.—When starting from the nasal mucous membrane. Discharge from the nares very offensive. Absorption of the bones of the nose. Melancholy dis- position. Calcium sulphide.—Lupus on the elbows. Ulcers with burning or stinging edges. Nodosities on the head sore to the touch. Swelling of the upper lip. Cistus.—Lupus on the face. Worse from cold air. Graphites.—Lupus on the nose. Obstruction of the nares. Dry, cracked skin. Every injury tends to ulceration, DESCRDPTION AND TREATMENT. 163 Guaraca trich.—Lupus of an ochre-red color. Yellow spots on the temples. Hydrastis.—Ulcers on the legs. Exfoliation of the skin. Purulent discharge from the nostrils. Faint, sinking feeling at the stomach. Kali bich.—Ulcers painful to the touch. Worse in cold weather. Ulceration of the nasal septum. Loss of appetite. All the secretions are tenacious and stringy. Lycopodium.—In recent cases. Hunger with con- stant feeling of satiety. Arms and fingers go to sleep easily. Purulent discharge from the ears. Weakness of memory. Melancholia. Nitric acid.—Lupus on the lobules of the ears. Offensive purulent discharge from the ears. Dry, scaly skin. Affections of the bones and glands. In dark complexioned individuals. Staphysagria.—Ulcers on the alae of the nose. Weary pains in the limbs as if bruised. Teeth turn black and decay. In scrofulous subjects. miliaria. Definition.—Miliaria is a disease of the skin clue to a disordered action of the sweat glands, characterized by the formation of numerous pin-head sized reddened papules or vesico-papules, attended with heat and tingling. Symptomatology.—The usual seat of the eruption is the trunk, but it may also appear upon the face, neck and arms. It is extremely fitful in its character, fre- 164 diseases of the skln. quently appearing and disappearing many times in twenty-four hours. The disease occurs more during summer time, and when the weather changes suddenly to hot. Super- flous clothing is a quite frequent cause. Miliaria is apt to relapse in successive years. Treatment.—A weak carbolated bran bath, fol- lowed by dusting with either the nitrate of bismuth and starch, or lycopodium powder is the best local treatment. Internally, Bryonia is the principal remedy. Ar- senicum alb., Centaurea, Hura Braziliensis, Ledum and Raphanus may be studied. MILIUM. Definition.—Milium is a disorder of the sebaceous glands, characterized by the formation of white, roundish sebaceous points beneath the epidermis. Synonyms.—Grutum. Acne punctata albida. Stro- phulus albidus. Symptomatology.—The white papules look like grains of sand. They occur mostly on the forehead and eyelids, and are more common in women than in men. They vary in size from a millet seed to a split pea, and are generally painless. The "skin-stones" or cutaneous calculi occasionally met with are generally milia which have undergone calcareous degeneration. Treatment.—The local treatment consists in open^ ing each milium with an ordinary lancet, and remov> DESCRIPTION AND TREATMENT. 165 ing the more or less hardened contents. To facilitate removal the milium needle (Fig. 11) may be used. Fig. 11. Milium Needle. To prevent the return of the milia the skin may be washed in saponaria bark water, and afterwards gently rubbed. The Calcium iodide is the most important internal remedy, and the next, Staphysagria. Tabacum may be thought of. MITE-DISEASE. Symptomatology.—Mite disease is found in the south- western states, especially along the Mississippi river, and is due to the leptus irritans, or irritating harvest- mite or "jigger." It occurs usually in summer and autumn, along the banks of rivers and in swampy places. The mite burrows in the skin, generally of the ank- les and legs, and causes considerable irritation, result- ing in the formation of papules, vesicles and pustules. Treatment.—Mild parasiticides, of which sulphur ointment is the type, will readily remove the trouble. Ledum is the principal internal remedy. MOLLUSCUM SEBACEUM. Definition.—Molluscum sebaceum is a disease of the sebaceous glands, characterized by roundish pea-sized tumors, umbilicated in the centre and of a pinkish- white color. 166 DISEASES OF THE SKIN. Synonyms.—Molluscum contagiosum. Acnft mol- luscum. Symptomatology.—The umbilicated appearance is given to the tumor by the distended gland duct, from which a white, cheesy matter may be squeezed. At times the disease appears to be semi-epidemic, but it has not as yet been clearly demonstrated to be contagious. It is mainly a disease of children, and attacks more especially the nice, though it may appear on other parts. Treatment.—In the early stages touching the parts once or twice a day with the acid nitrate of mercury is often of decided benefit. If the tumors are large, they may be removed by the knife or curved scissors. Silicea as an internal remedy ranks first, and Teu- crium next. Bryonia, Bromine, Cole, ars., Lycopod- ium, Natrum mur. and Potassium iodide complete the list. MJRPHOEA. Definition.—Morphoea is a rare disease, character- ized by roundish dirty alabaster looking, firm inelastic patches circumscribed by lilac-tinted borders, and vary- ing in diameter from one to three inches. Synonym.—Addison's keloid. Symptomatology.—It usually commences as a delicate purple-colored spot, in the centre of which a pale area shows itself. This central spot becomes more and more decided as it grows, and finally assumes the appearance of a piece of white wax, depressed and sur- rounded by a lilac-tinted ring. DESCRIPTION AND TREATMENT. 167 At times the patches become the seats of irregular deposits of pigment, and as the disease progresses atrophic changes are apt to take place in the affected parts. Morphcea occurs more in woman than in men, and selects the course of the left supra-orbital nerve as its -most frequent seat. The corium appears bound down to the subcutaneous tissue, and the skin is leather-like. It runs an extremely slow course, and occasionally terminates in spontaneous recovery. Etiology.—It is supposed to be of neurotic origin. Diagnosis.—It may be mistaken for scleroderma, leprosy, or leucoderma. It never has the sclerodermic hardness of scleroderma. Leprosy never has the waxy patches of morphcea. Leucoderma is simply a pig- mentary disease, and as such does not present the textural changes of morphcea. Treatment.—The patient should be well fed, and have a daily allowance of either cod liver or chaul- moogra oil. Locally, the constant galvanic current, with daily phosphorated oil inunctions is beneficial. Phosphorus is the principal internal remedy. N^VUS. Definition.—Nuev us is a congenital formation, seated in the skin and subcutaneous tissue,and maybe either pigmentary or vascular. Synonyms.—Claret stain. Port-wine stain. Mother's mark. Birth mark. Pigmentary mole. Symptomatology.—Pigmentary ncevi are dark- colored, slightly elevated, sharply defined spots, vary- 168 DISEASES OF THE SKlN. ing in size from a pin's head to a fifty-cent piece. When covered with hair they are called "mouse marks" (ncevus pilosus.) Vascular ncevi are the commoner of the two, and may be either arterial (fire-marks) or venous. They are of a reddish or purplish color, and may be large or small. They are met with on all parts of the body, have a variable course, and may elect to increase in size, remain stationary, or disappear. A vascular naevus consists of an aggregation of dilated bloodvessels, the walls of which are frequently thickened, and the plexuses arranged irregularly. Treatment.—The pigmentary naevi may be removed by the application of sodium ethylate, prepared by adding the metal sodium to absolute alcohol. Sodium ethylate is best applied by means of a glass rod. The vascular naevi are best treated by either elec- trolysis or the subcutaneous ligature. When treated by electrolysis one or several plati- num needles connected with the negative pole of an ordinary zinc and carbon battery of six or twelve cells are introduced into the naevus, the positive pole being placed above. After from ten to thirty seconds the needles are removed and the growth will present a bluish-white appearance. With proper care neither sloughing nor suppuration will occur. In superficial circumscribed naevi, multiple punc- ture with fine needles dipped in a twenty-five or fifty per cent, solution of chromic acid has been used with success. Description and treatment. 163 Carbo veg. is the principal internal remedy for the pigmentary naevus, and Thuja for the vascular. Cal- carea carb., and Condurango may be compared. NETTLE-RASH. Definition.—See Urticaria. ONYCHAUXIS. Definition.—Onychauxis manifests itself by simple increase in the normal growth of the nail. Treatment.—Graphites is the remedy. ONYCHIA. Definition.—Onychia is an inflammation of the mat- rix of the nail. Symptomatology.—It may occur in the course of such diseases as eczema, psoriasis and syphilis, or may be due to local injury. Treatment.—For simple onychia Fluoric acid is the internal remedy. When occurring from a bruise or other injury, Arnica both internally and exter- nally, proves serviceable. ONYCHOGRYPHOSIS. Definition.—Onychogryphosis is characterized by a twisted bent condition of the nails, which are thick- ened and of a yellowish or brownish color. It affects mostly the nails of the toes and fingers, and gener- ally attacks old people. Treatment.—Graphites and Silicea are the main remedies. 170 DISEASES OF THE SKTN. ONYCHO-MYCOSIS. Definition.—Onycho-mycosis is a disease generally confined to one nail, and is due to the ravages of one of the vegetable parasites. See Tinea tricophytina. PARONYCHIA. Definition.—Paronychia is an inflammation situated around and beneath the nail, terminating in suppura- tion. Synonym.—Run-around. Symptomatology.—It attacks mostly the thumb and fingers, and makes its appearance as a dusky-red, ex- tremely painful border, either completely or partially surrounding the nail. In a few days the pain becomes throbbing in character and pus forms, attended at times by more or less constitutional disturbance. A form of this affection is sometimes caused by in- growing of the nail, and more especially the nail of the big toe. Diagnosis.—Paronychia differs from whitlow or felon, in that the latter involves all or nearly all the structures of the fingers, and appears for the most part on the j)almar surfaces. Treatment.—Locally, the pith of the common bul- rush has been used with good results. Natrum sulph., is the principal internal remedy. In slight cases Graphites often proves beneficial, and when suppuration is tardy, Calcium sulphide renders excellent service. Rana bufo is useful when there are red streaks up the arm. DESCRIPTION AND TREATMENT. 171 PEMPHIGUS. Definition.—Pemphigus is a cutaneous disease, char- acterized by the appearance of bullae, usually in groups of three or four, and varying in size from a pea to a hickory nut. Synonym.—Pompholyx. Symptomatology.—The disease is almost always chronic and may exist in either of two forms, namely: P. foliaceus and P. vulgaris. Pemphigus vulgaris is most common upon the limbs and more especially about the ankles. Occasionally it appears on the mucous membrane and other parts of the body. The blisters or bullae are rounded or oval, and rise abruptly from the skin sometimes to the height of a centimeter or more, and may be attended by slight itching. Their contents are at first colorless, but later they become cloudy or milky. They usually appear iu successive crops, each bulla running its course in from four to five clays. Acute pemphigus is rarely met with, excepting in children. It runs its course in from three to six weeks, and relapses are prone to occur. Pemphigus foliaceus attacks the body generally, and is often a fatal though rare form of disease. It usually commences by the appearance of a single flaccid bulla on the sternum, and from there spreads over the whole surface. The bullae differ from those of pemphigus vulgaris, in that they do not become tense, but remain flaccid 172 Diseases of the SKrtf. and dry up to form yellowish parchment-like flak&^ which vary in size from one-third of an inch to two inches. Treatment.—The patient should be placed on a full animal diet, with plenty of fresh air and exercise. Such means should be used as may tend to bring the health up to its accustomed standard. Locally, bran, starch or gelatine baths are of decided benefit. The continuous bath, as recommended by Hebra, may be resorted to in some cases. Rhus tox., is the principal internal remedy for acute pemphigus vulgaris, and Arsenicum alb., for the chronic form. Thuja is oftenest indicated in the foliaceus variety. Others may be indicated as follows: Ammonium mur.—Blisters the size of peas on the right shoulder with itching. Burning at small spots on the chest. Chilliness especially when walking. Fat body but thin legs. Belladonna.—Painful, watery vesicles on the palm of the hand sensitive to the touch. Chill in the even- ing, mostly on the arms, with heat in the head. Causticum.—Large painful blisters on the left side of the chest and neck, which become flattened. Anguish in the chest with fever. Involuntary uriuation when sneezing or blowing the nose. Gummi gutti.—May be used when other remedies fail. Phosphoric acid.—Deep hard bullae on the ball of the thumb. Blisters on the balls of the toes. Great DESCRIPTION AND TREATMENT. 173 drowsiness and apathy. In debilitated individuals. After sexual excesses. Phosphorus.—Painful hard blisters, full to bursting. Chilliness every evening with shivering. Arms and hands become numb. Regurgitation of food. Small wounds bleed much. Ranunculus bulb.—Blisters on the fingers the size of a hazel nut, followed after healed by small deep' transparent dark-blue elevated blisters the size of or- dinary pin-heads. Raphanus.—Blisters full of water on the breast, without inflammation redness or pain. Sepia.—Pemphigus on the arms and hands. Heavi- ness of the limbs. Sensitive to cold air. Arthritic pains in the joints. PERNIO. Definition.—Pernio is an inflammation of the skin, occurring as a secondary effect of cold, and appearing for the most part upon the hands and feet. Synonyms.—Chilblains. Erythema pernio. Symptomatology.—Occasionally pernio attacks the nose and ears, and may appear on any part of the body. It commences after exposure to cold, by slight vesication attended with tingling, itching, burning sensations. In mild cases it may terminate in a few days with des- quamation. In severer cases, remissions and exacer- » bations are prone to occur and thus prolong the disease for months. The parts are usually left in an irritable state, and are liable to renewed attacks from the slight- est causes. Any sudden change of temperature, and 174 DISEASES OF THE SKIN. especially a combination of cold and moisture, m^f renew the trouble. In chronic cases the parts become livid or purplish in color, and are more or less swollen and itchy. Ulcers not unfrequently form. Prognosis.—Pernio when it becomes chronic may last for years, disappearing usually in the summer time,but returning again as winter approaches. Treatment.—When there is much inflammation a de- coction of marsh mallows, locally, acts well. Tamus communis tincture, is recommended as a top- ical remedy for unbroken chilblains. Broken chilblains may be dressed with either oxide of zinc ointment, or the glycerole of calendula. llesin ointment is adapted to the ulcers that some- times follow. The galvanic current acts favorably in most cases. The tincture of benzoin, painted on the parts once or twice a day, acts as a preventive. The remedies likely to prove beneficial are: Agaricus.—Violent itching, worse at night. Burn- ing in the fingers, lower limbs and toes. Itching, burning and redness of the toes. Muscular twitchings. Arsenicum alb.—Ulcerated chilblains. Red spots on the feet. Violent tearing pains in edges of ulcers when exposed to cold. Relieved by warm applications. Badaiga.—Flesh and integuments sore to the touch. Sensitive to cold air. Belladonna.—Bright red shining swelling, with pulsative pains. Burning in skin when touched. Tingling itching, worse at night. DESCRIPTION AND TREATMENT. 175 Cantharis.—Itching and swelling of the fingers. Blisters burning on touch. Burning in the soles of the feet at night in hysteric patients. Tearing and ulcera- tive pains. Citrus vulg.—Itching of the swollen hands and arms. General itching which prevents sleep. Nitric acid.—Itching of the feet. Spreading blisters on the toes. Ulcers with stinging and pricking pains as of splinters. Offensive profuse perspiration on the feet, causing soreness. Petroleum.—Broken chilblains with tendency to fester. Heel painfully swollen and red with stitches. Tips of fingers rough, cracked and fissured with stick- ing cutting pain. Unhealthy skin. Prunus spinosa.—Itching on tips of fingers as if frozen. Pulsatilla.—Blue-red chilblains with pricking burn- ing pain, worse toward evening. Redness and swell- ing of joints with stinging pains. Feet feel hot and swollen with tensive burning pains. Wandering pains. Rhus tox.—Inflamed chilblains with excessive itch- ing. Aching pains in the legs. Worse before storms and from getting wet. Sulphur.—Thick red chilblains on the fingers which itch severely when warm. Predisposition to chil- blains. Urtica dioica.—Has been used both internally and externally with good results. Veratrum vir.—Intense painful itching. Chil- blains on the nose. Prickling in the fingers and toes. Used internally and locally. 176 diseases of the skin. PHTHIRIASIS. Definition.—Phthiriasis is a contagious affection due to the presence of pediculi. Synonyms.—Pediculosis. Morbus pedicularis. Lice disease. Crabs. Symptomatology.—There are three varieties of this disease, each being the outward demonstration of the ravages of distinct species of pediculi. Thepediculus capitis or head louse, gives rise to the variety known as phthiriasis capitis. It may be found on all parts of the head, but its favorite seat is the oc- cipital region. Numerous ova or "nits" may be de- posited along the shafts of the hair. They exist mostly among the children of the poorer classes, but are quite frequently found on women. They cause considerable irritation not by biting, as imagined, but by inserting their suckers or haustella into the pores of the skin, and so distending them as to frequently cause drops of blood to follow on their withdrawal. This irritation together writh the scratching it induces gives rise to the development of papules, whose apices when scratched off, present the blood tipped appear- ance so characteristic of phthiriasis. The pediculus vestimenti, or body louse, has its hab- itat in the clothing, and attacks the body, giving rise to phthiriasis corporis. Its ova are deposited and hatched in the clothing. P. corporis is mainly a disease of adult years, and is seen mostly in the lower walks of life. The lesions are multiform, due principally to scratching, and have their chief seats on the trunk, hips and thighs. DESCRIPTION AND TREATMENT. 177 The pediculus pubis or crab louse, usually infests the hair of the pubis, but may wander to other parts. It attacks adults mostly. The pediculi are air-breathing insects and remain wholly upon the external surface. Treatment.—The treatment is mainly local, and consists in the destruction of the parasites and their ova. Phthiriasis capitis responds readily to repeated dusting with powdered staphysagria. Cocculus indi- cus tincture, often proves serviceable. Ordinary pet- roleum is a most effective application. White precip- itate ointment—ten grains (.6) of white precipitate to the ounce (32.) of cosmoline—is useful when "scratch- marks" prove troublesome. The "nits" may be re- moved by repeated washing with carbolized water. Phthiriasis corporis is best treated by staphysagria ointment—two drachms (8.) to the ounce (32.)—well rubbed in. The patient's clothing should be thorough- ly boiled or baked, so as to ensure the destruction of whatever pediculi may have made it their habitation. For phthiriasis pubis either cocculus indicus tincture, a mercuric bichloride lotion, or a chloroform appli- cation proves an effectual remedy. Internally, Oleander may be given in phthiriasis capitis, and Mercurius in the other varieties if desired. PITYRIASIS. Definition.—Pityriasis is a cutaneous affection char- acterized by fine dry bran-like scales, seated on a slightly reddened non-infiltrated surface. 178 DISEASES OF THE SKTN. Synonym.—Branny tetter. Symptomatology.—It affects mostly the scalp, face and upper part of the body, and seldom or never be- comes general. If left to itself it is apt to become chronic and last for years. When occurring on the scalp it tends to cause falling of the hair. It is accom- panied by slight itching, and may be caused either by heat, cold winds, or local irritants. The disease is seated in the deep layers of the epidermis, and consists in excessive cell proliferation. Treatment.—Locally an infusion of saponaria bark is the best remedy. If the affection is located on the hairy scalp it may be necessary to cut the hair. Gly- cerole of borax—two drachms (8.) of borax to one ounce (32.) of glycerine—is frequently of service. Arsenicum alb., is the principal internal remedy. Fluoric acid, Colchicum and Kali arsen., are occa- sionally indicated. PITYRIASIS RUBRA. Definition.—See Dermatitis exfoliativa. PRAIRIE ITCH. Symptomatology.—Prairie itch is an acute inflam- mation of the skin, appearing in new districts where it may be for a time endemic. It may be preceded by the premonitory symptoms of malaise, headache, and ~ slight febrile disturbance, or its onset may be first marked by the appearance of erythematous spots, cov- ered with small transparent vesicles, varying in size from a pin's head to a mustard seed and situated for DESCRIPTION AND TREATMENT. 179 the most part on the neck, shoulders, back and outer surface of the limbs. An intolerable nightly itching accompanies the eruption, creating an almost irresisti- ble desire to scratch the parts. The scratching oblit- erates the vesicles, and gives rise to scratch marks and to the secretion of an exceedingly acrid irritating fluid, which oftentimes indefinitely prolongs the dis- ease. Large blackish crusts covering suppurating ul- cers are an occasional result. Furuncles quite fre- quently complicate the trouble. Treatment.—Locally, the diluted lye of wood ashes is the best remedy. Internally, Rumex crispus will be oftenest called for. lihus tox., and Ledum may be studied. prurigo. Definition.—Prurigo is a disease characterized by the development of small papules, of the same color as the skin, accompanied by intense itching. Symptomatology.—It commences by the gradual formation of small, sub-epidermic elevations, which have a peculiar shot-like feel, and are frequently per- forated by small hairs. These papules are due to chronic inflammatory changes in the papillary layer. Intense itching or pruritus, with formication is one of the earliest symptoms and generally continues with more or less intensity throughout the entire course of the disease. Hence " scratch marks" are often found complicating the eruption. As the disease progresses the skin becomes thickened and presents a dry, rough, harsh appearance. 180 DISEASES OF THE SKIN. Prurigo is mainly an affection of the poorer classes, and occurs mostly on the extensor surfaces of the lower extremities, but is frequently found on the fore- arms and trunk. It starts as a rule before puberty, becomes aggravated during the winter months, and is apt to continue through life. It is a rare disease in this country. It differs from phthiriasis with which it has been frequently confounded, in that, pediculi which are the cause of the latter are never present in the foi mer. Diagnosis.—It is to be differentiated from papular eczema and urticaria, and from scabies. Prognosis.—The prognosis is always doubtful. Treatment.—A thoroughly nutritious diet should be ordered for the patient. Locally, either tar or sulphur baths are the most serviceable. To allay the itching a carbolic acid, dioscorea, or mezereum lotion may be used. Sulphur is the principal remedy for recent attacks, and Arsenicum iodide for the more chronic forms, Ambra, Arsenicum sulphide, Carbolic acid, Dioscorea^ Dolichos pruriens, Mercurius, Nitric acid and Oleander may be studied. PRURITUS. Definition.—Pruritus, or simple itching without any eruption can hardly be called a disease. It is merely a perverted sensation, and is a common accompaniment of a variety of cutaneous affections. When occurring to all appearances independently—as far as any eruption DESCRIPTION AND TREATMENT. 181 is concerned—it is even then simply symptomatic of some nerve disturbance, indicative of the circulation of bile or some other foreign material in the blood, or else dependent on local excitants. PSORIASIS. Definition.—Psoriasis is a constitutional, non-con- tagious disease of the skin, characterized by reddish thickened patches covered with whitish or yellowish- white mother-of-pearl colored scales. Synonyms.—Lepra vulgaris. Alphos. Dry or scaly tetter. Symptomatology.—The patches vary both in size and form. They usually commence as small reddish spots, hardly raised above the skin and covered with whitish scales. As a rule they develop rapidly, so that in a few days they may be as large as a nickel and pre- sent the appearance of drops of mortar. Generally the patches tend to run together as they increase in size, and lose the circular outline that at first charac- terized them. Occasionally the centers of the patches clear up, giving to the disease the appearance of rings. Frequently two rings come in contact with each other at the edges, thus forming the figure 8. At times the circles are incomplete, and as a consequence many lines are formed. Some writers err in speaking of these different stages, as distinct varieties of disease, and so allude to psoriasis punctata, psoriasis nummularis/ psoriasis gyrata, etc. Such, however, can not be held to be distinct varieties of cutaneous trouble, but are simply stages of one and the same affection. 182 Diseases of the skin. The scales of psoriasis are peculiar and character- istic. They are imbricated, of a silvery white color, and situated on a red and inflamed base. The presence of air in the scales is the supposed cause of their white appearance. The favorite seats of the disease are the tips of the elbows, the fronts of the knees and the head. It may, however, appear on any part of the cutaneous surface, and is apt to be symmetrical. It is never seen on the mucous membranes or the red mar- gins of the lips, and is but rarely observed on the palms and soles. In gouty individuals the scales are thin, often scanty, attended with marked itching, and seated on a very red and congested base. In strumous subjects, however, the scales are thick, oftentimes heaped up, attended with but slight itching, and seated on a less congested base. The involution of the disease is characterized by the diminished elevation of the patch, and the fading of the eruption, which leaves neither staining nor cica- trization. Etiology.—The etiology of psoriasis is still obscure. By some it is claimed to be of malarial and by others of traumatic origin. The disease is neither contagious nor hereditary. It occurs alike in both sexes, and very rarely appears before puberty. It prevails more in winter than in summer. Next to eczema it is one of the commonest cutaneous diseases of this country. My experience at the dis- pensary, ranks it the fourth in order of frequency. Lang claims to have discovered fungus elements in DESCRIPTION AND TREATMENT. 183 psoriasis, which he considers the cause of the disease. Morbid anatomy.—It forms principally in the upper layers of the corium and on the apices of the papillae, and is due to a perversion of the cell life of the rete. The scales are made up of masses of cells from the stratum lucidum. Diagnosis.—The diagnosis of psoriasis is generally easy. It may at times be mistaken for eczema, tinea tri- cophytina, lichen planus, lupus erythematosus, pityria- sis, ichthyosis, and the squamous syphilide. Sufficiently characteristic, however, are the silvery white heaped- up scales, seated on an inflamed cutis which inclines to bleed in pin-point drops on their removal, and the selection of the elbows, knees and head as sites. Treatment.—The diet in psoriasis should be a gener- ous one, including oils and fats. The local treatment consists in first removing the scales by means of saponaria or bran baths. Inunc- tions with cod liver oil or chaulmoogra oil may then be resorted to, and especially so, if, as occasionally happens, there is considerable attendant inflammation. In more obstinate cases unless the skin is very irritable the oil of white birch may be used in the form of an ointment, one drachm (4.) to the ounce (32.) of vas- eline. Marked success has followed the use of chry- sarobin paint, prepared by rubbing up one drachm (4.) of chrysarobin, and one drachm (4.) of salicylic acid in one ounce (32.) of liquor gutta-perchse. It may be thinly applied to the affected patches by means of 184 Diseases off the skin. k small stiff paint brush. A fifteen per cent, oint- ment of beta naphthol is recommended by Kaposi, especially in the treatment of psoriatic patches upon the face and scalp. It is best to commence the internal treatment with Sulphur. Afterwards one of the following remedies may be given: Ammonium carb.—White pea-sized spots upon the cheek, which continually exfoliate. Skin very sensi- tive to cold. Aversion to being washed. Nosebleed when washing the face in the morning. In weak nervous individuals. Arsenicum alb.—Skin dry and scaly. Great rest- lessness with weakness and prostration. Burning itching. Oppression of breathing. Aggravated by eating fruit, ice cream, etc. Arsenicum iodide.—Dry scaly burning itching eruption on various parts. Persistent itching on the back. In obstinate cases. Calcarea carb.—Scurfy spots on the leg. Burning And itching. Skin cracks. Profuse sweat from the slightest exertion. Large abdomen. Blue eyes, blonde hair, fair skin. Fluoric acid.—Roughness on the forehead like a rough line with its convexity upwards. Reddish spots above the eyebrows. Desquamation on the eyebrows. Nails brittle, edges bent in. Hydrocotyle.—Circular spots with slightly raised scaly edges. description and treatment. 185 Iris versicolor.—Irregular psoriatic patches on the knees and elbows, covered with shining scales. Skin fissured and irritable. Gastric and bilious derange- ments. Manganum.—In inveterate cases. Mercurius.—Psoriasis of the hands. Psoriasis in spots all over the body. Scaling off and exfoliation of the finger nails. The scalp is painful to the touch. Easy perspiration without relief. In recent cases. Mezereum.—Scurf-like scales on the back, chest, scalp and thighs. Roughness and scaling here and there. Pruritus increased by scratching or when undressing. Muriatic acid.—Psoriasis of the hands. Great sen- sitiveness to damp weather. Natrum ars.—Thin whitish scales, which when removed leave the skin slightly reddened. Petroleum.—Skin of the hands cracked and rough. Unhealthy skin. Aversion to the open air. Extreme sensitiveness to slight touch. Falling off of the hair. Phosphorus.—Psoriasis of the arms and hands, and on the knees and elbows. Arms and hands become numb. Coldness of the kees a,t night in bed. Falling out of the hair in large bunches. Dry cough with soreness in the chest. Phytolacca.—Surface of the skin shrunken and of a leaden color. Squamous eruption. Rheumatic pains in the extremities. Selenium.—Dry scaly eruption on the palms of the hands, with slight itching. 186 DISEASES OF THE SKIN. Sepia.—Psoriasis on the face. Red roughness of the skin. Falling off of the hair. During pregnancy and nursing. Dark complexioned individuals. Silicea.—Elevated scurfy spots near the coccyx. Small white scales on the face and neck. White spots on the cheeks. Sensation of numbness in the extrem- ities. Brittleness of the nails. In scrofulous, large bellied children. Imperfect assimilation. ■ Teucrium.—Psoriasis on the index finger of the right hand. PURPURA. Definition.—Purpura may be described as a disease of the skin characterized by an effusion of red blood globules, into the cutis, and the formation of small macules varying from one-twelfth to one-half inch in diameter, usually unattended by constitutional dis- turbance. Synonym.—Purples. Symptomatology.—The spots at the time of their appearance are bright red, but gradually become pur- plish, and subsequently undergo the. usual changes of color that are the accompaniments of a bruise. They appear mostly on the legs, and are usually symmetri- cally arranged ; they may also show themselves on any part of the body excepting the head. The disease occurs more in the old than in the young, and generally comes in successive crops, each crop running a course of eight or ten days. Haemor- rhage from the mucous membrane may at times com- description and treatment. 187 plicate the trouble {landscurvy). It is then apt to be attended by more or less constitutional disturbance. Treatment.—The diet should consist of the most nutritious articles. Malt preparations are useful foods. Outdoor exercise is very beneficial. Locally, hama- melis is one of the best remedies, and when there is much haemorrhage, ice treatment may be resorted to. Simple purpura responds best to Arsenicum alb , and the haemorrhagic form to Sulphuric acid. Other remedies may be indicated as follows: Aconite.—In simple cases when attended by fever. Arnica.—Yellow, blue and reddish blue spots. In lying-in women. Baptisia.—Livid spots all over the body and limbs, of the size of a three-cent piece. Great languor; desire to lie down. Tired, bruised, sick feeling all over the body. Berberis.—Petechiee on the right shoulder or left humerus, back of the hand and wrist. Bruised pain with stiffness and lameness in small of back. Renal or vesical complications. Bryonia.—fhemorrhagicpurpura. Aches and pains worse from motion. Weariness and heaviness in all the limbs. Worse when warm weather sets in after cold days. Chloral.—Deep red spots on reddene 1 bases, per- manent under pressure. Haemorrhagic purpura. Lips covered with sordes and dried blood. Great prostra- tion. Cocoa.—Dark spots like ecchymoses under the skin, ibS diseases of the skin. about the size of a pin's head, on the fingers. May be used to protect from skin diseases. Hamamelis.—Haemorrhagic purpura. Profuse epis- taxis. Passive, venous haemorrhages. Great lassitude and weariness. In old people. Lachesis.—Simple purpura. Blackish-blue spots. Great physical and mental exhaustion. Climacteric troubles. Mercurius.—Bluish-red spots, darker on the margin and lighter in the center. Increase of saliva with scorbutic gums. Tongue swollen, showing imprints of teeth on margin. Bruised feeling, with soreness in all the bones. Phosphorus.—Petechial spots on the skin. Bluish- red spots on the legs. Purple like exanthem over the whole body. Small wounds bleed much. Rrus tox.—Simple purpura. Dark brown spots on inside of ankles. Rheumatism of joints worse dur- ing rest. Patient changes position constantly. Swol- len aukles after sitting too long. Symptoms worse in wet weather. Terebinthina.—Haemorrhagic purpura. Intestinal haemorrhages. Haematuria. Great prostration. Veratrum vir.—Simple purpura. Galvanic-(ike shocks in the limbs. Rapid pulse; slow respirauon. In plethoric individuals. RING-WORM. Definition.—See Tricophytina. DESCRIPTION and treatment. 189 RHINOSCLEROMA. Definition.—Rhinoscleroma is characterized by irregularly shaped, sharp bordered, flat swellings of a normal or dark reddish-brown color, occurring for the most part on the nose and upper lip. Symptomatology.—Rhinoscleroma is almost unknown in this country. It was first described by Hebra and Kaposi in 1870. It is a disease of adult life, runs a slow course, and may remain stationary for years. The tubercles are seldom attended by pain, but are usually extremely sensitive to pressure. Treatment.—When treatment is necessary the tubercles are best removed by the use of the irido- platinum points (Fig. 10) and Squibb's fused nitrate as recommended in Lupus vulgaris. Calcarea phos. will probably be the most useful in- ternal remedy. Guaraca, and Rhus rad., may be studied. rodent ulcer. Definition.—See Epithelioma. ROSACEA. Definition.—Rosacea is a chronic disease, affecting more particularly the nose, cheeks aud forehead, result- ing from a dilatation of the blood vessels with increased growth of connective tissue, and characterized by red- ness and a tendency to the development of tubercles and pustules. Symptomatology.—Rosacea has three stages. In thtf 190 DISEASES OF THE SKIN. first there is more or less passive hyperaemia of the parts affected. The whole diseased surface may be red- dened, or it may be reddened only in spots. If the nose is attacked, it is apt to feel cold and greasy to the touch. After months or perhaps years, the second stage sets in. The redness is now more marked, and minute blood-vessels appear upon the surface. As the disease progresses these vessels increase in size, and take a tortuous course. Sooner or later, the integu- ment becomes thickened, acne papules and pustules show themselves, the nose becomes warm, and the dis- ease passes into the third stage. It may remain in this condition for years, or if the morbid action continues, great thickening and hyper- trophy of the parts, with deformity may result. Etiology.—It is mostly a disease of middle life. It attacks both sexes, but males more than females. Any- thing which tends to increase the circulation in the face may produce rosacea. Excessive spirituous indulgence is a prominent cause, as is also functional or organic disease of the uterus or ovaries. Prognosis.—The prognosis is generally favorable if the disease has not passed beyond the first stage. Treatment.—In the first stage a sulphur lotion one (4.) to three drachms (12.) to the ounce (32.) of lav- ender water, may be used with benefit. In the second stage the distended blood-vessels should be incised bi-weekly. Gossypium may be used to check the haemorrhage. Good results are obtained from single or multiple punctures of the vessels with DESCRIPTION AND TREATMENT. 191 a fine cambric needle attached to the negative pole of a galvanic battery, with from six to ten elements in the circuit. As a last resort, portions of the redundant integu- ment may be excised, or erased with the dermal curette (Fig. 9). The internal remedy will usually be one of the fol- low ing: Agaricus.—Redness with burning heat in the face. Burning itching on the cheeks. In drunkards and after sexual debauches. Antimonium crud.—Red points with white dots in the center. Thick white coating on the tongue. Gas- tric derangements. Arsenicum alb.—In long-lasting cases with debility. Rough, dirty looking skin. Burning itching, painful after scratching. Arsenicum bromide.—Violet papules on the nose. Arsenicum iodide.—Redness with itching. In scrofu- lous subjects. Belladonna.—Nose red, swollen and shining, with small red pimples. Great dryness of the nose. Swell- ing and tension of the upper lip. Parts feel hot to the touch. In plethoric subjects. Bromine.—Pimples on the nose. Soreness under the nose and on margins of nostrils. Swelling of the thyroid gland. In light-haired persons. Calcium sulphide.—When there is a pustular ten- dency. Calcarea phos.—Nose shining like oil. Heartburn with other gastric symptoms after dinner. 192 diseases of the skin. Cannabis.—Large pimples surrounded by red swell- ing. Aggravation in the morning, with burning like fire. Urinary complications. Carbo animalis.—Pimples on the face. Eruption like red spots on the cheeks. Morning nose-bleed pre- ceded by vertigo. Eructations tasting of food eaten long before. In scrofulous, venous constitutions. Causticum.—Pimples on the nose. Tendency to Ulceration. Curare.—Pimples like tubercles on the tip of the nose. Rosacea with varices and bleeding of the cheeks. Guarea trich.—Rosacea with pains as from excoria- tion when touched. Hydrocotyle.—Papular eruption on the face. Tick- ling in the nose. Nux juglans.—In strumous subjects. Nux vom.—Rosacea associated with dyspepsia and constipation. In drunkards. Opium.—Dusky red bloated appearance. Phosphorus.—Pimples on the face and wing of the nose. Petroleum.—In the second stage. Parts very pain- ful to slight touch. Nausea from riding in a carriage or ship. Rhus rad.—Tip of the nose red and painful, as if it would suppurate. Ruta.—Rosacea. Deep fine stitches in the, parts. Aggravated by eating uncooked food. Sulphur.—In chronic cases. DESCRIPTION AND TREATMENT. 193 ROSEOLA. Definition.—See Erythema. RUPIA. Definition.—Rupia may be the result of either the pustular or the bullous syphilide. It consists of thick, greenish or blackish "cockle-shaped" crusts, covering unhealthy punched-out looking ulcers. It is a late and malignant manifestation of syphilis,and is seldom met with in private practice. Treatment.—Mercurius bijodat., and Potassium iodide, are the principal internal remedies. Arsenicum, Berberis aqu., and Nit. acid may be studied. Locally, iodide of starch dressings are serviceable. SALT-RHEUM. Definition.—See Eczema. SARCOMA CUTIS. Definition.—Sarcoma cutis consists of brownish-red, variously sized tubercles or nodules, attended by a dif- fused thickening of the skin. It is a rare and malig- nant disease, occurs mostly in adult life, and usually terminates fatally. scabies. Definition.—Scabies is a contagious disease caused by the burrowing of an animal parasite called the acarus scabiei, in the skin, and is characterized by the formation of cuniculi attended with intense nightly itching and having as accidental accompaniments* ves- icles, pustules and crusts. 194 DISEASES OF THE SKIN. Synonym.—The itch. Symptomatology.—The first symptom after exposure to the contagion, is usually a more or less extensive local irritation of the skin, attended by the formation of minute inflammatory points or vesicles, and an itching characteristically worse at night. On examin- ing the parts carefully at this stage, a burrow or cun- ieulus, just beneath the horny layer, may be discovered as a slightly raised, straight or tortuous line, with a vesicle at one end, and the itch insect marked by a whitish-yellow speck, headed off by a dark curved line, at the other. The disease spreads from this point, usually with great rapidity, so that in four or six weeks it may cover the greater part of the body. The parts most obnoxious to this affection are, in adults the interdigits, the front of the arm and wrists, the flexures of the joints and the dorsal surface of the penis. In children the buttocks and ankles are as a rule primarily affected oftener than the other parts. The disease seldom appears above the nipple line, and in chronic cases is found more on the abdomen and inner surface of the upper part of the thigh. The vesicles are generally isolated, irregular in size and shape, stand out prominently, and are frequently topped with short burrows. On acount of the intense itching, "scratch-marks" may so mask the disease as to at times, almost obliterate the cuniculi aud vesicles. These "scratch-marks" are, however, in their turn, more or less characteristic of scabies. The cause of scabies is the acarus scabiei. The dis- DESCRIPTION AND TREATMENT. 195 ease arises only from contagion. It may be conveyed from one person to another by hand shaking or by sleeping with one who is affected. All are subject to the contagion, whether high or low, rich or poor. Men are as a rule oftener affected than women. It is one of the more common skin diseases in Europe, but in this country it is quite rare. The acarus exists male and female, and is barely visible to the n::ked eye, being about half a millimeter in length. To the zoologist it is a beautiful and ele- gant little creature. It resembles a turtle in shape, and has an oval body, convex on the back, and flat on the belly. The back is armed with short spines, which aie directed backwards, and are so arranged as to effectually thwart any attempt at retrogression on the part of the insect. The head is small and closely set to the body, and is devoid of eyes. There are four front legs armed with suckers, and four hind legs armed with hairs. The two inner hind legs in the male are armed with suckers. The organs of genera- tion are conspicuously marked on the under surface of the body. The female acarus is thrice the size of the male. Males are short lived. The female lives from t hrec to four months, and lays from 24 to 50 eggs at the rate of from one to two a day. As the male in- sect is seldom found on the skin, it is presumed that he plays but an inferior part in the development of scabies. The female acarus within thirty minutes after its arrival on the skin, commences boring perpendicularly 196 DISEASES OF THE SKLN. through the horny layer and tunnels a place in which to lay its eggs. This burrow or tunnel is called a cun- iculus, and may vary from two to several centimeters in length. Here is the little miner's habitat, in which the deposited eggs are usually hatched in about two weeks. The young acari or "brigands" as they are sometimes called, are liberated in the order of their birth, by the gradual wearing off of the horny layer of the cuticle, aud most invariably adopt the mining habits of their progenitors. The acarus has considerable tenacity of life. It has been known to live from eight to ten days in water, and from two to four days in vinegar. Diagnosis.—The following are the main diagnostic points of scabies: 1. The presence of cuniculi with their contained acari. 2. The seat of the eruption, which is mostly in the interdigits and wrists, and in the flexures of the body, the buttocks, and on the dorsal surface of the penis. Scabies seldom appears above the nipple line. 3. The multiformity of the eruption. 4. The itching, which though continuing through the day is characteristically worse at night. 5. The evidences of contagion in the household, other members of the family being affected. 6. The rapid disappearance of all the symptoms un- der parasiticidal treatment. Prognosis.—The prognosis may usually be con- sidered favorable, provided a correct diagnosis is made, Otherwise the disease may last for years. DESCRIPTION AND TREATMENT. 197 Treatment.—Once recognized the disease is speedily cured. A high potency of Sulphur given internally has the reputation of curing scabies, but perhaps the best and most prompt results will be had from well directed local treatment, as the disappearance of the trouble depends on the removal of the cause, or in other words, upon the death of the insect. Sulphur ointment—one (4.) to two drachms (8.) to the ounce (32.)—is to be recommended as the best parasiticide. Storax ointment is preferred by some, as being cheaper and less liable to irritate the skin. (Care must always be taken in using parasiticides not to have them too strong, as the secondary rash is in- variably aggravated thereby.) The Oil of lavender may at times be used, as may also the Balsam of Peru. Before using the parasiticide, the patient should be ordered to take a hot soap and water bath. The cerate or oil may then be rubbed firmly into the skin of the whole body for twenty minutes, and allowed to remain on all night. In the morning another hot soap and water bath should be taken. The same programme may be followed on the next and succeeding evenings, or until every trace of itching is gone. In this way the majority of cases of itch can be cured in from one to three clays. All the clothing of the patient should be carefully boiled or baked before being used. SCLERODERMA. Definition.—Scleroderma is a chronic affection char- acterized by hardness and inelasticity of the integu- ment. 198 DISEASES OF THE SKIN. Synonym.—Hide bound skin. Symptomatology.—It is a rare disease, and com- monly commences as a circumscribed infiltration of the skin and subcutaneous tissues. As the disease advances, the parts are found to become hard and im- movable, as if frozen orp>etrified. The skin has gen- erally a yellowish-brown or at times waxy appearance. Scleroderma may occur on any part of the body, and at any period of life, and is apt to be symmetrical. It is supposed to be due to a stagnation of lymph in the lymph spaces. It runs a chronic course, but tends to get well in years. Diagnosis.—The disease bears some resemblance to morphcea, with which it is apt to be confounded. Scleroderma, however, is pathologically a hypertro- phy, while morphcea is an atrophy. Treatment.—Galvanism is recommended as having proved beneficial in some cases. As internal remedies Antimonium crudum, Alumina, Berberis, Elaeis and Rhus tox., may be studied. SCLERIASIS. Definition.—Scleriasis is an induration of the cellu- lar tissue in new born children. Symptomatology.—It may be congenital or appear during the first months of infant life. The skin which is at first of a yellowish, brownish or reddish hue, gradually fades and becomes hard and rigid. The sur- face is generally cold, and more or less oedema is usually present. DESCRIPTION AND TREATMENT. 199 Etiology.—The causes of this disease are supposed to be congenital debility, vascular disturbances and affections of the navel. The inflexibility is caused by a stearine-like deposit in the subcutaneous tissue. Prognosis.—The prognosis is unfavorable, as most children die with some affection of the lungs. Treatment.—Elms guineensis may prove useful as an internal remedy. Hydrocotyle, Phosphorus and Stillingia may be thought of. SCROFULODERMA. Definition.—Scrofuloderma is a strumous disease of the skin, commencing as indolent, painless livid tuber- cles that slowly soften and give place to unhealthy ulcers with free incrustation. Symptomatology.—It is oftenest encountered on the neck, and beneath the lower jaw, but is frequently met with on the thorax, and in the axillae and groins. The cause of this disease is to be found in that peculiar condition of system, which has been termed scrofulosis. Diagnosis.—It is to be differentiated from syphilis, lupus, and epithelioma. Treatment.—Such patients should be allowed an abundance of fresh air, plenty of outdoor exercise, and a generous diet. Cod liver oil should be one of their standard foods. Locally, the ulcers when formed may be dressed with the iodide of starch paste. The Calcium sulphide, is the principal internal remedy. The Calcium iodide, Theridion, and Scrofularia may be compared. 200 DISEASES OF THE SKIN. SEBACEOUS CYST. Definition.—A sebaceous cyst is a whitish round or oval tumor of variable size, composed of sebaceous matter enclosed in a sac. Synonym.—Wen. Symptomatology.—The tumors occur either singly or in numbers, and appear mostly on the scalp, face and back. Their contents are either hard and friable, soft and cheesy, or fluid in character. They are usually painless, run a chronic course, and may end spontan- eously by degeneration of the contents and destruction of the cyst. Treatment.—Excision is the best local remedy. Potassium iodide lx, Baryta carb., and Bromine, have more or less repute in removing cysts, and may be used to prevent their return. SEBORRHCEA. Definition.—Seborrhcea is a functional disorder of the sebaceous glands, characterized by an excessive secretion of sebum. Synonyms.—Steatorrhoea. Sebaceous flux. Symptomatology.—It may appear on any portion of r,he body, but attacks chiefly the scalp and face. It occurs at all periods of life, is seen more in women than in men, and is either local or general. In the newly-born it is a physiological rather than a pathol- ogical process, and constitutes the vernix caseosa. As a disease it appears either in the form of an oily coat- ing on the skin, or as dirty-white or yellow flat scales, description and treatment. 201 which are more or less greasy, and slightly adherent {dandruff). Light complexioned people are more subject to the former, and dark complexioned to the latter. When occurring on the scalp, seborrhcea is one of the most frequent causes of baldness; and as a sequel of variola an oily nose is not uncommon. Diagnosis.—This affection may at times be very easily confounded with eczema. But if it is remem- bered that seborrhcea is always a dry or oily disease, and that eczema has always a history of discharge; and also that the scales of seborrhcea are usually seated on a pale bluish-colored skin, and abundant, while those of eczema are scanty and seated on a red- dened more or less infiltrated surface, the diagnosis will not be difficult. Treatment.—The hygienic influences should be so arranged as to keep the system in the healthiest possi- ble state. All oily scales and crusts should be satur- ated with some oily substance, such as olive oil or glycerine, before their removal is attempted. Ten or twelve hours generally suffices to macerate them, so ihat they can be readily removed with warm soap and Water. The common hard soap is scarcely strong enough for this purpose, and so sapo viridis should be used.^ An elegant preparation is made by mixing four drachms (16.) of sapo viridis with three drachms (12.) of cologne water. After this treatment one of the simple oils should be applied, otherwise the skin will become dry and harsh. 202 DISEASES OF THE SKIN. In mild cases all the local treatment that is neces- sary is an infusion of saponaria bark applied morning and evening. For seborrhcea occurring on the face, a tannin dust- ing powder prepared by mixing from twenty grains (1.3) to one drachm (4.) of tannic acid with one ounce (32.) of rice powder has been highly recommended. The most serviceable internal remedies are the fol- lowing : Arsenicum alb.—Smutty brown, mottled skin. Yellow color of face. Ammonium mur.—Large accumulation of bran- like scales, with falling off of the hair. Bufo.—Skin greenish, and always looking dirty and oily. Bryonia.—In long lasting cases. Calcarea carb.—Nose shines as from oil. Sebor- rhcea with hyperaemia of the scalp and headache. Graphites.—Seborrhcea behind the ears. Iodine.—Firmly adhering scales, which leave the skin red and painful, on removal. Kali carb.—Dry hair rapidly falling off, with much dai druff. Lycopodium.—Seborrhcea on the chin. Mercurius sol.—Seborrhcea of the genitals, accom- panied with hyperaemia. Mezereum.—Excessive formation of smegma. Natrum mur.—Severe itching of the scalp. The hair falls out in masses. Seborrhcea of the face. Plumbum.—The skin of the face shines as if oily, and feels oily. DESCRIPTION AND TREATMENT. 203 Phosphorus.—Copious dandruff; falls off in clouds. Potassium bromide.—Seborrhcea on hairy portions of the face, forehead and neck. Raphanus.—Skin is greasy and makes the hands greasy to touch it. Sepia.—Seborrhcea of the genitals in women. Sulphur.—Dandruff. Thuja.—White scaly dandruff. Hair dry and fal- ling off. Vinca minor.—Seborrhcea on upper lip and base of the nose. SHINGLES. Definition.—See Zoster. STROPHULUS. Definition.—Strophulus is a disease of early life, due to congestion about the mouths of the sweat follicles, and is characterized by the appearance of small red or white papules, varying in size from a pin's head to a millet seed. Synonyms.—Red-gum. Tooth rash. Symptomatology.—The face, neck and arms are the usual seats of the eruption, but it may be general in its distribution. There are two forms of the affection. One variety mostly due to over-clothing, appears in infants a few weeks old. In this the eruption reaches its height in two or three days, and then gradually disappears. The other variety is frequently met with during the period of dentition, lasts longer than the former variety, and is often associated with gastro- intestinal disturbance. 204 DISEASES OF THE SKIN. Treatment.—The diet should be carefully regulated. and all superfluous clothing abandoned. Lancing the gums is proper only when they are swollen or so tender as to distress the child. Chamomilla is the principal internal remedy. Cal- carea carb. may be called for when there is a chronic acidity. Spiranthes is often indicated. Borax, Ledum, Apis, Cicuta, and Sumbul, may be studied. SUDAMINA. Definition.—Sudamina is a disorder of the sweat glands, characterized by pin-head sized vesicles formed by the collection of sweat between the layers of the epidermis. Symptomatology.—It is more particularly met with during the summer months, and in acute febrile and constitutional diseases. It occurs both in children and adults, and may be esteemed a sign of general debility. The mal-administration of Turkish baths occasionally gives rise to a general attack. Treatment.—Bryonia, Ammonium mur., and Urtica urens, are the most important remedies. SYCOSIS. Definition.—Sycosis is a catarrhal inflammation of the hair follicles of the beard, and is characterized by the formation of papules, tubercles and pustules, at- tended with pain, heat and swelling. Synonyms.—Mentagra. Folliculitis pilorum. Symptomatology.—The affection demonstrates itself by the development of acuminated, more or less in- DESCRIPTION AND TREATMENT. 205 durated, pin-head or split-pea sized pustules immedi- ately around the hairs, containing a thick yellow fluid. More or less pen-follicular inflammation usually ac- companies the disease, and according as this is slight or severe, the patient suffers pain. If the inflamma- tion is severe the pustules are crowded together, other- wise they are generally discrete. The hairs of the affected part are as a rule healthy, and cause pain on extraction (a characteristic). The disease is not con- tagious. Treatment.—Shaving is the first thing to be done, and it must, if necessary, be kept up daily for months. Hot fomentations should be applied if there is much inflammation. As regards the internal treatment, Tartar EMET.,is allowed by common consent to rank first. Other remedies occasionally of service, are: Calcium sulphide.—Many little pimples on the chin, sore when touched. Large sores surrounded by small pustules. CEdematous swelling of the parts. Cereus serpentinus.—Pustules on the right upper lip and angle of the mouth, on parts covered by beard. Itching of the parts covered by the beard. Cicuta.—Elevated eruption which causes burning pain when touched. Itching papular eruption on chin. Graphites.—Chin covered with eruption. Hard white pimples on red base. Dry skin; never perspires. Worse on the left side. Kali bich.—Pustules on the right side of the chin. 206 DISEASES OF THE SKIN seated on reddened bases. In fat, light-haired persons. Mercurius precip. ruber is, next to Tartar emet., one of the most prompt remedies for sycosis. Petroleum.—Papular eruption at the corner of the mouth with sticking pain. Painful pustules on the chin. Sulphur.—Painful pea-sized pimples, with red areolae. syphilides. Definition.—Syphilides are the manifestations of general syphilis upon the skin. Symptomatology.—They may be divided into two arbitrary groups, viz., the secondary and the tertiary; and possess the following general features: They have a history of syphilitic inoculation. They are of a reddish, yellow-brown color, often described as copper-colored. They are polymorphous and elec- tive. They are devoid of both pain and itching. The crusts are thick, greenish-black. The ulcers are of an ash-gray color, are often serpiginous or horse-shoe shaped, and are bounded by sharply cut edges. The diffused eruptions are generally symmetrical. Later the distribution is irregular. The scales occur in small circular spots, and are thinner and fewer in number than in non-syphilitic cases. They are of a non-inflammatory character and are prone to recur. They occur in the ratio of about five per cent, of all cutaneous cases. The secondary syphilides are', 1. Erythematous syphilide.—This consists in the description and treatment. 207 formation of flat or slightly raised patches, varying in size from a split pea to a two-cent piece. It is the earliest and most frequent cutaneous manifestation of constitutional syphilis, and appears generally at about the sixth week. It often comes on slowly, but may- appear suddenly, and is confined in the majority of cases, to the covered parts of the body. When it occurs early in the disease it may last for months. The rash is unaccompanied by itching, but is usually at- tended by such significant signs of syphilis, as the chancre or its scar, the redness of the fauces, and the mucous patches. Treatment.—The white precipitate ointment, ten (.6) to twenty grains (1.3) to the ounce (32.), may be used externally, and Merc, iodat., or Merc, cor., given at the same time internally. 2. Papular syphilide.—This eruption is usually superficial and may either follow the former, or occur as the first outbreak after chancre. It may appear as early as the third week after the chancre, or not until the fourth month, and usually lasts from three to eight weeks. The papules may be either acuminated or broad and flattened, and may vary in size from a millet seed to a split pea or larger. They are at first rose-colored, and are surrounded by a white border of fine scales. Later they assume a tawny hue, and may be moist, or covered with thin scales. They are usually most marked on the nape of the neck, the flexor sur- faces of the extremities, and on the perineum and gen- itals. 208 DISEASES OF. THE SKIN. Treatment.—The five per cent, oleate of mercury is the best local application. Internally, Potassium iodide and Merc. cor. are the principal remedies. 3. Vesicular syphilide.—This is a rare type of syphilitic eruption, and in the majority of cases, takes the form of herpes. Occasionally it is varicella form. The vesicles of the herpetic manifestation vary in size from a millet seed to a pea, and are seated upon a cop- per colored base. They are arranged either in circles or in segments of circles, usually last about a week, and disappear without scarring. Their first appearance is generally about three weeks after the disappearance of the primary lesion. The vesicles of the varicellaform eruption are about the size of small peas, are surrounded by a coppery- red areola, and are now and then umbilicated. They may be either isolated or confluent, and are succeeded by greenish-brown scabs which fall off in about two weeks, leaving slowly disappearing purplish discolor- ations. The lesion appears about the sixth month after chancre, and shows itself mostly about the face. Treatment.—Merc, cor., Cinnabar, and Merc, jod- atus are three main internal remedies. A Merc. cor. lotion or the oleate of mercury, may be used exter- nally. 4. Pigmentary syphilide.—This consists of "coffee- with-milk" colored macules, varying in size from a cent piece to a half dollar. It occurs oftenest in women, and appears mostly on the neck, but occasion- ally extends to the body and extremities. It comes DESCRIPTION AND TREATMENT. 209 between the fourth and twelfth month, and lasts one or two months, or longer. Treatment.—Nitric acid is the generally indicated remedy. The Calcium sulphide is sometimes called for. 5. Pustular syphilide.—This may exist in either of three forms: {a.) As small millet-seed sized ephemeral dead- gray colored pustules which dry up and form brownish, rough, scabs, or else liuger as slightly ulcerating, veg- etating surfaces. They are apt to appear on the fore- head, angles of the mouth and base of the nose, and usually leave a brownish centrally depressed spot on their disappearance. {b.) As pin-head or split-pea sized acuminated pus- tules which form brownish colored scabs, and leave small, white, depressed cicatrices. They develop about six months after chancre, and last about two months. They appear mostly on the scalp, face, and trunk, and more rarely on the lower extremities. (c.) As ecthymatous umbilicated pustules, which vary in size from a pea to a hickory nut, and are sur- rounded by a dark areola. These form rough, dark, greenish-brown scabs, and leave slight copper-colored cicatrices, which gradually disappear. Treatment.—Locally, white precipitate ointment may be used. Kali bich. and Merc. nit. are the more common in- ternal remedies. 6. Bullous syphilide,—The eruption is character- 210 DISEASES OF THE SKIN. ized by blebs, which vary in size from a pea to a wal- nut, and after lasting a variable time, dry up and form dark greenish-brown scabs. It is a rare and late man- ifestation of syphilis, but may occur on the palms and soles of the newly-born as a result of inherited disease. Treatment.—Potassium iodide and Syphilinum, are the generally used remedies. 7. Squamous syphilide.—This may develop on the syphilized,in the course of other eruptions, or start as a primary condition with febrile symptoms, by the formation of small, red, circular blotches, which in a few days become covered with scales. After a few weeks the scales fall off, leaving dark colored spots, that gradually disappear without cicatrization. Lentil-sized, copper colored spots, sometimes form on the palms of the hands and soles of the feet. The patches may be either fissured, or covered by adherent grayish scales, and are usually limited by the charac- teristic livid areola. The eruption is commonly symmetrica], and may last for months, or even years. The scaly syphilides rarely appear before the sixth month from the chancre, and when entirely removed by treatment are not apt to return. Treatment.—The local treatment consists in the use of the red precipitate ointment. The internal remedies are Merc, precip. ruber. Arsenicum sulphide and Cinnabar, Sarsaparilla, Merc. cor., and Phytolacca. 8. Tubercular syphilide.—This is a common fornj description and treatment. 211 of sotundary syphilis verging on the tertiary. It rarely appearv. before a year or longer after chancre, and con- sists of "Jrcumscribed, dome-shaped, brownish-red ele- vations, which vary in size from a split pea to a nut. They art situated for the most part on the face and back, but occasionally appear on the extremities. They develop slowly, may last for weeks or months, and disappear either by absorption or ulceration. When absorption takes place, small depressed pig- mented spots remain, which either finally disappear or leave but very superficial cicatrices. If ulceration ensues, the tubercles become covered with a brownish or blackish crust, and the ulcers have a punched- out appearance. Occasionally the eruption is grouped into circles or figures-of-eight,a peculiarity observed mostly about the forehead and nose. Treatment.—Tho tubercles may be treated locally with the acid nitrate of mercury, and when ulcers form they may be dressed with iodide of starch paste. Merc, biniod., and Potassium iodide are the gener- ally indicated rem 3dies. Thuja is adapted to mucous tubercles. The tertiary syphilides are principally Rupia and the Gummatous syphilide. 9. Gummatous syphilide.—This is a late syphilide, and appears first as little hard lumps, seldom larger than a hazel-nut sVtuated on the head, buttocks and ffexor surfaces of the extremities. They are loosely imbedded in the tissues, may be either single or mul- tiple aad grow slowly. They either undergo absorp- 212 diseases of the skin. tion or eventually break down, and form grayish deeply excavated ulcers that vary in size from a finger nail to the palm of the hand. Treatment.—In addition to the treatment suggested for the eighth syphilide, Carbo animalis, Condurango, Berberis aqui, and Bi-cyanide of Mercury may be thought of. In mercurio-syphilitic ulcers, Cistus canadensis acts well. Syphilides in children.—The cutaneous manifesta- tions of hereditary syphilis, as observed in children, differ from those of the acquired form as seen in the syphilized adult. Usually within two or three weeks after the birth of the tainted child, distinctive signs' of syphilization show themselves. The little one, hitherto, it may be, of robust appearance, gradually declines in health. Fissures and chaps appear about the mouth, anus and genitals. The skin becomes harsh and dry and assumes a dingy, yellowish hue. The face grows wrinkled, and the babe patient appears like a little dried up old man. Sooner or later snuf- fles sets in, the disease extends to the larynx, and the child has a peculiar hoarse cry. About the same time coppery-red mucous patches varying in size from a finger-nail to the palm of the hand, appear on the buttocks, thighs or genitals. Occasionally the hands exfoliate in thin dry scales. After a variable season, dry or moist papules—the moist predominating— make their appearance on the reddened patches. Tu- bercles may form. The matrix of the nail may sup- purate and the nail be shed several times, Mccon1?' DESCRIPTION and treatment. 213 lions and mucous patches are the most common, and at the same time, the most characteristic manifestations of syphilis in the young. Occasionally syphilis is ac- quired by a healthy baby from nursing a woman with chancre, or through vaccination. This is called In-, fantile syphilis. If the child is born with a general eruption, death is almost inevitable. The bullous syphilide in infants usually manifests itself at birth, and generally results fatally. Treatment.—The Calcium iodide is the principal remedy, and next Merc. viv. Corallium rub., is adapted to the syphilitic erosions. A five per cent, oleate of mercury inunction is highly recommended. If the simple oleate irritates the skin, equal parts of a ten per cent, oleate and vaseline may be used. One-half of a drachm of the unguent may be used at each appli- cation. telangiectasis, Definition.—Telangiectasis is characterized by cir- cumscribed, vascular cutaneous growths, appearing for the most part during adult life. Synonyms.—Spider naevus. Symptomatology.—The growths are usually of a bright red color, and vary in size from a pin's head to a split pea. They differ from naevi in that they are not congenital, but acquired. Telangiectasis selects as its favorite seats the face and neck. It runs a chronic course, and may either terminate spontane- ously or remain through life. Treatment.—The treatment is the same as that of najvus. 214 DISEASES^ OF THE SKIN. Condurango is reported as having cured some cases. THE TINEiE. Definition.—" The tineae " is a generic term given to a class of cutaneous affections that owe their origin to vegetable parasites. Symptomatology.—At the Chicago Homoeopathic Hospital they constitute about four per cent, of all the cases in the department for skin diseases. They are all contagious, occur more in populous districts, and are curable by parasiticides. Parasites.—The parasites are the Achorion Schon- leinii, the Tricophyton and the Microsporon furfur. They exist in three forms: 1. Conidia or spores, which are made up of an outer and inner enveloping membrane composed of cellulose, enclosing a liquid containing floating granules. They present an average diameter of .006 mm. 2. Mycelia, or thread-like structures, which vary in size and shape from simple, fine, transparent fila- ments, to large, double-contoured tubes. 3. Granules, the nuclear form of the fully developed fungus. They require a high power for their detection. The conidia are the most developed parts of the fungus. They may be either round or oval. The mycelia aie the growing or producing structures. They may be either long or short, branched or straight, filled with or almost devoid of granules; and the granules being the more elementary forms, may be either numerous or only sparcely distributed. DESCRIPTION AND TREATMENT. ' 215 From this it maybe noted, that whenever.in the field of the microscope, a large number of conidia or spores are seen it can be safely said that the fungus has age, and that consequently the disease has been running for some time, or has become chronic. If on the other hand sprouting mycelia filled with granules, marked oft* as it were by partitions, and called sporo- phores, are present in large numbers, it may be taken for granted that the fungus growth is active, and that consequently the disease is spreading rapidly, or is in the acute stage. Varieties of Tineae.—There are three varieties of " the tinew" due respectively to the ravages com' mifcted by the afore-mentioned parasites upon the skin. They are Tinea favosa, Tinea tricophytina and Tinea versicolor. TINEA FAVOSA. Definition.—Tinea favosa is a contagious disease, characterized by tlie presence of one or more clustered or scattered variously sized cup-shaped scabs of a sulphur-yellow color, and pierced by a hair. Synonyms.—Favus. Crusted ringworm. Honey- combed ringworm. Symptomatology.—It appears mostly among the poorer classes and flourishes in dirt. It is oftenest found on the head, frequently on the trunk, and occasionally on the lower extremities. It shows itself first at the point where the vegetable parasite touches the skin, as a slight redness, accompanied by a varying amount of itching. Scales soon make their appearance 216 DISEASES OF THE SKIN. on the reddened surface and assume the form of pin- head sized crusts. These continue to increase, and the disease spreads, so that at the end of two weeks, the collected mass presents the umbilicated form of the fully developed favus cup. They may now remain separated, or coalesce and form yellowish-colored, -- aggregations, having a characteristic honeycomb as- pect. The scabs are peculiarly cup-shaped in appearance, with the concavity directed upwards, and vary in size from a split pea to a ten cent piece or even larger. They have a straw or sulphur-yellow color, and are as a rule pierced by a hair. A special odor generally attaches to the favus crust: it is that of stale straw, mice or cat's urine. On removing the scab, the skin is seen to present a more or less reddened, hollowed out appearance, cor- responding to the convexity on its under surface. Most generally the hair is loosened in the follicle, by the fungus affecting its formative apparatus, and comes away with the scab. If the disease is severe, and the ravages of the parasite are in any way exten- sive, the hair follicles may be destroyed and the scalp left red, smooth and shining. Favus may, at least in v this country, be classed among the rarer diseases. It is eminently contagious, never originates spontaneously, but may be communicated from animals to man. It may have its seat in either the hair follicles or the hair, or upon the surface of the skin, and is due to the action of the vegetable parasite known as the achorion schonleinii. This fungus was named after Schonlein, DESCRIPTION AND TREATMENT. 217 its discoverer, by Remy. Its history dates back to 1839. Under the microscope it presents the following characteristics: A field studded mostly with oval conidia, varied as to size, and mycelia variable as to length and more or less filled with granules. The oval fungus has a double envelope, and an average diameter of .034 mm. The mycelia present a pale grayish watery appearance, and have an average diameter of .0026 mm. They—the mycelia—are usually abundant, and occasionally as- sume a peculiar grouping with the conidia. (I allude to the clustering of four or five of the spores in a row at the end of a mycelial thread.) This is oftener fotfnd than many would have us believe, and when present is characteristic of favus. Diagnosis.—As regards the diagnosis of tinea favosa, little difficulty is usually experienced. Briefly, the distinguishing points are: The characteristic pea-sized, straw-colored, cup- shaped, honey-combed crusts. The stale straw odor. Its prevalence among the poorer classes and children. The presence of the achorion schonleinii, as revealed by the microscope. Its contagiousness. From eczema, for which it is most liable to be mis" taken, it may be distinguished by having no stage of discharge, by having sulphur-yellow instead of green- ish-yellow crusts; by its stale straw odor, as con- trasted with the nauseous smell of eczema; by being contagious, and eczema not; and by being cured by parasiticides, while eczema would be aggravated there- by 218 DISEASES OF THE SKIN, Treatment.—The cardinal point in the treatment, is either to starve out or kill the parasite. The former may be accomplished by the administration of inter- nal remedies which may so alter the soil as to render it less suitable to the fructification of the plant, and the latter by the use of local applications, called par- asiticides. Before local treatment is commenced, all crusts must be removed and the diseased hairs pulled out. Almond oil, a marsh-mallow, or mashed turnip poultice, will soften the crusts. The hairs are best removed by a broad-lipped epilation forceps. (Fig. 12). After the scabs and diseased hairs have been Fig 12. Epilating Forceps. removed, a parasiticide of greater or less strength, depending upon the irritability of the skin and the stubbornness of the parasite, should be applied. A mercuric bichloride lotion—one (.06) to three grains (.19) to the ounce (32.)—acts well. If the fungus has caused considerable irritation, enough over and above the scabbing to occasion a discharge, the oleate of mercury five per cent, will be of service. The positive electrode of a galvanic battery—current of 15 to 20 miliamperes—moistened with the bichloride solution and held on the diseased parts 10 or 15 minutes, causea more rapid penetration of the parasiticide. The internal remedies are: DESCRIPTION AND TREATMENT 219 Agaricus.—Favus with biting itching in the scalp. '"rusts sometimes spread to other parts of the body. Sensation as if ice-cold needles were piercing the skin. Arsenicum iodide.—Scalp dry and rough, and cov- ered with dry scales and scabs. Extend to forehead, face and ears. Intense itching and burning. Bromine.—In children with light hair and blue " eyes. \V hen the fungus excites considerable irritation 9t tlie skin. Profuse dirty looking, offensive smelling discharge. Crawling beneath the skin of the occiput. Calcarea carb.—Thick scabs covering a quantity of thick yellow pus. Large scabs, covering sometimes over one-half the entire scalp. Burning and itching. Glandular- swellings on the neck. In fair, plump children. Dulcamara.—In scrofulous children when the crusts are thick and the hair falls out. Bleeding after scratch- ing. Glandular swellings in the neighborhood of the emotion. Graphites.—Exudation of clear, glutinous fluid forming moist scabs. Secretion from scratching. Fall- ing out ^t" '/>air. Skin dry and inclined to crack. Ten- dency to ulceration. Kali carb.—Exudation of moisture after scratch- ing. Sensitiveness to cold. Frequent urination,espec- ially at night. Dryness and falling out of the hair. In old over-treated cases. Lappa major.—Grayish-white, foul smelling crusts. Most of the hair has disappeared. Swelling and sup- puration of the axillary glands. Boils all over the body. 220 DISEASES OF THE SKIN. Lycopodium.—Eruption beginning on the back of the head. When there are several spots, and when the crusts are fetid, thick and bleed «ssily, Hunger, but a small quantity of food fills him up. Constipation. Mezereum.—Elevated white chalk-like scabs with ichor beneath, breeding vermin. Itching as if the head were in an ant's nest. Worse at night. In scrofulous children. Oleander.—Favus on the back part of the head and behind the ears. Biting itching of the scalp as from vermin. Skin sensitive and sore. Phosphorus.—May be used when the follicles ap- pear to have been destroyed, and the scalp left smooth and shining. Sulphur.—May be necessary to help along the ac- tion of the indicated drug. Ustilago mad.—When there is great moisture, with matting and falling of the hair. Vinca minor.—Offensive, moist eruption with brownish crusts. Abundance of lice on the head. Hair matted together. The hair falls out in single spots and white hairs grow there. Viola tricolor,—Thick crusts; hair becomes matted; urine smells like cat's urine. Swelling of thr cervi- cal glands. Intolerable itching at ni^ht. TINEA TRICOPHYTINA. Definition.—Tinea tricophytina is the variety o* tinea that owes its origin to the tricophyton. Synonyms.—Ringworm. Barber's itch. DESCRIPTION AND TREATMENT. 221 Symptomatology.—Under this head are included the diseases commonly described as, tinea tonsurans, tinea circinnata, tinea sycosis, and tinea kerion. The trico- phyton finds its affinity in children of lymphatic tem- perament, selects as its seat either the scalp or body, and there produces the disease known by the common name, "ringworm." In middle life it frequently at- tacks the beard, where it grows luxuriantly and causes the affection having the vernacular "barber's itch." When the fungus is first planted on the skin, the fates being propitious, it demonstrates its presence as does the favus fungus by the appearance of an itching erythematous redness, accompanied usually by a crop of evanescent vesicles, which are quickly followed by a scaly formation. If the parasite attacks the scalp, it will be noticed that the hairs covering the patch or patches, gradually become brittle and break off, or are loosened and come out easily. The breaking off of the hairs gives to an old patch a "stubble-like" appearance, which together with a semblance of "goose-skin," due to the promi- nence of the follicles, may be held as characteristic. On the body, where it presents its best developed ringworm appearance, tinea tricophytina spreads in a circular fairy-ring-like manner, until it covers an area of a silver dollar or even larger. For, as the skin be- comes accustomed to the presence of the fungus which has already assumed the cellular form in the oldest part of the patch, the central redness gradually fades, while the disease is all the time spreading in the direc- 222 DISEASES OF THE SKIN. tion of the periphery, where the sprouting mycelia aro most active. When the parasite attacks the beard, a slight inflammation is first noticed around one or more hair follicles of the chin, which gradually increases until papules make their appearance. The papules steadily enlarge, so that in about a week's time they may have reached the size of split-peas or hazel-nuts, and have in fact become tubercles. These tubercles are surrounded by a little pus, and pierced by a hair, which loosened by the destructive changes going on around it, will, if pulled, come out, causing scarcely per-. ceptible pain. This is an eminently contagious form of tinea tricophytina, and is acquired mostly m ton- sorial parlors, through the carelessness of barbers. When the tricophyton attacks the nails it produces the disease sometimes called onychomycosis. Tinea kerion from the Greek kerion a honeycomb, is the name applied by some writers to a form of this variety of tinea, that is simply the result of a more violent action of the tricophyton, in which the hair follicles become specially inflamed and pour out a viscid mucus, resembling the juice of the mistletoe berry. The tricophyton, from thrix, a hair, and phuton, a plant, was discovered by Gruby in 1844. It was after- wards more fully described by Bazin, of Paris, in 1854. __ It has an average diameter of .004 mm. and is com- posed mostly of spores and mycelia, having but com- • paratively few granules. The spores are round, al- most uniform in size, and look like fish-roe. The mycelia appear as slightly greenish tubes more or less DESCRIPTION AND TREATMENT. 223 filled with granules and jointed. The spores are more abundant on the hairy portions of the body, while the mycelia predominate on the non-hairy regions. Diagnosis.—The main diseases with which tinea tricophytina is apt to be confounded, are: seborrhcea, eczema, psoriasis, favus, sycosis, and acne. ; From seborrhcea, it may be diagnosed by the acute, character of the disorder, and by the absence of en- larged follicles and a greasy surface. From the squamous stage of eczema, it may be distinguished by the abrupt marginal form of the eruption, the loosening of the hair, the history of contagion, and the more rapid course. From psoriasis, it may be told, by the history of the case, and the decision of the microscope. From favus, by the absence of the char- acteristic crusts of the latter, and the different fungus. From sycosis, by the loosened hairs, the characteristic tubercles, and the ever present fungus. And from acne, by its seldom or never appearing on the non- hairy parts of the face, as the cheeks and forehead, which are the favorite seats of acne. A very easy way to detect the nature of the trouble is, to apply a little chloroform to the suspected part. If fungus is present, it turns whitish-yellow as if sprinkled with sulphur powder, otherwise the appear- ance is unaltered. Treatment.—As in tinea favosa so in tinea tricophy- ; tina, the cardinal point to be remembered is—kill the parasite. This is best done by epilation and the use of parasiticides, 224 DISEASES OF THE SKIN. Mercuric bichloride lotion—one (.06) to three grains (.19) to the ounce (32.)—is one of the most use- ful. Clipping every alternate day, and epilation on the days between, accompanied by a diligent use of the mercuric bichloride lotion, proves a sovereign remedy for the form "barber's itch/' Sulphurous acid (absolutely fresh) either as a lotion of fifty per cent. strength, or as a spray, will sometimes do better ser- vice on an irritable skin than will the mere, bichl. lotion. Red precipitate ointment, from one-half (2.) to one drachm (4.) to the ounce (32.), may be used. The positive electrode moistened with desired lotion may be applied as suggested in favus (p. 218). The following are the internal remedies: Sepia and Tellurium are adapted to the ringworm variety, as occurring on either body or scalp. For the form, "barber's itch," wrongly termed tinea sycosis, Merc, precip. ruber, Kali bich., Plantago, Tartar emet., and Cicuta are the main remedies. Cocculus indicus and the remedies mentioned in the treatment of favus may also be compared. TINEA VERSICOLOR. Definition.—Tinea versicolor is characterized by the appearance of fawn-colored patches slightly raised above the level of the skin, accompanied by consider- able itching and desquamation. Synonyms.—Chromophy tosis, Pityriasis versicolor. Symptomatology.—Tinea versicolor is a disease of the superficial cells of the cuticle, caused by the presence of a parasite—the microsporon furfur—and has been DESCRIPTION AND TREATMENT. 225 confusedly termed, by some, pityriasis versicolor. It is the mildest of all the tineae, and occurs mostly in phthisical patients between the ages of twenty and forty, and attacks women oftener than men. The chest and aY)domen are most obnoxious to the disease, which when at all extensive give3 to the skin a pecul- iarly mapped appearance. *Fig. 13. Microsporon Furfur. The microsporon furfur (Fig. 13) was discovered by Eichstedt in 1846. Under the microscope its conidia appear of variable size oval or irregularly rounded, and bilinear. They are of a yellowish-gray color, ♦From a drawing by Dr. F. R. Day, of this city, taken from a choice specimen found in his private collection. 226 DISEASES OF THE SKEST. have an average diameter of .005 mm. and are gen- erally devoid of granules. They manifest a peculiarity in that, they tend to cluster, which none of the other conidia do. The mycelia differ but little from those of the tri- cophyton, only they are shorter, more branched, and are occasionally tipped with single spores. They have an average diameter of .0025 mm. The parasite at- tacks neither hair nor nail. It is the most superficially seated of all the vegetable parasites, having its habitat in the horny layer of the epidermis, and is less tena- cious of life than any of the other fungi. Diagnosis.—The main disease with which tinea versicolor is most liable to be confounded is the ery- thematous syphilide. The microscope will easily set- tle this question, even if the syphilitic history of the one does not. Next to tinea tricophytina it is the most common of the parasitic diseases. It may be found in all classes of society, and tends to run a chronic course. Re- lapses are frequent, but are more easily managed than in the other varieties of tinea. Its contagious prop- erties are feeble. Treatment.—The affected parts should be thorougly bathed with soap and water, or an infusion of saponaria bark every day, and the milder parasiticides used. A ' sulphurous acid (absolutely fresh) or a hypo-sulphite of soda lotion will generally be all that is needed. At times acetic acid baths may be resorted to. Sepia and Natrum ars., are the principal internal remedies. DESCRIPTION AND TREATMENT. 227 TRICHIASIS. Definition.—Trichiasis is characterized by an abnor- mal direction of the hair after it leaves the follicle. Symptomatology.—It affects more commonly the eyelashes, but is occasionally seen on the scalp and eyebrows. Treatment.—The treatment which is mainly local consists cither in pulling out the hairs, which is pallia- tive, or in excising a portion of the palpebral skin if it affects the eyelids, and bringing the edges of the wound together with three or four sutures. Borax has been recommended as a useful remedy both internally and locally. TRICHOCLASIS. Definition.—Trichoclasis is characterized by brittle- ness of the hair and the development of little knots along the shaft which look like "nits." Symptomatology.—It is usually confined to the hair of the beard, and is not contagious. Treatment — Shaving off the hair is occasionally necessary. JVatrum mur. may be given internally, and salt water—Brigg's concentrated sea water—washes used externally. URTICARIA. Definition.—Urticaria is an inflammation of the skin, characterized by capriciousness of eruption and the development of reddish or whitish "wheals," attended by tingling and stinging. 228 diseases of the skin. Synonyms.—Nettle rash. Hives. Febris urticata. Symptomatology.—The wheals of this affection vary greatly in size, but are ordinarily of the dimensions of a finger nail—occasionally they attain the size of half an egg {giant urticaria)—and are commonly sur- rounded by an areola. They may be multiform, but are usually roundish or oval. To the touch they may be either soft or hard. When simple or uncomplicated they disappear without leaving any mark or scar. A very annoying, burning, stinging, tingling sensation, likened to the sting of the nettle, is a more or less constant accompaniment, and gives rise to an almost irresistible desire to scratch. And so ephemeral is the disease that " scratch marks" are often all that is left for inspection. The wheals come and go suddenly, are oftentimes excited by simply rubbing the skin, and are prone to change base. Urticaria occurs at all periods of life, and may ap- pear on any part of the body or mucous membrane; sometimes it attacks the tongue, and the patient may be almost choked. It usually presents itself as an acute disorder, the result of some dietetic error, lasting only a week or two. Occasionally, however, it appears as a chronic affection. Sometimes an cedematous condition pre- cedes and accompanies the eruption, and at times an effusion of blood into the wheals, may take place ( U.purpurea.) An acute attack is generally ushered in with febrile symptoms, headach" j,nd more or less gastric derange* DESCRIPTION AND TREATMENT 229 ment. The eruption appears suddenly, accompanied by intolerable itching, and the entire surface may be covered in a very short time. After a while, it may be on the removal of the exciting cause, the symptoms begin to subside, and soon all vestiges of the disease have vanished. Etiology.—Urticaria constitutes about ten per cent of all skin affections. Its causes are many. Organic uterine disease in women, and intestinal irritation in children are not infrequent sources. Acute urticaria may be precipitated by overloading the stomach, 01 by the excessive use of wine or highly seasoned food. A peculiar idiosyncrasy may cause its appearance after eating crabs, oysters, lobsters, sausage, mush- rooms, strawberries, eggs, canned good2, etc. Over- dosing with copaiva, cubebs, chloral, turpentine, or valerian will give rise to the rash. Diagnosis.—Urticaria can hardly be mistaken for any other disease, although it bears some resemblance to dermatitis contusiformis. It, however, wants the lividity, the regular course, the oval shape of the tumors, and the absence of itching of the latter. Treatment.—All dietetic errors should be corrected, and if an overloaded stomach is the cause, an emetic should be administered. The exciting cause must in all cases be removed as early as possible. Locally,* warm vinegar and water lotions may be used to allay the itching and burning. Chloroform and cream mixture—one-half drachm (2.) to the ounce (32.)— will frequently prove serviceable. Favorable men- 230 DISEASES OF THE SKIN. tion may also be made of the benzoic acid wash—five (.33) to ten grains (.66) to the ounce (32.) A weak carbolic acid lotion at times acts well. The Turkish bath may help when other means fail. One of the following internal remedies will gener- ally be indicated: Allium cepa.—Nettle-rash on the thighs with stitches and burnings. Acute catarrhal symptoms. Anacardium.—Nettle-rash from emotional causes. Dull pressure as from a plug in various parts. Weak- ness of memory. Antimonium crud.—Chronic nettle-rash on the face and j .tints accompanied by thirst, nausea and thick, white coated tongue. Gastric derangement. Apis mel.—Reel and inflamed raised patches of hives, with stinging and burning. Aggravated by heat, ameliorated by cold water. Itching and appear- ance of blotches after scratching. Uterine catarrh. Urine scanty and high colored. Arsenicum alb.—Wheals of a scarlet color on the face and neck, the size of a half dollar. Intense burn- ing. Itching better from external heat; worse from cold or from scratching. Astacus fluv.— In chronic cases when other reme- dies fail. Clay colored stools. Aurum.—Dirty, yellow blotches on calves and legs with burning. Better in a warm room. Melancholy. In light-haired, scrofulous subjects. Belladonna.—Bright scarlet red elevated puffy spots, surrounded by a white border. Parts sensitive to the touch. After eating cabbage or sour-krout. DESCRIPTION AND TREATMENT. 231 Berberis—Blotches like nettle-rash on the shoulder and right arm, accompanied with burning and sting- ing. Momentary cold sensation on the parts. Heart- burn with soap-sud taste in mouth. Bryonia.—Nettle-rash with rheumatic pains from atmospheric changes. Symptoms worse from expos- ure to the heat of the fire. Caladium.—Nettle-rash on the chest alternating with asthma. Itching and sudden, violent corrosive burning, often on small spots. Worse at night. Calcarea carb.—Chronic nettle-rash. White ele- vated hard nettle-rash which disappears in the cold air. Symptoms aggravated by drinking milk. Acidity. Calcium sul phide.—Chronic nettle-rash on the fin- gers and hands. Burning and itching of the skin after scratching. Carbo veg.—Blotches on the calves of the legs, wrists and feet. Burning in various places on the skin. In cachectic individuals, accompanying dyspep- sia. Causticum.—Rash on the thighs just above the knees. Worse during dry, better during wet weather. Chronic nettle-rash. Cinchona.—Nettle-rash coming out after scratching. Frightful swelling of the face, forearms and hands in the"morning. Debility after loss of animal-fluids. Malarial complications. Cimicifuga.—Urticaria from menstrual disorders. Excessive muscular soreness. Brain feels too large for cranium. In nervous hysterical females. 232 DISEASES OF THE SKIN. Cina.—White wheals surrounded by erythematous redness, first on the nose, then all over the body. From worms. Chloral.—Large raised wheals on the arms and legs, coming on suddenly, from a chill. Aggravated by the smallest quantity of wine, beer, or spirits. In > grain doses in obstinate cases. Cocculus.—Hard blotches, surrounded by red areolae, on the limbs, wrists and back of the fingers. Burning itching as from nettles. Conium.—Stinging like flea-bites, onlv one stitch at a time. Evanescent itching. Copaiva.—Urticaria at first on the face, especially the forehead, then on the back of the hands, and finally in isolated patches all over the body. Large red blotches, with constipation and fever. Urine scanty and full of sediment. Great restlessness. Condurango.—Chronic urticaria. Gastric pains, mostly at the cul-de-sac of the stomach. Dulcamara.—White blotches with red areolae, on the arms and thighs. Nettle-rash over the whole body without fever. Eruption preceding the menses. Fagopyrum.—Sore, red blotches inducing scratch- ing, which aggravates. Swelling, the size of a hen's egg, on the neck and shoulder. Dreadful stinging itching. Graphites.—Red spots like flea-bites all over, espec- ially on the calves of the legs. Itching worse in the evening and at night. Skin dry, never perspires, and is inclined to crack. In females with disposition to delayed menstruation. DESCRIPTION AND TREATMENT. 233 iifypericum.—Eruption like nettle-rash on both hands at 4 p. m. Crawling in the hands and feet, they felt fuzzy. Ignatia.—During chilly stage of intermittent fever. Frequent discharge of much watery urine. In nervous subjects. Kali carb.—Urticaria during menstruation. Worse in warm weather. In persons with dry skin, or Avho are inclined to pulmonary troubles. Lycopus.—Troublesome urticaria, especially affect- ing the left forearm and right leg, before eating. Magnesia carb.—Hard blotches as if from nettle sting, worse during menstruation. Menstrual flo t more profuse at night. Lycopodium.—Itching with nettle-rash eruption on the extremities. Desire to eat, but a small quantity of food fills him up. Inclined to constipation. Mercurius.—Small flat light-red blotches on the sexual parts, abdomen, chest and inner side of the thighs. Easy perspiration without relief. Natrum mur.—WThite blotches on the arms and hands, turning red on scratching. Red blotches over the whole body. Violent itching. Nux vom.—When accompanied by constipation, vertigo and headache. Podophyllum.—Intolerable itching of the skin on the body and arms; on scratching it raises up m blotches like hives. Pulsatilla nig.—Red, hot spots like nettle-'f.su. After eating fat pork, fruits or buckwheat. 234 DISEASES OF THE SKIN. Pulsatilla nut.—Blotches on the right breast, stand- :ng out like measles, with red base, turning white on scratching. Violent itching, worse at night before bed time. Rhus tox.—Burning itching. Skin swollen and red. Fever, rheumatic pains. Worse in cold air. Robinia—Burning itching wherever a part of the face is touched. Itching of skin where rests upon it. Sour stomach. Sarsaparilla.—Blotches as from nettles. Burning itching with chilliness after abuse of mercury. Sepia.—Red lentil-sized blotches on the hands. Chronic nettle-rash, especially on the face, arms and thorax. Aggravated by cold. Ameliorated by warmth. iVfter milk and pork. Spigelia.—Small elevations like hives on the lower extremities after scratching. Stannum.—Small itching hives below the wrist through the day. Itching aggravated by rubbing. In patients with phthisis. SuLPnuR.—Itching hives over the whole body. Ag- gravated by the warmth of the bed. Chronic cases. Tartar emetic.—White lumps with red areolae. Eruption comes and goes. Worse after meat. , Triosteum perf.—Nettle-rash with gastric derange- ment. Urtica urens.—Nettle-rash attending or preceding rheumatism. Itching swellings all over the fingers. Aggravated every year at the same time. Ustilago.—Terrible nightly itching. Menstruation DESCRIPTION AND TREATMENT. 235 irregular from ovarian irritation. During the cli- max is. Veratrum alb.—Nettle-rash about the joints only. Zincum met.—Stinging itching in the skin with nettle-rash eruption after rubbing. Itching rash in hollows of the knees and bends of the elbows. After moderate wine drinking. VERRUCA. Definition.—Verruca may be defined as a hypertro- plned papilla of the skin, covered with a hypertrophic layer of epidermis. Synonym.—Wart. Symptomatology.—Warts may develop as small cir- cumscribed split-pea sized elevations, broad at the base, and of the same color or a little darker than the surrounding skin, or as flat and broad slightly ele- vated finger nail sized, brownish colored growths, The former develop mostly on the hands in young people, and the latter on the back in elderly persons. At times they appear as slender, conical, thread-like growths, and are about three millimeters long. These may occur either singly or in groups, and are seen mostly on the neck, face and eyelids. Digitated broad warts sometimes form on the scalp. They somewhat resemble a crab in appearance, and hence have obtained the vernacular "crab warts." Venereal warts are pinkish or reddish vascular vege- tations, and occur for the most part on the genitals, preferably on the penis and labia. They may also form about the mouth and anus, in the axilla and 236 DISEASES OF THE SKIN. between the toes. They are apt to grow very rapidity, and may attain considerable size. They are caused by the contact of irritating fluids, and may be either dry or moist, according to their location. They may occur in connection with gonorrhoea, but are never like the condylomata, a sign of constitutional syphilis. Treatment..—The smaller warts should be removed by the curved scissors, and the larger and more vascular ones by the curette, ligature or galvano-caustic wire. Venereal warts need the strictest cleanliness. The dry cnes may be treated locally by thuja or mercuric bichloride lotion. The moist ones respond best to dusting with the mercuric chloride. Thuja has great reputation in removing all kinds of warts. Moles may be removed by the topical use of the acid nitrate of mercury. The following are the generally indicated remedies for warts: Antimonium crud.—Soft smooth warts on the neck, arms and hands. Berberis.—Warts the size of millet seeds. Bufo.—Warts on the back of the hands. Calcarea carb.—Small, soft warts. Cinnabar.—Warts on the prepuce which bleed when touched. Causticum.—Warts on the nose and eyebrows. Painful warts. Dulcamara.—Flat warts. Lachesis.—Warts on the thumb. DESCRIPTION AND TREATMENT. 237 Lycopodium.—Pediculated warts. Magnesia carb.—May be given two or three grains a day, when other remedies fail. Natrum oarb.—Ulcerated warts. Nitric acid. Soft warts. Warts on the eyelids. Sepia.—Large, hard warts. Sulphur.—Hard warts. Warts under the eyes. Thuja.—Warts on the fingers. Horny, hard warts. It follows well after Calcarea. washerwoman's itch. Definition.—Washerwoman's itch is an inflamma- tion of the skin occurring on the hands in washer- women. See Eczema. xanthoma. Definition.—Xanthoma is a connective tissue new growth, characterized by the presence of slightly raised circumscribed " chamois-leather" patches or golden-yellow tubercles. Synonyms.—Xanthelasma. Vitiligoidea. Fibroma lipomatodes. Symptomatology.—Its most common seat is the eyelid, near the inner canthus, but it may occur on any part of the body. It never occurs in children, is more common in women than in men, and is frequently associated with jaundice. The macular form appears as yellow rounded, oval, or semi-circular, " chamois-leather" looking patches, unaccompanied by pain. The tubercular form consists of rounded, golden-yellow tubercles, varying in size 238 DISEASES OF THE SKIN. from a pin's-head to a large pea. This variety is found less frequently upon the eyelids than on other parts. In both forms the new growth consists of fibrous tissue containing fat granules, and it is to the latter that the disease owes its color. Treatment.—Xanthoma can only be cured by remov- ing the patches. XERODERMA. Definition.—See Ichthyosis. I ZOSTER. Definition.—Zoster is an acute disease characterized by the appearance of groups of vesicles upon inflamed bases, along the course of the cutaneous nerves, at- tended by neuralgic pain. Synonyms.—Herpes zoster. Zona. Shingles. Symptomatology.—Like the eruptive fevers, zoster is attended by symptoms preceding the outbreak of the eruption, such as fever and neuralgic pain; the eruption, too, presents definite characters, runs a clearly defined course, and with it the febrile malady disappears. Moreover it rarely attacks the same per- son twice, and is usually attended by sequela—notably neuralgic pain. It appears mostly on the chest, along the course of the intercostal nerves, and is generally unilateral. When occurring in the orbital region, it may seriously affect the eye, and is apt to leave behind a severe neu-. ralgia. The eruption is usually preceded by a feeling of prickling, stinging itching of the parts, which lasts lrom twenty-four to forty-eight hours, and abates oq DESCRIPTION AND TREATMENT. 239 the appearance of the vesicles. The vesicles are at first filled with a clear serum, which soon becomes turbid. They last from eight to ten days, and if not broken, either undergo absorption or dry up and dis- appear in little brown scales. Zoster occurs most frequently between the ages of twelve and twenty-four, and attacks males more than females. It is a self-limited affection and usually runs its course in from one to two weeks. Etiology.—Zoster is due to an inflammation of the sympathetic fibres of the ganglia through which the nerves course to the part affected. The eruption in- volves generally the stratum corneum, the stratum lucidum and the rete, and acts, if the expression is allowed, as the explosion of the nerve disease on the surface. Atmospheric changes and mechanical violence play important parts in its causation. Diagnosis.— The characters of zoster are usually so well marked, that it can hardly be mistaken for any other affection. From herpes with which it may be confounded, it can be distinguished as follows: Zoster appears but once in a life time, and is gen- erally unilateral. Herpes is prone to recur and is usually bi-lateral. Zoster is associated with a lesion of some nerve or ganglion, and appears along the course of a nerve or nerves. Herpes follows in the train of catarrhal affections and pneumonia, and is generally confined to the face and genitals. Neuralgic pains precede the eruption of zoster; herpes has only 240 DISEASES OF THE SKIN. a burning itching. Zoster often leaves cicatrices and a troublesome neuralgia; herpes never does. Treatment.—The galvanic current from four to eight cells of a battery of ordinary strength, has been found very beneficial if the pain is sharp, when applied from fifteen to twenty minutes daily. The local treatment consists in protecting the vesicles and relieving the neuralgic pain. To this end the parts may be painted with collodion, or dusted with the sub-nitrate of bis- muth and starch, equal parts, and a protective bandage applied. Chaulmoogra o:1 will oftentimes prove a very beneficial application. Cantharis lotion has been highly recommended, and will at times be of service. Rhus tox., is the principal internal remedy. Others may be indicated as follows: Aconite.—In the earlier stages, when the neuralgic pain is accompanied by febrile symptoms. Apis.—Burning and stinging pains with swelling. Large vesicles, sometimes confluent. Better from cold applications. Arsenicum alb.—Confluent eruption with intense burning of the blisters. Worse after midnight, and from cold applications. Neuralgia. In debilitated constitutions. Cantharis.—Large blisters, burning when touched. Smarting and stinging. Mostly on the rmht aide. Worse in the open air. Cistus.—Zoster on the back. Neuralgic symptoms. In scrofulous subjects. DESCRIPTION AND TREATMENT. 241 Comocladia.—Zoster on the legs. Rheumatic pains aggravated by rest; relieved by motion. Dulcamara.—Zoster after taking cold from damp air. Moist, suppurating eruption. Glandular swell- ings in neighborhood of eruption. Eruption precedes the menses. Graphites.—Zoster on the left side. Large blisters from the spine to the umbilicus, burning when touched. Worse indoors. Better in the open air. Dry skin, tendency to ulceration. In blonde individuals inclined to obesity. Iris versicolor.—Zoster especially on the right side. Following gastric derangement. Pain in the liver. Neuralgic pains. Kalmia lat.—Facial neuralgia remaining after zos- ter. Worse at night. Palpitation of the heart. Rheu- matic pains. Lachesis.—Zoster during spring and fall. The ves- icles turn dark and are very painful. All symptoms are worse after sleep. Mercurius.—Zoster on the right side, extending across the abdomen. Worse at night, from the warmth of the bed. Tendency to suppuration. Easy perspiration without relief. Mezereum.—Zoster in old people. Constant chilli- ness. Neuralgic pains. Worse at 9 p. m. Burning, '•hanging location after scratching. In scrofulous persons. Ranunculus bulb.—Zoster aggravated by change of temperature. Neuralgic sequels. In rheumatic sub- jects, 242 DISEASES OF THE SKIN. Rhus tox.—Burning and stinging pains aggravated by scratching. Small burning vesicles with redness of the skin. Confluent vesicles. Worse in cold weather. Rheumatic pains during rest. Sleeplessness with rest- less tossing about. Zoster brought on by getting wet, while over-heated. Sempervivium tect.—In obstinate cases. May be used internally and locally. Thuja.—Zoster with eruption only on covered parts. Better from gentle rubbing. In individuals of lymph- atic temperament. Zincum.—Neuralgia following zoster. Pains re- lieved by touching the parts. Worse after dinner and towards evening. Zincum phos.—When other remedies fail. Follow- ing brain-fag in literary persons. ------o------ Note.—In the treatment of skin diseases it should be remembered that the absorption of medicinal sub- stances is hastened under the influence of the positive electrode of a galvanic battery placed upon the skin previously covered with the medicament, and the nega- tive electrode placed at some other point to complete the circuit. The strength of current required is from fifteen to twenty miliamperes. S§ PART III.—A Chart of Characteristics, With Diagnostic, Therapeutic, Dietetic, and Hygienic Hints. CLASS. DISEASES. DEFINITIONS and diagnostic FEATURES. THERAPEUTIC, DIETETIC AND HYGIENIC HINTS. in P < C H r1 v J*. O CO C5 H P « O P M Anidkosis. Functional disease of the perspiratory apparatus. Char-acterized by insufficient sweat. May be either congenital or ac-quired. iEthusa. Plumbum, etc. Turkish baths. Free use of water internally and exter-nally. Bromidrosis. (Osmidrosis.) Functional disorder of sweat glands. Characterized by offen-sive sweat. Most in axillae and feet. General or local. Conium mac, [acrid.) Petro-leum, (axillae). Silicea, (feet). Staphysagria, ( rotten ). Zin-cum, (profuse), etc. Alum or Carbolic acid lotion and Dia-c by Ion plaster dressings. Strictest cleanliness. Chromidrosis. Functional disorder of sweat glands. Characterized b y colored perspiration. Fitful secretion. In hypochondri-acs and unmarrie d women with uterine disorders. Nux Vomica. Comedo. (Grub.) Disorder of sebaceous glands Characterized by small black-topped, sebaceous points. Chin. forehead and cheeks. Young people. Face looks as if sprinkled with gunpowder. Baryta carb. Selenium, Sumbul. etc. Remove "grubs" with comedo extractor. Sul-phur lotion. Matrimony. Ex-clude fatty food. co P w w O OQ « m p « o CO M P M Sebaceous Cyst. (Wen.) A white, round or oval tumor, of variable size, composed of se-baceous matter enclosed in a sac. Single or multiple. Painless. Scalp, face and neck. Potassium iodide. Baryta or Bromine. Excision. Hyperidrosis. Functional disorder of sweat glands. Characterized by exces-sive sweat. General or local. Sym-metrical or unilateral. Local. Most on head, hands, feet and genitals. Flat-footed people. Baptisia. Boletus. Calc. carb. Jaborandi. Lactic acid. Sele-nium, etc. Use as little water as possible. Miliaria. (Prickly heat.) Disordered action of the sweat glands. Characterized by numer-ous pin-head sized red d e n e d papules or vesico-papules attend-ed with heat and tingling. Trunk usual seat. May appear on neck, face and arms. More in summer. Apt to relapse. Bryonia, Arsenicum alb. Raphanus, etc. Carbolated bran baths, followed by dusting with sub-nitrate of bismuth and starch, or lycopodium powder. Cast off superfluous clothing. Milium. (Skin-stones.) Disorder of sebaceous glands. Characterized by white, round-ish sebaceous points beneath the epidermis, size from millet-seed to a split-pea. Eyelids and fore-head. More common in women than in men. Calcium iodide and Staphysa-gria, and Tabacum. Remove by knife. Use Saponaria bark wash. CO p fc -"1 (J © H O CO « P o CO M P 1 Molluscum Sebaceum. Disease of sebaceous glands. Characterized by roundish, pea-sized tumors, umbilicated in the center and of a pinkish white color. Face mostly. In chil-dren. May be semi-epidemic. Tumors contain cheesy matter. Silicea and Teucrium. Calc. ars. Bromine, etc. In early stage, Acid nitrate of Mercury, locally. If tumors are large use the knife. Seborrhcea. (Sebaceous flux.) Functional disorder of seba-ceous glands. Characterized by excessive secretion of sebum. On face and scalp. More in women than in men. Appears in the light complexioned, as an oily coating; and in the dark complexioned, as dirty white or yellow flat scales, (dandruff). Bufo. Bryonia. Calc. carb. Kali carb. Natrum. Plumbum. Raphanus, etc. Locally, in mild cases. Saponaria bark wash. Glyceral tannin, or tannin and rice powder, (face). In chronic cases. Sapo viridis. Merc. cor. lotion, or Red precipitate oint. Keep system in healthy state. Sudamina. Disorder of sweat glands, Characterized by pin-head sized vesicles, formed by the collec-tion of sweat between the layers of epidermis. In summer and in acute diseases. Sign of general debility. Bryonia, Ammonium mur.i and Urtica urens. Look after ■ the general health. co A O' M H < < p M H Acne. (Stone-pock.) Disease of the sebaceous glands. Caused by retention of sebum. Characterized by papules, tuber-cles and pustules. Pin-head or pea-sized elevations around glandular orifices. On face and back. At puberty. From gastric derange-ment, functional derangement of sexual system. Tar, etc. Ant. crud. Bell. Chel. maj. Granatum. Kali. bich. Kali. bromat. Potass, iod. Nit. acid. Nux. jug. Ledum. Phos. acid. Sulphur. Sumbul, etc. Extract comedos. Stimulating lotions in mild forms. Soothing appli-cations in severe cases. Rumex lotion. Merc. corr. Merc, jodat, andBi-jodat (indurated). Light diet. Sea-salt baths. Anthrax. (Carbuncle.) Phlegmonous inflammation, characterized by necrosis of the cellular tissue, with suppuration and the discharge of the necrosed masses, called cores, with pus, through corresponding sieve-like openings. Circumscribed. Com-mences with burning pains. Size from a fifty-cent piece to a saucer. On nape of neck, shoulders, fore-head and buttocks. More in win-ter. May be epidemic. Anthracinum. Ars. alb. Arc-tium lappa. Nit. acid. La-chesis. Phytolacca. Silicea, etc. Locally : Ice-bags in early stages. Later: hot flaxseed meal poultices. Nourishing diet. Brandy and egg, etc. Dermatitis Contusiformis. (Erythema nodosum.) Characterized by oval or round purplish nodules, varying in size from a hickory nut to a fist. Fe-brile disturbance. Nodules form suddenly. Never suppurate. Fade away like bruises. Anterior surface of leg. Young persons, especially females. Relapses. Rhus venenat. Arnica. Pte-lea trif., etc. Locally : Arnica or Hamamelis. Horizontal pos-ture. Dermatitis Exfoliativa. (Pityriasis rubra.) A O M Dysidrosis. H < a « «$ p ^ £ M M ►H Ecthyma. Characterized by highly red-dened skin, and abundant ex-foliation of epidermis in large white flakes. Whole surface. Handfuls of flakes shed. Adult life. Involves papillary layer. Due to disturbance of trophic nerves. Ars. alb. Ars. jodat. Kali ars. Piper methyst., etc. Bran baths or decoction of walnut leaves, followed by oily inunc-tions. Tarry preparations. Disease of sweat structures of hands and feet. Characterized by redness and swelling of the parts, with distension of the sweat ducts in the shape of sago-like points, and the develop-ment of bullae. In summer. The nervously debilitated. At-tacks symmetrically the fingers, palms and soles. Clematis and Natrum sulph. Alkaline starch baths. Carron oil. Characterized by large, isolat-ed, painful pustules, situated upon hard and iDflamed bases, and followed by dark brown crusts. Slight fever. Superfi-cial lesion. Develops rapidly. On neck, shoulders and back. Ars. alb. Merc. Tart, emet., etc. Weak, White Precipitate oint. Carbolic acid wash. Gen-erous diet. II. inflammations. Eczema. (Salt-rheum.) (Grocer's itch.) (Washerwoman's itch.) Simple inflammation of the skin,characterized by an erythe-matous, papular, vesicular or pustular eruption with burning and itching. Discharge stiffens linen. Acute or chronic. Light florid complexioned in-dividuals. Head in infancy. Trunk and genitals in adult life. Itching. Greenish yel-low crusts. Due to faulty in-nervation. Ars. alb. Bovista, Calc. carb-Croton tig. Graph. JNux.jug. Oleander. Rhus. Sarsap. Sul-phur, etc. Locally —Early; Bran washes, emollient poul-tices, etc. Later: Zinc and starch, Lycopodium orGlyceral tannin. For itching: Diosco-rea, Carbolic acid or Hydro-cyanic acid, lotions or Grindel. cerate (acute cases); pyroligne-ousoilof Juniper(?'r? noninflam-matory cases). Benz. oxide of Zinc oint. or Oleate of Lith-arge. White or red precipitate oint. Chrysophanic cerate (squamous stage). Sapo viridis (chronic.) Oil of white birch. Erythema. Characterized by macules, papules or tubercles, attended by m ore or less itching and b urn-ing. Redness disappears under pressure leaves a yellow spot, which becomes red again. In children and young people. On back of hands and feet, arms, legs and forehead. Spring and fall. Known by its superficial protean character, and general distribution. Aconite. Ars. jodat. Bell. Chel. maj. Chloral hydrate. Lactic acid. Mezereum. Nux. vom. Ustilago, etc. Carbolic acid. Grindeliaor Verat. vir., lotion. Oxide of Zinc or Lyco-podium powder. FuaiJNCLE. (Boil.) Herpes. A o M H § (Fever blister.) fa JH P M «J A ► fa O SCLERIASIS. ONYCHOGRY- PHOSIS. An induration of cellular tis- sue, in new-born children. May be congenital or appear during early months of infant life. Stearine-like deposit in the sub cutaneous tissues. Usually fa- tal. Characterized by twisted bent nails, which are thickened, and of a yellowish or brownish col- or. Mostly nails of toes and fin- gers. Attacks old peoph. i?iaeis guineensis. Graphites and Silicea. fa M CO M fa fc> O fa o CO s 5 fa O fa H fa 2 fa fa o fa fap S CO o b o fa o Dermatol- YSIS. Leucoder- ma. (Acquired Pie- bald Skin.) MORPHOLA. A hypertrophy of the skin assuming the form of pendulous purse-like folds. Seldom ap- pears before puberty. Runs a chronic course. Characterized by localized loss of pigment. Patches round or •val, of milk white color. Usually on face, hands, and genitals. Adult life. Progno- sis unfavorable. Characterized by roundish, dirty alabaster-looking patches, circumscribed by lilac-tinted borders, and varying in diame- ter from half an inch to two inches. Course of left supra- orbital nerve most frequent seat. Runs slow course. May recover spontaneously. Bromide of Ammonium. Large folds may be ligatured or excised. Sulphide of Arsenicum. Na- trum. Nitric acid. Phosphide of Zinc, etc. Galvanism. Local- ly: Acetic acid for pigmentation around the patch. Phosphorus. Constant g a 1 - vanic current. Well fed. Cod Liver or Chaulmoogra oil. AT'lOPHY of THE NAIL. May be either cougenital or ac-quired, and is characterized by deiicient growths of nail sub-stance. Nails are brittle and look as if worm-eaten. Have a leaden hue. Silicea. Linear ATROPHY. Characterized by white or claret colored, depressed, scar-like streaks or spots. Streaks are one or two lines broad by several inches long. Spots vary from pin's head to a pea in size. Mostly on the thighs. Due to cessation of trophic nerve influ-ence in localized areas. Cocculus (claret spots). Sul-phur or Graphites (wk'de spots). Sabadilla (streaks). Cod-liver oil. fa CO CO M H fa > M H O fa A A o fa o Fibroma. (Polypus of the Skin.) Characterized by sessile or Pe_ dunculated outgrowths, from the connective tissue, generally club-shaped, and varying in size from a pea to a large pear. Pain-less. Small ones are soft. The large ones are elastic and fib-rous. Large ones may ulcerate. Cal. ars. Lycop, etc. Remove large tumors by knife elastic ligature or galvano — caustic. Smaller ones disappear under Acid nitrate of Mercury, locally. Keloid. Characterized by one or more flattish smooth-surfaced tumors, usually upon the site of cicatri-ces. Tumor is made up of a body having numerous prolongations or claws. Size of five-cent piece or larger. Mostly on sternum mammae. Adult life. Negroes. Spontaneous evolution may take place. Characterized by variously sized golden-yellow, non-indur-ated macules or tubercles. On eyelid and inner canthus. Wom-en mostly. kk Chamois-leather" patches. Golden-yellow tuber-cles. Consists of fibrous tissue containing fat granules. Fluoric acid. Graph. Nit. acid. Sabina, etc. Galvanism. Xanthoma. Removal of the patch. CO CD a P H fa * CO 1/2 O fa fa > 0 P fa O o p fa fa > o Nevus. (Port-wine stain.) (Mother's- mark.) Telangiec- tasis. A congenital formation seated in the skin and subcutaneous tis- sue. May be either pigmentary or vascular. Pigmentary are dark colored sharply defined spots. When covered with hair they are called a mouse marks." Vascular naevi may be arterial or venous. Redish or purplish col- or. Characterized by circum- scribed vascular cutaneous growths, appearing for the most part during adult life. Bright red pin-head or split pea sized. On face and neck, may terminate spontaneously, or remain through life. Carbo veg. (pigmentary). Thuja (vascular). Condurango, Calcarea carb., etc. Locally: for pigmentary. Collodion and Merc. cor. paint. For vascular, Electrolysis or the subcutaneous ligature. Same treatment as naevus. Condurago. Epithelio- ma. (Epithelial can- oer.) An affection of middle life. May start either as a flat infil- tration, a wart or other growth. Earliest sign a simple crack, or hard pale dusky lump which sooner or later fissures. Typi- : cal ulcer is roundish, split-pea size or larger, has hard sharply defined edges, and secretes a scanty yellpw viscid fluid. This form is met with in smokers. Se- lects as seat the lower lip. On the scrotum it is chimney sweeper's cancer. On the upper part of face, rodent ulcers. Second form commences as papules, which grow, and later tend to form red- dish or purplish, walnut-sized aggregations. Sharp pains. Ulcerate. Ulcers have hard, everted, indurated and under- mined edges, secrete an offen- sive pale yellow viscid fluid, and bleed easily. Patient may even- tually die from exhaustion. At- tacks mucous membrane of cheeks preferably. Third form, may develop as wart-like growths or cauliflower excres- ences. Split-pea or hazel-nut sized. Runs course of second form mostly. E. Originates in the endothelium of the lymphat- ics. Thuja. Ars. alb. Conduran- go, and Red-clover, blossom tea. Locally: Arsenical mucil- age. The knife, or the galvano caustic. to OS OS Leprosy. CO CO M Lupus ery- thematosus. (Erythematous scrofulide. (Butterfly lu- pus.) A constitutional disease. Characterized by formation of a new growth, resembling gran- ulation tissue, usually resulting in the destruction of the parts, with anaesthesia and great de- formity. Endemic in some countries. Warm climates. Ma- cular. Tubercular. Anaesthetic. Gradual decline in health. Ma- cular: faint brownish patches or bullae followed by scars and pigmentation, patches are dirty- grey color in center, and brown- ish at periphery. Hyperaesthesia at first, then anaesthesia. On trunk and extensor surfaces of extremities. Tubercular: Dull brownish-red tubercles varying in size from a pea to a plum. Mostly on face. Leonine ex- pression. Ulceration. Characterized by one or more usually roundish or oval, varia- bly-sized, reddish patches, cov- ered with fine, thin whitish or grayish fatty adherent scales. Pin-head sized pale red spots on cheeks and'nose. Centers mark- ed by greenish comedo-points. Covered with adherent fatty scales. Follicles distended and patulous. Seldom before the 20th year. Extend at periphery. Hydrocotyle. Piper methys- ticum. Calotropis gig. Graph. Sepia. Hura brazil. Guano. Cuprum, etc. Locally: Warm baths and Gurjun oil inunctions. Generous diet. Cod liver or Chaulmoogra oil. Segregation of the lepers. Iodine. Guaraca. Hydroco- tyle. Cistus. Apis, etc. Locally: Saponaria bark or Sulphur baths. Oil of white birch. Curette. Good diet. Fresh air and frequent bathing. 3 > H O > a H H to os » p CO CO H CO H EH o A fa O o H * -4 P fa P * fc ■« • fa £ O fa o Lupus vul- garis. (Tubercular scrot'ullde.) (Wolf.) Rhino- scleroma. A disease of the derma, char- acterized by variously-shaped, pea-sized or larger, yellowish or reddish elevations, which usual- ly terminate in ulceration and cicatrization. Begins as yellow or red solid points, which en- large to form tubercles. May terminate by insensible absorp- tion or ulceration. Puberty. Face and extremities. Crusts after ulceration, are brownish- red and scanty. Cicatrices are shrunken and yellowish. Characterized by irregularly- shaped, sharp bordered, flat swellings, of a normal or dark reddish-brown color, occurring mostly on nose and upper lip. Unattended by pain, but sensi- tive to pressure.____________ Ars. alb. Cistus. Graph. Guaraca. Hydrocotyle. Sta- physagra, etc. Locally: Early stage, Bin-iodide of Mercury oint. Later, Irido-platinum needle dipped in fused Nitrate. Arsenical mucilage. Cosme's paste. Pyrogallic oint. Curette. Nutritious diet. Fresh air. Out- door exercise. Calcarea phos. Guaraca. Rhus rad., etc. Removed by using the irido-platinum points and Squib b's fused Nitrate. Sarcoma cutis. Scrofulo- derma. Syphilides. (Syphilis of the SkinJ Consists of brownish-red or bluish-red, variously-sized tu-bercles or nodules, attended by a diffused thickening of the skin. A rare and malignant disease. Occurs mostly in adult life. Usually terminates fatally. Calc. phos. Silicea. Condu-rango. Nitric acid, etc. A strumous disease of the skin, commencing as indolent, painless, livid tubercles, that slowly soften and give place to unhealthy ulcers, with free in-crustation. Mostly on neck and beneath the lower jaw. Oc-casionally on thorax, in axillae and on groins. Calcium sulphide. Calcium iodide. Theridion. Scrofularia, etc. Locally: Iodide of starch paste to ulcers. Generous diet. Out-door exercise. Fresh air. Cod-liver oil. Manifestations of general syphilis on the skin. May be sec-ondary or tertiary. Have a his-tory of syphilitic inoculation. Are of a reddish yellow-brown color. Are polymorphous. Are devoid of pain and itching. Crusts are thick, greenish black. Ulcers are of an ash-gray color, often serpiginous or horse-shoe shaped. Diffused eruptions, generally symmetrical, later ir-regularly distributed. Scales are thin and occur in small cir-cular spots. Are non-inflamma-tory and tend to recur. to fa P to w CO H H O fa O o H -4 Is P fa P A 1?5 -4 P *> fa O Syphilides. Flat split-pea sized or larger, slightly raised patches. Earliest manifestation. No itching. May lastfor months, significant signs of syphilis attend it. Papules may be acuminated or broad. Are first rose colored, surrounded bv white border of scales. Later they have a tawny hue. Most marked on the nape of the neck, flexor surface of extremities, perineum and gen- itals. Appears between third week and fourth month. Lasts from three to eight weeks. Merc, jodat. Merc. corr. Locally: White precipitate ointment. Potas. iod. and Merc. corr. Locally: The 5 per cent, ole- ate of Mercury. SYPHILIDES. May be hervelic or varicellajorm. Herpet- ic vesicles, are millet-seed or pea-sized, and are seated on coffee-colored base. May be arranged in circles or segments of eircles. They last a week and disappear without scarring. Varicellaform vesicles are about the size of small peas, are surrounded by coopery red areolae, and are occasionally umbilicated. Form greenish-brown scabs. Leave purplish discolorations. On face mostly. Sixth month after chancre. "■ Coffee- with-milk " colored macules, varying in size from a cent-piece to a half- dollar. Oftenest in women. Mostly on neck. Lasts one or two months. Comes between fourth and twelfth month. Three forms: 1st. Millet-seed sized ephemeral dead-grey-colored pustules, which dry and form brownish rough scabs on forehead, angles of mouth and base of nose. 2d. Pin-head or split-pea sized acu- minated pustules, which form brownish scabs, and leave small, white depressed cicatrices. On scalp, face and trunk. 3d. Ecthymatous umbilicated pustules. Size, from a pea to a hickory-nut. Have dark areola. Greenish brown scabs, which leave copper-colored cicatrices. Merc. corr. Cin- nabar, and Merc. iodide. Locally : Merc. corr. lotion or the Oleate of Mer- cury. Nitric acid or Cal- cium sulphide. Kali bich. and Merc. nit. Locally: W bite precipitate ointment. to -a Pea to walnut-sized blebs. Dark, greenish-brown scabs. Rare. May occur in the newly- born. Small red circular blotches covered with scales. Leave dark colored spots. Commonly symmetrical. Sixth month after chancre. Circumscribed dome-shaped brownish-red elevations. Split- pea or walnut-sized. On face and back. Leave pigmented spots brownish or blackisb scabs covering punched-out-looking ulcers. Figure-of-eight appear- ance of eruption. Potass, iodide, and Syphil- inum. Merc, precip. ruber. Ar- senicum sulphide. Cinna- bar. Sarsaparilla. Merc. corr. Phytolacca, etc. Lo- cally : Red precipitate oint. Merc, bijodat. and Potass. iod. Thuja (mucous tu- bercles). Locally: Treat the tubercles with Acid Nitrate of Mercury, and dress the ulcers with Iodide of Starch paste. Syphilides. Appears first as hazel-nut sized hard lumps, situated on head, buttocks, and flexor surfaces of the extremities. Either single or multiple. Undergo absorp- tion or break down, and form deeply-excavated ulcers. A tertiary syphilide. Decline in health. Fissures and chaps about the mouth, anus and genitals. Skin dry, harsh and dingy yellowish hue. Face wrinkled. Looks like little dried up old man. Snuffles. Hoarse cry. Coppery-red mucous patches. Dry or moist papules. Tubercles. Bullous syphilde. Excoriations and mucous patch- es most common. Carbo animalis. Condu- rango, etc., and remedies for the tubercular. Berberis aqu. Bi-cyanide of Mer- cury. Cistus for mercurio- sypnilitic ulcers. Calcium iodide. Corallium rub. Locally: A five per cent Oleate of Mercury inunction. a > w H O w >> > w PC on H M o m W H a to Dekmatalgia. An affection of the skin char- acterized by pain, unattended by structural change. Attacks principally covered parts. More in women than in men. Sensi- tive to external impressions. Pain worse at night, of a burn- ing, boring, or shooting charac- ter. Lasts a week or longer. Baryta carb. Bell. Bry. China. Ferrum. Manganm. Nux mosch. Phos. Sepia. Silicea. Spigelia. Sul., etc. Galvanic current. 274 DISEASES OF THE SKIN. Bromine. Kali carb. Lycop. Mezereum. Phos., etc. Epila-tion. Parasiticides. Hyposul-phite of Soda, Merc, corr., or Sulphurous acid lotion. Chry-sophanic or White precipitate cerate. Sepia and Tellurium (Bing-■icorm). Merc, precip. ruber. Kali bich. Plantago. Tart. emet. and Cicuta(Barber's Itch). Cocculus Indicus, ttc. Epila-tion. Shaving every other day. Merc. corr. or Sulphurous acid lotion. Acetic acid or Coster's paint. Chrysophanic Cerate or W bite precipitate oint. Characterized iiy pea-sized, straw-colored, cup-shaped, iion-ey-comb crusts. Siale straw odor. Achorion Sdionldnii. Contagious. Poorer classes. Mostly on head, frequently on the trunk. Characterized by itching ery-thematous redness and crop of vesiclesfollowed by scaly forma-tion. On scalp, hairs become brit-tle and break off. Stubble-liko appearance. On body, spreads in fairy-ring-like manner. On nead, split-pea or haze 1-n u t sized papules or tubercles ap-pear. Hairs come out without pain. On nails, called Onycho-Mycosis. Follicles occasionally, pour out viscid mucus resem-bling juice ot the mistletoe-berry (Kerion). Contagious. Children of lymphatic temperament. Tricopkyum. In youth atlacks scalp or body. In adult lite the beard. Fungus scales or scabs turn whitish yellow on addition of Chloroform. Timea fa-vosa. (Fayus.) (Honey-oomb Tetter.) Tinea tri-cophytina. (Ring-worm.j (Barbers Itch.) •oix AUJOLvreaaa ao anavxaoaA •sasvasia oixisvava *iiia CO w OQ S co M Q a M OQ •< P3 Pi M M 6 M >< W Pn O H < « P o w « H 0 w Tinea ver-sicolor. (Variegated dandruff.) Fawn-colored patches accom-panied by itching and desquam-ation. In phthisical patients between ages of twenty and forty. Chest and abdomen. Mapped appearance. Microspo-ron Jurfur. Next to tricophy-ton in frequency. Feebly con-tagious. Sepia and Natrum ars. Mild parasiticides. Sulphurous acid lotion. Acetic acid baths. Alopecia AREATA. Characterized by more or less sudden appearance of variously sized white bald patches. Starts on parietal protuberances. Fre-quently unilateral. Oval areas devoid of hair. Spreads rapidly. Smooth polished surface. Fine lanugo. Phos. Natrum mur. Fluoric acid. Calcium sulphide. Man-cinella. Phos. acid, etc. Epila-tion of marginal hairs. Acetic acid, tine, of Arnica, Cantharis, or Capsicum applications. Merc. cor. or weak Phosphorus lotion. ~a Guinea-WORM DIS-EASE. Due to the filaria medinensis. Common in tropical climates. Pointed tumors surmounted by blebs. Swelling and pain. Tu-mor breaks, and shows the worm. Remove the worm. Dress sore, as a common ulcer. d o Elephant-iasis. (Elephant leg-.) Due to the filaria sanguinis. See class IV. < P. MlTE DIS-g EASE. Due to the leplus irritans. "jigger." Papules, vesicles and pustules. On ankles and legs. South-western states. Along the Mississippi. Mostly in summer. Mild parasiticides. Sulphur ointment. P g Phthiria-sis. (Lice disease.) Due to pediculi. Contagious. Three varieties: P. capitis, P. corporis, and P. pubis. P. cap-itis. Occipital region. "Nits" in children. " Scratch marks." P. corporis. Ova or pediculi de-posited in clothing. Multiform lesions. On trunk, hips and thighs. " Scratch marks." P. pubis. Due to crab louse. In adults mostly. Oleander P. capitis) and Mer-curious. Locally: Powdered Sta-physagria. Cocculus ind. tinct., White percipitate oint., Merc. corr. lotion or Chloroform appli-cation. Bake the clothing. M ft O M y • M CO *> w < CO P5 •< < W Ph M M M o H Ph o O N P e -0 Scabies. (Itch.) Contagious disease due to the acarus scabiei. Characterized by cuniculi attended by nightly itch-ing, and formation of papules vesicles and crusts. Occurs mostly in the interdigits and on wrists, in flexures of body, but-tocks and dorsal surface of penis. Seldom above the nipple line. Multiform eruption. Evidences of contagion. Disappears rapid-under parasiticidal treatment. Sulphur. Locally : Sulphur oint. Stor-axoint. Oil of lavender. Balsam of Peru, etc. Bake clothing. PART IV. ORTHOEPIC GLOSSARY. t ------------- Ac'a rus (acarus. mite). A genus of minute insects infecting the skin. Ac'a-rus sca-bi-e'l The itch insect. Ac'NE(acme top). See Part II. A-cu'min-at'ed (acumen, a point). Pointed. Ag'ri-us (agrios, fierce). An adjective signifying inflamed. Al-o-pe'ci-a. Baldness. Al-o-pe'ci-a a-re-at'a. See Part II. An-^e'mi-a. Deficiency of blood. An-.es-the'sia. Loss of sensibility. An-i-dro'sis. See Part II. An'-thuax (anthrax, a burning coal). See Part II. A'-rea. An open place. At'ko-phy. Deficient nutrition. At'ro-phy, lin'e-ar. See Part II. Ax-il'l^;. Arm-pits. Bac-chi'-a. A synonym of Rosacea. Bleb. A synonym of Bulla. 278 ORTlIOElTC GLOSSARY. 279 trom-i-dro'-sis (bromos, a stench). Fetid perspiration. Bul'la. A water-bubble. See Part II. CA-cnEC'Tic (kakos, bad). Pertaining to a depraved condition of system. Cal-los'i-tas. See Part II. CAN'CER(acra&). See Part II. Cau'bun-cle (dim. of carbo, coal). A synonym of anthrax. Car'ron oil. A mixture of about equal parts of lime solution and flaxseed oil. Chaul-moo'gra oil. Expressed from the seeds of the Gyno- cardia odorata. Chil'blain. A synonym of Pernio. Chlo-as'-ma. See Part II. Chlo-ro'-sis (chloros, green). Green sickness. Chro-mi-dro'-sis (chroma, color). See Part II. Ci-ca'trix. A scar. Cin'-gulum (a girdle). A synonym of Zoster. Cla'vus (a nail). See Part II. Com'e-do (a glutton). See Part II. Con-dy-lo'ma-ta (kondulos, a tubercle). See Part II. Coni'dia. Fungus spores. Crus'ta lac'tea (milk crust). A term formerly used to designate Eczema of the face in children. Cu-nic'ulus (a burrow). Made by the itch insect. Cu-ret'te. A small scoop. Cyst (kustis, a sac). See Part II. Dan'dkuff. Scurfiness. Dffi-pjL'A-TO-RY. A remedy which causes the hair to fall off. 280 DISEASES OF THE SKIN. Der-ma-talgi-a (derma, skin, and algos, pain). Sec Part II, Der-ma-ti'tis. Inflammation of the skin. Der-ma-ti'tis con-tu'si-formis. See Part II. Der-ma-ti'tis ex-fo'li-a-tiva. See Part II. Der-ma-tol'o-gy (derma, skin and logos, discourse). That branch of science which treats of the physiology and pathol- ogy of the skin. Der-ma-to-ly'sis. See Part II. Der-ma-to-phy'ton (derma, skin, phuton plant). A vegetable parasite. Der-ma-to-zo'a (derma, skin, and zoon, an animal). Ani- mal parasites. Der'moid. Resembling the skin. Dys-idro'sis (dus, difficult and hydros, sweat). See Part II. Ec-thy'ma. See Part II. Ec'ze-ma (to boil up). See Part II. Ele-phan-ti'a-sis (elephas, an elephant). See Part II. Em'bo-lism. Obstruction of a vessel by a clot. En-dem'ic. Belonging to a particular district. Eph'e-lis (epi, upon, and helios, the sun). See Part II. E-phem'e-ral. Short lived. Ep-i-dem'ic. Generally prevailing. Epi-theli-o'ma. See Part II. Er-y-sip'e-las. See Part II. Er-y-the'ma (eruthaino, to redden). See Part II. Fa'vus (a honey-comb). A synonym of Tinea favosa. Fi'bro-ma (flbra, a fibre). See Part II. Fi-la'ri-a med-i-nen'sis. The Guinea-worm. ORTHOEPIC GLOSSARY. 281 Fi-la'ri-a SAN'our-Nis. An animal parasite; the cause of Elephantiasis. Fis'sure (ftssura, cleft). See Part I. Frambce'sia, pronounced f ram-be'she-a, from framboise a rasp- berry. See Part II. Fun'gus (fungus, a mushroom). Fur-fur-a'ceous. Scaly. Fu'-runc-le (furunculus. a petty thief). See Part II. Gran'ule. A little grain. Haus'tel-lum. A sucker. IIeu'pes (herpo, to creep). See Part II. IIir-su'ties. Hir-su'she-es, {hirsutus, hairy). See Part II. II y'-dro-a (hudor, water). See Part II. IIy-'dro ad-en-i'tis. See Part II. 11 y-per-^e'mia. Excess of blood in any part. Hy-per-jes-the'sia. Over-sensitiveness of the skin. Hyper-idko'sis (huper, in excess, and hidrosis, sweating.) See Part II. IIy PER-rLA'siA. Excessive formation of tissue. Hy-per'tro-phy. ThickeniDg or enlargement. Ich-thy-o'sis (ichthua, the scale of a fish). See Part II. Im-pe-ti'go con-tagio'sa. See Part II. In-crus-ta'tion. The act of forming crusts. In-du-ra'tion. The proces.i of hardening. In-ner-va'tion. The act of giving nervous energy. In-ter-tri'go (inter, between, and tero, to rub.) Sec Part II. Ke'-loid. Kele, a crab's claw. See Part II. Ke'-rion (kerion, a honey comb). A term formerly applied to 282 DISEASES OF THE SKIN. a modified form of Tinea Tricophytina, when the follicles become inflamed; and pour out a viscid secretion. La-nu'-go (lana, wool). Downy hairs. Len ti'go. See Part II. Lep'-ro-sy (lepra). See Part II. Leu-co-der'-ma (leukos, white). See Part II. Li'chen pla'nus. See Part II. Li'chen sim'plex. See Part II. Mac'-ule (a spot). See Sec. 2, Part I. Mic ro-spo'ron fur'fur (mikros, little, and sporas, seed). The fungus of Tinea versicolor. Mil i-a'ri-a. See Part II. Mil'ium (a millet seed). See Part II. Mol-lus'cum se-ba'-ceum (mollis, soft). See Part II. Mor'-phcea (morphe, form). See Part II. My-ce'li-a (mukes, fungus). The tbread-like structure of a fungus. N^e'vus. A mark or blemish. See Part II. Ony-chau'xis. See Part II. O-nych'i-a (onux, nail). See Part II. On-y-cho-gry-pho'sis. See Part II. On-y-cho-myco'sis. See Part II. Os-midro'sis (osme, ordor). A synonym of Bromidrosis. Pap'-ule (dim. of pa'pa, a teat). See Sec. 2, Part I. Par'-a-site (parasitos, a sponger). A term applied to a vege- table or animal that draws its sustenance from another. Par-a-sit'i-cide (anything that kills a parasite). Pe-dic'u-lus. A louse. Pem'phigus (pemphix, a blister.) See Part II. ORTHOEPIC GLOSSARY. 283 l te'-chi-a (petechio, a flea bite). A red or purple spot. PaTiii-Ri'A-sis (phtheir, a louse). See Part II Pig'ment. Coloring matter. Pit-y-ri'a-sis (pituron, bran). See Part II. Pol-y-mor'phous. Having many forms. Prai'rie itch. See Part II. Pru-ri'go. See Part II. Pru-ri'tus (prurio, to itch). Itching. Pso-ri'a-sis. See Part II. Pur'pu-ra (porphura, purple-). See Part II. Pus'tule. See Sec. 2, Part II. Rh ag'-a des (rhagas, a rent), chaps or excoriations of the skin Rhi no scle-ro'ma (rhin, the nose, and skleros, to harden) See Part II. Ro-sa'cea, pronounced ro-sa'she-a. See Part II. Ro-se'o-la (dim. of rosa, a rose). See Part II. Ru'pi-a (rhupos, filth). See Part II. Sar-co'ma cu'tis. See Fart II. Sca'bi-es (scabere, to scratch). See Part II. Scler'o-derma (tkkros, hard, derma, skin). See Part II. Scle-ri'a-sis (skleros, hard). See Part II. Scrof'ulo-derma. See Part II. Se-ba'ceous (sebum, suet), fatty. Se-bor-rhe'-a (sebum, grease, and rheo, to flow). See Part II Se-que'la (sequor, to follow). The consequent of a disease Spo-rad'ic (speiro, to s,cw). Occurring singly. Squa'mous (squama, a scale). Scaly. Stroph'u-lus. See Part II. 284 DISEASES OF THE skxn. Su-dam'i-na (sudo, to sweat). See Part II. Sy-co'sis (sukon, a flg). See Part II. SyphT-lide. See Part II. Sy-phil'i-des. Skin diseases arising from syphilis. See Part II. Te-lan-gi-ec'ta-sis. See Part II. Tin'e-a. A moth-worm. See Part II. Tin'e-a fa'vosa. See Part II. Tin'e-a trich-o-phy-ti'na. See Part II. Tin'e-a ver'si-color. See Part II. Tri-ciii'a-sis. See Part II. TRicn-o-CLA'sis. See Part II. TniCH-o phy'ton (thrix, hair, and phuton, plant). The fungus of tinea tricophytina. Troph'ic (trophe, nourishment.) Tu'ber cle (dim. of tuber, a swelling). See Sec. 2 , Part I. Um-bil'i-cated (umbilicus, the navel). Depressed in the center. Ur-ti-ca'ri-a (urtica, a nettle). See Part II. Var-i-cel'la-form. Resembling varicella. Vis'cid (viscum, bird-lime), gluey, adhesive. Ver-ru'ca. See Part II. Ves'i-cle (dim. of vesica, a bladder). See Sec. 2, Part I. WnEAL, pronounced "fcwecL" See Sec. 2, Part I. Xan-tiio'ma (xanthos, yellow). See Part II. Xer-o-der'ma (Xeros, dry). See Part II. Zos'ter (zoster, a belt). See part 7* PART V. DIET AND HYGIENE IN DISEASES OF THE SKIN. In the management of skin diseases attention to the matter of food is an item of the utmost importance, as not infrequently a wisely selected diet will accom- plish marked results. Generally the health of the skin is best maintained by a plentiful, digestible,mixed diet, avoiding a predominance of meat and abstaining either partially or altogether from the use of spirit- uous liquors. In dyspeptics it is often advisable not to take animal and vegetable food at the same meal, but to eat animal food at one meal and vegetable food at another. During the summer months the carbo-hydrates— starches, green vegetables and fruits—should be used freely, but in winter time the use of the albuminoids and fatty foods is advisable. Fish may often be used with advantage in cutaneous troubles in place of meat. Fresh vegetables and whole wheat products are valu- 286 DISEASES OF THE SKIN. able articles of diet. Tea and coffee if taken should be used only with the greatest moderation. Cocoa made from the nibs is more healthful than either tea or coffee. Milk is a useful and nutritious food, but when used as a beverage by adults it should be taken alone and on an empty stomach. Water should not be taken in excess nor too cold with meals. In reasonable quantities its use as a beverage is beneficial as it di- lutes the intestinal contents and promotes absorption. Between meals fluids may be freely used if desired. Benefit often follows the taking of half a pint of hot water an hour before each meal. It operates as a stim- ulant to the central nervous system and tends to in- crease the secretion of the gastric juice. Fermented liquors, alcohol and tobacco should as a rule be avoided. Acids unless they come from unripe fruit are generally not harmful. Oatmeal often appears to render the skin irritable, and frequently has to be eliminated from the dietary in cutaneous diseases. Patients should be instructed not to eat excessively nor too rapidly, to thoroughly masticate the food and to refrain from over physical or mental labor directly after a substantial meal. As a rule an interval of at least five hours should, elapse between meals. Where, the patient lives plainly, and the disorder is not speci- ally connected with the digestive system no change need be made in the diet list. Otherwise the follow- ing hints may serve as useful guides: DIET AND HYGIENE. 287 FOODS EASY OF DIGESTION. A i..its.—Mutton, venison, chicken or turkey (white meat), squab, •partridge, pheasant, grouse, sweet-bread (plainly cooked), fresh fish, haddock, flounder, shad, sole, perch, trout, oysters, raw or stewed (rejecting the hard portion), eggs (soft boiled), beef tea, mutton broth, clam broth. Vegetables and fruits.—Asparagus, beans and peas (young and fresh), cauliflower, squash, oyster-plant (stewed), ripe peaches and pears, apples (baked), summer fruits when perfectly fresh and in season. Bread and farinaceous articles. — Wheat bread (stale), dry and milk toast, steamed crackers, tapioca, rice, arrowroot, sago, maccaroni. Beverages.—Cocoa (from nibs or shells), weak tea with slice of lemon (no sugar or cream), toast tea, coffee with a beaten raw egg instead of milk, milk, pure water. MODERATELY DIGESTIBLE FOODS. Meats.—Beef, lamb, rabbit, duck, snipe, woodcock, black meat of chicken or turkey, turtle, cod, eggs (scrambled). Vegetables and fruits.—Potatoes (white), beets, turnips, parsnips, lettuce, celery (raw or stewed), spinach, cabbage, water-cress, onions, mushrooms, oranges, grapes, apricots, currants, strawberries, raspberries, 388 DISEASES OF THE SKIN. rhubarb, foreign and cooked fruits, salads of all sorts. Bread and farinaceous articles.—Fresh wheat bread, graham bread (hot and fresh), cracked wheat, hominy, oatmeal porridge, indian mush, farinaceous puddings, j^ain cakes, jellies, ice cream. Beverages.—Coffe and tea (strong with sugar and cr^Yi), chocolate, lemonade. FOODS DIFFICULT TO DIGEST. Meats.—Pork, veal, goose, sausage, corned beef, dried Veef, kidneys, liver, salt meat, salt or smoked fish, mi "skerel, salmon, eels, herring, halibut, lobster, crabs, clans, shrimps, fried or hard boiled eggs, gravies. Vegetables and fruits.—Cucumbers, radishes, sauer- kraut, piclxes, corn, white potatoes (new), sweet pota- toes, nuts, pineapples, blackberries, bananas, raisins, figs, preserver pickles, pepper, water ices, richly made dishes. Bread and farinaceous articles.—Hot bread, buck- wheat cakes and ^11 hot griddle cakes, muffins, fritters, dumplings, custarOs, pastry, rich cakes, cheese. Beverages.—Fernvmted liquors and alcoholic beve- rages Disturbances of the >V"omach and intestinal canal are often reflected upon the cutaneous surface in the form of erythema, herpes, seborrhcea, eczema or urticaria. Urticaria may accompany jp-twiW"1 intermittent fever. DIET AND HYGIENE. 289 or disordered menstruation. Pruritus ani is very common in liver derangement. Lichen, anthrax and furuncle are often induced by jaundice. In diabetes the nails sometimes loosen and fall oft". Rosacea fre- quently results from gluttony and intemperance. Acne may develop from the harmful effect of tobacco, or be caused by faulty digestion. Patients suffering from eczema should avoid sugar and starchy foods, and take more fatty foods. The diet should be light and unstimulating, yet nutritious. A strickly milk diet or a skim-milk diet may often prove beneficial. Mothers nursing eczematous children should not resort to the use of ale, beer, or wine to in- crease the flow of breast milk, but should use milk or gruel instead. The hygiene and dietetics of skin diseases are close- ly associated. Turkish baths, not too frequently re- peated, are often serviceable in the management of eczema, psoriasis, ichthyosis and in many diseases of the skin resulting from rheumatism or gout. Warm or vapor baths are an excellent means of medication in psoriasis, eczema, lichen, ichthyosis, acne and urti- caria. Massage often proves useful in debilitated states of the system. Exercise (walking, horseback rid- ing, rowing, light gymnastics) is an excellent adjuvant in obstinate cases and should be proportioned to the general strength of the individual. METRIC TABLE. APPROXIMATE WEIGHTS. 1 Milligram = 0.015 gr. 1 Centigram = 0.154 gr. 1 Decigram = 1.513grs. I Gram = I 5.432 grs. 4 Grams = 1 fl. drachm. 1 Kilogram = 21 lbs. avoir. APPROXIMATE MEASURES OF LENGTH. 1 Millimeter = 0.039 in. 1 Centimeter = 0.394 in. 1 Decimeter = 3.937 inches. I Meter = 39.37 The United States "nickel" five-cent piece weighs five grams, and is two centimeters in diameter. (Haines.) A meter is about the one ten-millionth part of the earth's polar quadrant. APPROXIMATE FLUID MEASURES. 1 Cubic Centimeter = 15 minims = I fl. drachm. 4 f ubic Centimeters = 60 minims = I fl. drachm. I Liter = 15,000 minims = I Quart An ordinary back-gammon die is about the size of a cubic centimeter. (Haines.) 290 INDEX. ACARUS, foUiculorum, 73. scabiei, 195. Achorion Schonleinii, 216. Acne, acute, 46. artificial 47. cachectic, 47. chronic, 46. indurata, 48. vulgaris, 47. treatment of 49. Acne lance, 50. Addison's keloid, 166. Adipose tissue, anatomy of, 19. Age, as a predisposing cause 35. Albinism, 152. Alopecia, 56. areata,56. Anaesthesia, 59. Anatomy of the skin, 17. Anidrosis, 59. Animal parasitic affections, 37. Anthrax, 60. treatment of, 61. Anus, eczema of the, 88. Arms, eczema of the, 88. Artificial eruptions, 36. Atrophy, linear, 63. of the nail, 64. BAKER'S itch, 65. Baldness, 65. Barbadoes leg, 109. Barber's itch, 65. Beard, ringworm of the, 220. Bibliography, 289. Birth-mark. 167. Bloodvessels, anatomy of the, £1. Body louse, 176. Boil, 123. treatment of, 124. Breasts, eczema of the, 88. Bricklayer's itch, 65. Bromidrosis, 65. Bullae definition of, 31. flALLOSITAS,68. U Carbuncle, 69. treatment of, 61. Chart of characteristics, etc., 243-280. Chilblain 173. Chloasma, 69. Chrornidrosis, 71. Chronic eczema, 89. Claret stain, 167. Classification of skin diseases, 42. Clavus, 71. Cold sores, 129. Comedo, 73. Comedo extractor, 49. Condylomata, 74. 291 292 INDEX. Corium, anatomy of, 19 Corns, 71. Corn knife, 72. ( ornu cutaneum, 76. Corpuscles, tactile, 22. Crab lice, 176. Crabs, 176. Cracks or fissures, definition of 33. Crusts, definition of, 33. Crnsta lactea, 84. Cuniculi in scabies, 196. Curette, 159. Cutaneous horns, 76. Cutis, anserina, 22. variegata, 224. Cutisector, 39. Cysts, sebaceous, 200. DANDRUFF, 177, 200. Dermatalgia, 76. Dermatitis, contusiformis, 77, exfoliativa, 79. traumatica, 144. Dermatology, definition of, 282. Dermatolysis, 80. Dietetic hints, 285. Dry tetter, 181. Dysidrosis, 80. EARS, eczema of the, 88 Ecthyma, 81. Eczema, 84-108. acute, 84. chronic, 89. definition of, 84. diagnosis of, 92. diet in, 95. erythematosum, 86. etiology of, 90. impetiginosum, 86. itching of, 85. location of, 87. papulosum, 86. rubrum, 86. squamosum, 86. stages of, 85. treatment of, 95. Elasticity of the hair, 25. Elephantiasis, 108. Ephelis, 110. Epidermis, anatomy of the, 20. Epithelioma, 111. treatment of, 113. Epilating forceps, 218. Erysipelas, 117. treatment of, 119. Erectores pili, 22. Erythema, 114. annulare, 114. iris, 114. gyratum, 114. nodosum, 77. papulatum, 114. tuberculatum, 114. treatment of. 115. Etiology of skin diseases, 35. Excessive sweating, 135. Excoriations, definition of, 33, FAVUS, 215. treatment of, 218. Febrile herpes. 129. Fever sores. 129. Fibroma, 122. Filaria, medinensis, 128. sanguinis, 109. Fish-skin disease, 122. Fissures, definition of, 33. Framboesia, 122. Freckles, 110. Furuncle, 123. treatment of, 124. GIANT urticaria, 227. Glands of the skin, 23. Grocer's itch, 128. Grubs, 73. Guinea-worm disease, 128. HAIR, anatomy of the, 25. elasticity of the, 25. excessive growth of, 132. Hairy mole, 132. INDEX. 293 Harvest mite, eruption from, 165. Head louse, 176. Her pes; 129. treatment of, 130. Hirsuties, 132. Hives, 227. Iioney-eombed ringworm, 215. Hydroa, 131. Hydro-adenitis, 134. Hygienic hints, 213. Hypersestbesia, 135. Hyperidrosis, 135. TCHTHYOSIS, 138.' 1 Impetigo contagiosa, 141. Infantile syphilis, 213. Intertrigo, 144. Irido-platinum needle, 162. Itch.193 KELOID, 145. Kerion, 222. King's evil, 199. LAND scurvy, 117. Lentigo, 146. Leontiasis, 147. Lepra, 147. Leptus in itans, 165. Leprosy, 147. Leucoderma, 152. Lice disease, 176. Lichen, planus, 153. simplex, 156. Liver spots, 69. Loss of hair, 56. Lupus, 158-163. erythematosus, 158. exedens, 160. treatment of, 159,161. vulgaris, 160. Lymphatics, anatomy of, 21. Microsporon furfur, 226. Miliaria, 163. Milium, 164. Milk crust, 84. Moist tetter, 84. Mite disease, 165. Mole, hairy, 132. pigmentary, 167. Molluscum, contagiosum, 166. sebaceum, 165. Morphcea, 166. Moth patches. 69. Mother's mark, 167. Mueous patches, 74. N^VUS, 167. Nails, diseases of the, 64. 169. Nerves, anatomy of the, 22. Nettle-rash, 169. Nits of pediculi, 176. ONYCHAUXIS, 169. Onychia, 169. Onychogryphosis, 169. Onycho-mycosis, 170. Orthoepic glossary, 281. Osmidrosis, 65» PACINIAN corpuscles. 22. Papular syphilide, 267. Papules, definition of, 29. Parasitic diseases, 193-214. Paronychia, 170. Pediculosis, 176. Pemphigus, 171. Pernio, 173. Phthiriasis, 176. Physiology of the skin, 17, Pityriasis, 177. rubra, 79. versicolor, 224. Porcupine men, 139. Port wine marks, 167. Prairie itch, 178. Prurigo, 179. Pruritus, 180. MACULES, definition of, 29. Metric table, 288. 294 INDEX. Psoriasis, 181. treatment of, 188. Purpura, 186. Pustules, definition of, 31. RED~gum, 203. Removal of superfluous hairs, 133. Rete malpighii, anatomy of, 20. Rhinoscleroma, 189. Ring-worm, 188. Rodent ulcer, 189. Rosacea, 189. Rupia, 193. SALT rheum, 84.193, Sarcoma cutis, 193. Scabies. 193. Scales, definition of, 32. Scars, definition of, 34. Scleroderma, 197. Scleriasis, 198. Scrofuloderma, 199. Scrofulide, erythematous, 158. tubercular, 160. Sebaceous glands, anatomy of, 24. Sebaceous cyst, 200. Seborrhcea, 200. Seguin's surface thermometer, 40. Sex in skin diseases, 35. Shingles, 203. Skin, anatomy of the, 17. Skin grafting scissors. 39. Strophulus, 203. Superfluous hairs, 132. Sudamina, 204. Sweat glands, anatomy of the, 23. Sycosis, 204. Syphilides, 206. Syphilide, erythematous, 206 papular, 207. pigmentary, 208. pustular, 209. squamous, 210. tubercular, 210. tertiary, 211. vesicular, 208. TACTILE corpuscles, anat- omy of the, 22. Telangiectasis, 213. Tetter, branny, 177. dry,181. moist, 84. scaly, 181. Thermometer, Seguin's surface, 40. Tinea, favosa, 215. tricophytina, 220. versicolor, 224. Tooth-rash, 203. T.rcchauxis,132, Trichiasis, 227. Trichoclasis,227. Tricophyton, description of the, 222. Tricophytina, 220. Tuoercles, definition of, 32. Tylosis, 68. ULCERS, definition of, 33. rodent, 111. Urticaria, 227. etiology of, 229. treatment of, 229 TTRNEREAL warts, 235. V Verruca, 235. Vesicles, definition of, 31. Vitiligoidea, 237. WASHERWOMAN'S itch. Warts, 235. Wens, 200. Wheals, definition of, 32. XANTHOMA, 237. Xeroderma, 238. yAWS, 122. ZONA, 238. Zoster, 238. etiology of, 239. treatment of, 240, CATALOGUE OF MEDICAL BOOKS PUBLISHED BY Qross & Delbridqe, 48 Madison Street, CHICAGO. =Any BooK in this Catalogue EESent by Mail op Express — Prepaid, on receipt of Price. Remittances may be made by Bank Draft, P. 0- Money Order, or Registered Letter at the Risk pf the Publishers. GROSS 6- DELBRIDGES MEDICAL WORKS. SCIENCE AND ART OF OBSTETRICS, by Sheldon Leavitt, M. D., Professor of Obstetrics, Etc., in Hahnemann Medical College and Clinical Professor of Midwifery in the Hahnemann Hospital of Chicago, Member of the American Institute of t Homoeopathy, Vice-President of the American Ob- stetrical Society, Etc., Etc. Second Edition, re- * written and enlarged. Large octavo, 793 pp. Price ► in cloth, $6.00, sheep $7.00. Postage, 33 cents. The first edition of this work has been out of print for more than three years, and during that time the author has economized the spare hours gathered from an extensive practice in preparing this second edition. Every page has been reduced to manuscript and reset, hundreds of pages have been displaced by entirely new matter, not a single page being reproduced without change. The size of the work has been augmented by upward of one hundred pages, the therapeutic hints have been increased in number and perspicuity, improved methods have been introduced, imperfect cuts have been improved and some excellent ones added, until we are able to send out an entirely remodeled and reconstructed book. The author has bestowed unusual pains on the Index, making every important subject, as well as the names of all authors quoted, readily accessible to the practitioner and student. The publishers now present the work to the Profession with the full confidence that it will meet the needs and fulfill the expectations of those for whom it is intended. The book is printed on the best paper in large, plain type and handsomely bound- in cloth and sheep with 314 Illustrations. I have taken much interest in reviewing the second edition of Prof. Leavitt's Obstetrics, and rejoice that he has brought out a text- book so creditable to our school. I have placed it on the list of our text-books.— T. Nicholas Mitchell, M. D., Professor of Obstetrics in the Hahnemann Medical College of Philadelphia. \ We unhesitatingly place this book at the head of its department &nd have no doubt it will become the text-book of ail our colleges.— New York Medical Times. I have given Prof. Leavitt's Obstetrics a prominent place among my books of reference. I consider it one of the best text-books in our literature, and an honor to the publishers thereof.—E. M. Hale. M.D. It shall be at the head of my list of Obstetrical text-books.—C. A. Pauly, M. D., Prof, of Obstetrics in Pulta Medical College. GROSS & DELBRIDGE, Publishers, 48 MADISON STREET, CHICAGO. GROSS <5- DELBRIDGE'S MEDICAL WORKS. A TEXT-BOOK OF MATERIA MEDICA AND THERAPEUTICS, CHARACTERISTIC, ANALYTICAL, AND COMPARATIVE. By A. C. Cowperthwaite, M. D., Ph.D., LL.D., Professor of Materia Medica and Therapeutics in the Chicago Homoeopathic Medical College. Author of "A Text- Book of Gynaecology," "Insanity in its Medico-Legal Relations," etc. Sixth edition. Entirely rewritten and ^revised, with Clinical Index, pp. 834, Price, cloth, $6.00; sheep, $7.00. Postage, 32 cents. Chicago: Gross & Delbridge, 1892. The publishers take great pleasure in announcing the publica- tion of the sixth edition of the above popular work, which has for the past ten years unquestionably taken the lead of all other works on Materia Medica, being conceded to possess not only the best, simplest and most practical arrangement and presentation of the subject, but also to be the most authentic and reliable. The Sixth Edition retains all the valuable and popular features of former editions, and includes also many new features, the whole forming the most perfect work on Materia Medica and Therapeutics possible to obtain, and certainly the best ever offered to the Profes- sion. The entire text has been completely rewritten, and thoroughly revised. Every symptom of doubtful origin has been expunged, and a few authentic symptoms not appearing in former editions have been added. . . The "General Analysis" of each drug has been rewritten and in many instances changed to conform to ideas resulting from more re- cent investigations in drug pathogenesy. Only those clinical symp- toms that have been repeatedly verified, and which are undoubtedly reliable, are retained, and these are given a distinguishing mark, so that the student can tell at a glance whether a symptom is of patho- genetic or clinical origin. The most important new feature of the sixth edition consists in the section on "Therapeutics" under each remedy. The brief "Therapeutic range" of former editions is omitted, and in its place appears a complete resume of the clinical uses of the drug, and which, while comparatively brief, covers the entire range of thera- peutic action, together with the chief symptomatic drug indications in all important diseased states. The author has given special atten- tion to this feature of the new book. The volume is a whole library in itself and the publishers are confident that it has only to be seen to be appreciated. GROSS & DELBRIDGE, Publishers, 48 MADISON STREET, CHICAGO. GROSS & DELBRIDGE'S MEDICAL WORKS. A TEXT-BOOK OF GYNECOLOGY, DE- SIGNED FOR THE STUDENT AND GENERAL PRACTITIONER, by A. C. Cowperthwaite, M. D., Ph. D., LL. D., Professor of Materia Medica and Diseases of Women in the Homoeopathic Medical Depart- ment of the University of Iowa; President of the American Institute of Homoeopathy; Author of "A Text-Book of Materia Medica," etc. Cloth $5.00. Sheep $6.00. Chicago. Gross & Delbridge. 1888. This work is the outgrowth of a need felt by the au- thor, as a teacher of Gynecology, for a reliable "and syste- matic Text-book upon that subject, which should include the Homoeopathic treatment of Gynecological diseases. The enviable reputation of Prof. Cowperthwaite as an author and teacher is sufficient guarantee as to the accuracy and reliabil- ity of this work. The author's well-known talent for concise- ness of language is well illustrated in this instance. In both pathology and treatment the very latest views and methods known to science are included. Under each sub- ject are given the synonyms,definition, pathology, etiology, symptoms, diagnosis, prognosis and treatment, the latter not only embracing Homoeopathic therapeutics, but also giving the latest and most approved methods of local and surgical treatment. The book is profusely illustrated. Yes, we like the book and heartily recommend it.—A merican Homoeopathisl. A book so well written by an authority like Prof. Cowperthwaite, should be found upon the library table of every physician of our school. T. Griswold Comstock. The volume before us is the result of the author's eleven years' experience as a teacher in that department of which it treats, and will become popular in the medical schools to which it is appropriate, and with practitioners who are in ac- cord with its teachings. The physical part of the work is excellent.—New York Med. Times. The work is beautifully written and systematically arranged, covering the en- tire field of Gynecology, and making up a text-book far superior to anything be- fore possessed by our school, and equal, we think, to the standard works of the old school.—Medical Era. The work as presented seems to us an excellent one. The treatment is ad- mirable and rational; the indications for the remedies being clear-cut and concise and local treatment not discarded. The publishers have done their part in giving us a beautiful volume—paper, type and illustrations all being unexceptionable.— California Homoeopath. A cursory reading of Dr. Cowperthwaite's book impresses one instantly with the author's commendable terseness in the statement of medical landmarks, and that other still more laudable trait of "knowing exactly when to stop." The book is what it professes to be, A Text-Book and more. It is safe to work by in our of- fices; the operations described are vividly presented, and the measures and treat- ment proposed are in consonance with that in current use. In both pathology and treatment, the very latest views and methods known to science are included.—A m. Homocopathist, GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. GROSS & DELBRIDGES MEDICAL WORKS. DISEASES AND INJURIES OF THE EYE. A Practical Treatise on the Medical and Surgical Treatment of the Diseases and Injuries of the Eye. By J. H. BUFFUM, M. D., O. et A. Chin; Professor of Ophthalmology and Otology in the Chicago Ho- moeopathic Medical College. 428 pages. Containing 150 wood engravings and 25 colored lithographs. Cloth, $4.50. Postage, 20 cents. This work is intended as a text-book for students, and a hand-book for the general practitioner. It is written in the clear and practical style so characteristic of the many other contributions to medical literature by the author. The Homoeopathic treatment given has been clearly in- dicated, and only those remedies are considered which have borne the test in extensive hospital and private practice. As avant courier of the coming year, sure to be full of good things, comes this new candidate for public favor. We have taken it up with interest, scanned its well-filled pages, and now lay it down with a feeling of satisfaction because it has met our expectations. For the first time we have a representative work in this department. It is well-written and handsomely printed.—Medical Advance. Chicago has spoken again, and this time through the medium of its well-known oculist, Dr. Buffum. The book is well written and practi- cal ; the descriptions are concise and to the point.—New England Medi- cal Gazette. This book is the joint production of New York and Chicago—an Eastern man in a Western land. We find in it much to commend— nothing to condemn. The style is verj' happy, and presents us with a specimen of English which is clear and plain. We do not think there is an ambiguous expression in the entire book. The one hundred and fifty well-executed engravings light it up so that its lessons amount al- most to demonstrations. Its twenty-five colored lithographs illuminate it so that a diagnosis becomes easy and almost certain. There has been a demand for just such a work as this, and the demand could not have been better answered.—Medical Era. Great credit is due Dr. Buffum for his able condensation of the pres- ent views pertaining to ophthalmic science. It will be of much service and value to students and general practitioners. Only words of praise are rendered the publishers for the manner in which they have done their work.__Prof. G. S. Norton, in North American Journal c Homoe- opathy for November, 1883. Dr. Buffum has succeeded with rare skill in giving to the reader an admirable monograph upon the eye.—Dr. F. Park Lewis, in Medical Counselor. I shall recommend it to our class in preference to all others.—IF. A. Phillips, M. D., Prof, of Ophthalmology and Otology in Cleveland Horn. Med. College. GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. GROSS & DELBRIDGES MEDICAL WORKS. KE^-NOTES OF MEDICAL PRACTICE. By Charles Gatchell, M. D., formerly Professor of the Theory and Practice of Medicine, University of Michigan; Attending Physician- to Cook County Hospital; Author of "How to Feed the Sick," "Treatment of Cholera," " Haschisch, ' etc. Pocket Book. Flexible leather. 217 pages. Fifth edi- tion, revised and enlarged. $2.00. Postage, 4 cents. This is a complete hand-book of Medicine, Surgery and Obstetrics and is in such form as to actually go into the pocket, making it a veritable vade-mecum. When I began practice such a book would have been worth a hundred dollars to me.—A. C. Cowperthwaite, 71/. D. Really an excellent compendium of all that the practitioner wants to have at hand.—Dr. Richard Hughes, England. This is the book for which I have been waiting for many years.— Dr. Sanders. The exceeding usefulness of this handsome pocket book, which is designed to be taken out and referred to as an account book, makes Prof. Gatchell's condensation and selection of just what one wishes at a moment's notice the best guide in emergencies which the practitioner can have on his rounds. As a ready reference compendium we have never seen its equal. The key-notes for the selection of remedies are really what they are called, and the general measures recommended will be verified in practice. No one except a trained teacher, literarj craftsman, careful student and successful physician could have collated such a handy epitome of Practical Medicine.—North Am. Journal of Horn. Prof. Gatchell has written what might be styled an Emergency Prac- tice. He gives attention to all those diseases upon which a young physi- cian may be called for an opinion at any moment. He omits all theor- izing and gives in the tersest possible style just what a doctor wants to know when he is face to face with a critical case. Here is a book which looks just like a private memorandum book ; which nobody need feel sensitive about pulling otct and consulting. We wish we could put a copy of this book into every student's hand that is about to graduate this Spring. It would aid him to become a skilled practitioner, if he would thoughtfully consult It in every case in which he was called, and would thus do much to prevent hasty and ill-considered prescribing.— The American Homceo path. GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. GROSS & DELBRIDGES MZDICAL WORKS. LECTURES ON FEVERS. By J. R. Kippax, M. D., LL.B., Professor of Principles and Practice of Medicine in the Chicago Homoeopathic Medical College; Clinical Lecturer and Visiting Physician to the Cook County Hospital; Author of " Handbook of Skin Diseases," etc. 460 pages. Illustrated. $4.50. Postage, 20 cents. These Lectures have been published at the request of students and practitioners who have been from time to time under the instruction of the Author, and who have expressed a desire to have them prepared in the present form. They embrace every form of Fever, its Definition Histology, Etiology, Pathology and Homoeopathic Treatment, making a most important and valuable addition to our literature. Printed in large type and on good paper. We have derived more real information—more of l;just what we have long needed"—in a month's ownership of this valuable work than from any other book in our possession. No homoeopathic physician nor enlightened allopath will regret the purchase of this work. We don't see how we have got along without it so long.—Dr. Fisher, in Southern Homoeopathic Journal. It gives us pleasure to speak in high terms of commendation of these lectures on Fevers. No wonder they took with the students. They are written in a plain style, and therefore more easily impressed upon the mind. The charts all through the work are a great aid to memorize each, and the differential diagnosis has been treated con amore. The publishers have done their part well, as usual, and deserve the thanks of us who must be saving of our eyesight.—Dr. Lilienthal, in North American Journal of Homoeopathy. This work cannot fail to be a valuable text-book, and will doubt- less be adopted by the Medical Colleges for this purpose.—New Tork Medical Times. We commend this work to our readers.—New England Medical GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. GROSS & DELBRIDGES MEDICAL WORKS. SKIN DISEASES AND THEIR HOMCEOPATHIC TREATMENT. By John R. Kippax, M.D., LL.B., Professor of Principles and Practice of Medicine and Medical Jurisprudence in the Chicago Homoeopathic Medical College; late Clinical Lecturer and Visiting Physician to Cook County Hospital; Member of the American Institute of Homoeopathy; Member of the College of Physicians and Surgeons, Ontario; Author of Lectures on Fevers, etc., etc. Fifth edition, revised and enlarged. 294 pages. Cloth. Price, $2.00. Post- age 13 cts. The Hahnemann Monthly says: "Dr. Kippax has given us in this book excellent material briefly disposed and well described. The Homeopathic indications are excellent? The Homeopathic Physician says: "To the busy practitioner, as well as to the student who desires to quickly gather a hint as to the diagnosis or treatment of any skin affection Dr. Kippax's Hand Book will be of service." The American Homeopath says: The book will be found a useful guide in the study of skin affections and their treatment. We have been in the habit of commending it to students, and find the new edition still more useful as a Hand Book." The Medical Counsellor says: " The fourth edition of Kippax on Skin Diseases differs from the first published in 1880 in the revision of the text as necessitated by the advances made in dermatology during the last few years. The book is conveniently arranged is concise, and answers well the purposes of a hand-book." The Physicians and Surgeons Investigator says: "No matter whether a doctor is a Homoeopath or any other, he will do well to read this work. He can obtain an understanding of the diseases of the skin more thoroughly from this book than from almost any other. We congratulate the author and publishers on producing such an interesting work? The Chironian says: "The rapid sale of the third edition, and the demand for a fourth, shows conclusively that a book of this kind was needed. Dr. Kippax has compactly and conveniently arranged a large amount of material. The student or busy practitioner who desires a reliable guide in the treatment of skin diseases cannot do better than to procure a copy of this work." Cincinnati Eclectic Medical Journal says: "As the diagnosis and treatment of skin diseases is a difficult matter for most physicians, they may be glad to consult a new authority (American), and see what Homoeopathy promises for relief. In a brief examination of the work, the author seems to describe disease as he has observed it, and where he has seen the necessity for potent means he employs them." GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. GROSS & DELBRIDGES MEDICAL WORKS. A PHYSIOLOGICAL MATERIA MEDICA. Comprising- the Physiological Action of our Rem- edies, their Characteristic Indications and their Phar- macology. By W. H. BURT, M. D. Octavo. Fourth edition. Cloth, $7.00; sheep, $8.00. Dr. Burt has brought together in a compact and well-arranged form an immense amount of information. The profession will fully appre- ciate the labor and skill with which the author has presented the physio- logical and pathological action of each drug on the organism.—New Tork Medical Times. We are sure that Dr. Burt's new work will have deservedly a rapid sale. Paper and printing leave nothing to be desired. May the pub- lishers never falter in such laudable work, and the eyes of the readers will bless them forever.—Dr. Lilienthal, in North American Journal of Homoeopathy. An enthusiastic yearning for the whys and wherefores of our won- drous Therapeutic art has brought Dr. Burt to the front again among the best bookmakers of our time.—St. Louis Clinical Review. Dr. Burt has enriched our literature with many valuable contri- butions, and the work before us gives proof of the value of his well- directed labors.—Detroit Medical Observer. We can recommend the book as full of interesting and profitable reading.—Hahnemannian Monthly. Dr. Burt has the power of sifting the tares from the wheat.—Chica- go Medical Times. We cordially recommend Dr. Burt's book.—New England Medical Gazette. Have just received Burt's Materia Medica. It is a work long needed, and the printing and binding are a credit to the house.—R. W. Nelson, M. D. It is a key-stone of medical study, and the printing and binding are the very best.—G. H. Morrison, M. D. The work is a credit to Chicago.—Medical Investigator. CLINICAL COMPANION to " The Physiolog- ical Materia Medica." Being a Compendium of Diseases, their Homoeopathic and Accessory Treat- ment, with Valuable Tables and Practical Hints on Etiology, Pathology, Hygiene, etc. By W. H. BURT, M. D. 252 pages. Illustrated. Price, cloth, $2.50; flexible leather, $3.00. GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. 14 GROSS <& DELBRIDGES MEDICAL WORKS. A TREATISE ON THE DECLINE OF MANHOOD, OR SEXUAL NEUROSIS. By Alvin E. Small, A.M., M. D., late President of Hahnemann Medical College and Hospital. Fourth edition, revised and greatly enlarged. Cloth. Price, $1.00. Postage 6 cts. The above is a work of great value, treating of the various causes that induce the premature decline of manhood and the most judicious means of removing them and curing their effects. The wise, fatherly counsels of the venerable author make it a safe book to put into the hands of erring and despondent young men. The work also abounds in practical hints for the medical adviser. THE HOMOEOPATHIC VETERINARY DOCTOR. Giving the History, Means of Prevention, and Symp- toms of all Diseases of the Horse, Ox, Sheep, Hog, Dog, Cat, Poultry and Birds, and the most approved Methods of Treatment. By George H. Hammerton, V. S. Octavo. Cloth. 435 pages. Price, $3.00. Postage 22 cts. A work on veterinary medicine, based on homoeopathic practice, will be hailed with pleasure by physicians of our school. The one before us is especially valuable to the practitioner of the country, considering, as it does, the ailments of all the domestic animals with a thoroughness not hitherto attempted in any work. The author has made special efforts in elaborating the principles of diagnosis. Great care is shown in the differentiation of similar diseases, the plan of contrasting the symptoms in parallel columns, as is customary in works on the Practice of Medicine, being here adopted. —Hahnemannian Monthly. This book should be in the hands of every homoeopathic physi- cian, and in the interests of humanity, if nothing more, he should try and place it in the hands of every patron who has occasion to be interested in veterinary diseases. The physical execution of the book is first-class.—North- Western Journal of Homceopathy. The book before us is a most complete description of the diseases from which those animals suffer, of which it treats, together with the therapeutics necessary to intelligent treatment Physicians as well as laymen will find the book of great service. ~N".w York Medical Times. A very valuable book and a great improvement upon allopathic treatment. In general terms we can commend the work to all who are interested in the treatment of the dumb creation.— Medical Visitor. GROSS & DELBRIDGES MEDICAL WORKS. THE HOMOEOPATHIC VETERINARY DOCTOR. Giving the History, Means of Prevention, and Symp- toms of all Diseases of the Horse, Ox, Sheep, Hog, Dog, Cat, Poultry and Birds, and the most approved Methods of Treatment. By George H. Hammerton, V. S. Octavo. Cloth. 535 pages. Price, $3.00. Postage, 22 cts. This book pleases us more than any work on the subject that we have ever seen. It starts in with the horse, and, after an inter- esting historical account of this animal, continues with the various diseases to which it is subject. The ox, dog, hog, cat, poultry and house birds are each treated of in turn. It is a very useful book for the farmer and the stable-man. Well printed, finely illustrated and handsomely bound; giving the homoeopathic treatment in all its detail. Many a farmer or stable-man has had horses sick with pneumonia, and had them cured with homoeopathic remedies, yet they continue to give condition powders, brimstone, aud all sorts of unheard of remedies, for the"common affections of horse-life, not realizing that homoeopathy offers for these affections the same prompt and beneficial results that it does in pneumonia. This book should be in every livery stable on this Coast, and physicians cannot make a better investment than to buy it, for no one can tell how soon one will be called upon to treat a sick pet dog, cat or canary bird.—California Homcsopath. A work on veterinary medicine, based on homoeopathic practice, will be hailed with pleasure by physicians of our school. The one before us is especially valuable to the practitioner of the country, considering as it does the ailments of all the domestic animals with a thoroughness not hitherto attempted in any work. The author has made special efforts in elaborating the principles of diagnosis. Great care is"shown in the differentiation of similar diseases, the plan of contrasting the symptoms in parallel columns, as is customary in works on the Practice of Medicine, being here adopted. —Hahnemannian Monthly. This book should be in the hands of every homoeopathic physi- cian, aud in the interests of humanity, if nothing more, he should try and place it in the hands of every patron who has occasion to be inter- ested in veterinary diseases. The physical execution of the book is first-class.—Northwestern Journal of Homoeopathy. The book before us is a most complete description of the diseases from which those animals suffer, of which it treats, together with the therapeutics necessary to intelligent treatment. Physicians as well as laymen will find the book of great service. J —New York Medical Times. A very valuable book and a great improvement upon allopathic treatment. In general terms we can commend the work to all who are interested in the treatment of the dumb creation. —Medical Visitor. GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. GROSS & DELBRIDGES MtiDlCAL WORKS. PHILOSOPHY IN HOMCEOPATHY. By Chas. S. Mack, M.D., Professor of Materia Medica and Thera- peutics in the Homoeopathic Medical College of the University of Michigan. Addressed to the Medical Profession and to the General Reader. 174 pages. Cloth. Price, $1.25. The articles in this book are ten in number, some of them being reprints. Among these reprints is Similia Similibus Curantur? revised and enlarged by one whole Part. In the matter hitherto unpublished are papers entitled: The Relation between Patient and Physician—between the State and the Medical Profession; Is Homoe- opathy Exclusive; The "Physiological Action" of Drugs; there is also An Address delivered in response to an invitation from some students in the (non-homceopathic) Department of Medicine and Surgery of the University of Michigan; in this address seventeen questions propounded by these students are answered, and the attitude of the "so-called old school" toward homoeopathy is discussed. "Philosophy in Homoeopathy" takes up such subjects as the relation between the physician and his patient, the physician and the state, and the " exclusiveness" of homoeopathy. Dr. Mack is, how- ever, evidently preoccupied with an attempt to explain the meaning and scope of similia stmilibus curantur, and regards his branch of medicine as being under the divine protection after a fashion which— when one considers the doctrine of similars—implies a certain vanity on the part of homoeopathy. Dr. Mack, who is professor in the Medi- cal School of the University of Michigan, addresses his book to the general reader as well as to the profession.—Boston Post. 'Tis a book well worth reading by any one capable of understand- ing it. We heartily recommend it.—Medical Visitor. It is a thoughtful little brochure and contains matter that will interest the lay reader as soon as the physician.—Argonaut. A very valuable little book, remarkable for its deep thought and careful scientific study.—Boston Home Journal. The work is clear in style and candid in manner. —Religio-Philo. Journal. This book will ably serve the purpose for which it was written. There are no obscure lines anywhere, nor an uninteresting page. —Clinique. His argument is well sustained and shows that he has thought long and deeply upon the question.—Homoeopathic Physician. The doctor has done a real service to the cause by publishing it —California Homoeopath. This little book is excellently written, clear, able and dispas- sionate.— The Arena. GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. GROSS & DELBRIDGES MEDICAL WORKS. RUDDOCK'S FAMILY DOCTOR. Being a Reprint of Dr. Ruddock's " Vade-Mecum," "Diseases of Women," "Diseases of Infants and Children." and " Essentials of Diet." With Notes and Additional Chapters, by James E. Gross. M. D. 772 pages. Octavo. Cloth, $2.00; full morocco, $3.00. Post- age, 30 cents. Dr. Ruddock's popular books have had a remarkable sale, both in England and America. This book is a handsome reprint of the whole, with notes and chapters adapting it to the American public. Every disease has received full attention, special care having been given to those of women and children. Dr. Ruddock's well-known Vade-Mecum, Diseases of Women, Dis- eases of Infants and Children and his Essentials of Diet have been re- arranged and extended by Dr. Gross, of the Chicago Medical Era, and are now published in one handsome volume, under the title of "Ruddock's Family Doctor." These works have already benefited thou- sands upon thousands, and in the new dress in which they are now pre- sented deserve and cannot fail to have a large circulation.—American Homceopalhisl. This splendid volume is the most complete book for the family that has ever been published for our school, and I most heartily recom- mend it to all.—.C. M. Hale, M. D. " Ruddock's Family Doctor," edited by Dr. Gross, is in my opinion to be preferred above all other works for family use.—J. H. Buffum, M. D., Prof, of Diseases of the Eye and Ear in the Chicago Homoeopathic Med. College. In the editor's preface to "Dr. Ruddock's Family Doctor," the entire story as to its usefulness has been told, namely, that the author's popular writings are unequaled—with the exception that in the com- pilation they have been "Americanized ;" that is to say, they have been made even more domestic by the additional chapters and notes of Dr. Gross. After a careful reading it is my opinion, as a guide for domestic treatment, that "Dr. Ruddock's Family Doctor" is positively unexcelled. — T. D. Williams, M.^D., Author of American Homoeopathic Dispen- satory. We can commend it in good faith to all our readers, strict Hahne- mannians or otherwise.—North American Journal of Homoeopathy. Full to overflowing of valuable material gathered from all sources. As an exponent of the best treatment of disease, in brief form and up to date, it is not surpassed.—Hahnemannian Monthly. I consider it the best medical work for the use of families yet pubs lished. It is full of practical hints.—John R. Kippax, M. D., LL. B.. Prof . of Principles and Practice of Medicine, Chicago Homoeopathic Mcd» C°Ucg«. GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO, GROSS & DELBRIDGES MEDICAL WORKS. THE PHYSICIAN'S CHEMISTRY. By Clif- ford Mitchell, A. B., M. D., Author of "Stu- dent's Manual of Urinary Analysis," "Clinical Sig- nificance of Urine," "Practitioner's Guide to Urinary Analysis." 1886. 301 pages. Price, $1.50. Post- age, 10 cents. This book was made for the medical student and physician. The aim has been to give much information in as small space as possible, and to simplify Chemical Theory so that the beginner can learn to read formulae without a teacher. Professor Mitchell has done a real service in bringing out this book. We have examined it at some length, and find it commendable in all respects. The theory of inorganic chemistry is followed by a condensed statement of all that will usually be required by tne physician concern- ing chemical bodies, organic as well as inorganic. The chapter on the examination of urine is valuable. The last half of the book is taken up chiefly by a well-digested Toxicology and an appendix of important chemical memoranda. The book is well printed and bound, and pre- sents a very handsome appearance.—Homoeopathic Recorder. PRACTITIONER'S GUIDE TO URINARY ANALYSIS. By Clifford Mitchell, A. B. (Harv.), M. D., Professor of Chemistry, Chicago Homoeopathic College; Author of "Physicians' Chemistry," " Manual of Urinary Analysis," "Clini- cal Significance of Urine," "Manual of Simple Chemical Tests," etc. Third edition, thoroughly revised. 12mo. Cloth. $1.50. Postage, 8 cents. This neat volume, by its precision and clearness of language, by the excellent taste shown in the arrangement of its contents, and by the many evidences of thoroughness and good sense, with which the subject of Urinary Analysis is treated, recommends itself at Or.ce to the reader's favorable consideration. GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. GROSS & DELBRIDGES MEDICAL WORKS. THE AMERICAN HOMOEOPATHIC DIS- PENSATORY. Designed as a Text-Book for the Physician, Student and Druggist. By T. D. Wil- liams, M. D., Member Illinois State Pharmaceutical Association, Active Member American Public Health Association. 713 pages. Octavo. _ Half leather $4.00. Postage, 30 cents. This important work is written in a plain and concise manner by a gentieman of large experience as a pharmacist, and who seems therefore to have fully comprehended the want of a reliable and scientific Dispen- satory. The work is a very satisfactory one.— The Medical Record. It will be a long time before a Dispensatory equally valuable will be given to the profession, and it is a work every physician should have in his library.—Dr. E. M. Hale. PULMONARY CONSUMPTION, ITS PRO- PHYLAXIS AND CURE BY SURALIMENTA- TION OF LIQUID FOOD. By William H. Burt, M. D., Author of "Physiological Materia Medica," "Characteristic Materia Medica," "Therapeutics of Tubercular Consumption," etc., etc. Second edition. Price, $2.50. Postage, 10 cents. - A book written by Dr. Burt needs no introduction. His name is a guarantee of its value.—Medical Argus. < It may not be denied that Dr. Burt's little work is based upon physiological principles, and doubtless in many cases his plan of feeding would yield remarkable results. The book is well worth buying.—North Am. Journal of Homoeopathy. The style of the work is clear and terse and the range of action of the various drugs is admirably described.—Clinique. I have more confidence in the open-air walkings and the surali- mentation of Burt than in the sanitary-rest treatment of Detweiler. Our reliance Tnust be on liquid foods, which is better than all the nastiness ever offered to a consumptive.—Lilianthall. GROSS & DELBRIDGE, Publishers, 48 MADISON ST., CHICAGO. GROSS <5- DELBRIDGES MEDICAL WORKS. A MANUAL OF VENEREAL DISEASES. Being a Condensed Description of those Affections and the Homoeopathic Treatment. By E. C. Frank- lin, M. D., late Professor of Surgery in the Homoe- opathic Department of the University of Michigan; Surgeon to the University Homoeopathic Hospital; Author of "Science and Art of Surgery," "A Com- plete Minor Surgery," etc. Octavo. Price, $1.25. Postage, 7 cents. The work is written clearly, the description of disease is "to the point," the diagnostic symptoms cannot well be misunderstood, and the indications for the use of the remedies considered are selected with care and sound judgment. ANTISEPTIC MEDICATION; or DECLAT'S METHOD. By Nicho. Francis Cooke, M. D., LL. D. Second edition. Cloth. $1.00. Postage, 5 cents. THE BABY. HOW TO KEEP IT WELL. By J. B. Dunham, M. D. Cloth. 50 cents. Postage, 5 cents. THE PHYSICIAN'S CONDENSED AC- COUNT BOOK. An Epitomized System of Book- keeping, avoiding the necessity of separate Journal, Day Book and Ledger, combining system, accuracy and easy reference with a minimum of labor. 272 pages. Price, $3.50, net. Sent postpaid. Send for sample page. THE PHYSICIAN'S DAY BOOK AND LEDGER. Arranged by T. D. Williams, M. D., Author of "American Homoeopathic Dispensatory." Price, $2.00, net. Sent postpaid. Sample pages sent on application, L£J3EL BOOK, for the Use of Physicians and Pharmacists. Containing more tfcan thirty, five hundred gummed labels in large, clear- type, and bound in a neat and substantial manner. Price, 50 cents, net, Sent postpaid.- - GROSS & DELBRIDGE, Publishers, 48 Madison St., CHICAGO. NLM005765416