applying the blister, let me refer the reader to my paper in the "Medical Times." (See RETROSPECT, vol. xxiv., p. 361.)

For three or four days after the application of the blister, the quieter the patient is the better. So soon, however, as the blistered surface begins to heal up, a few mild injections may be given. The best kind have always appeared to me to be those of sulphate of zine, in the following form:

B. Zinc. sulph. gr. x. ad j; sp. camph. mxx.; aquæ distil. 3j. A teaspoonful to be used three times a day.

Here, as in every stage of gonorrhoea, the bowels should be kept gently open; the diet should be light; quiet and abstinence enforced. Under this treatment, a cure is frequently effected in six days from the first employment of a blister, often in less, and occasionally, in some long standing cases requiring a second blister, it has extended over a fortnight.

The cleanest, most painless, and most certain plan of blistering seems to be that with Mr. Brown's blistering tissue. This chemist has also invented a dressing tissue which is extremely cleanly and convenient. It is highly desirable that some such process should be extended to the oxide of zinc. What a step in the right direction since the days of Cirillo's filthy and painful blistering ointment of corrcsive sublimate!

Now and then it will happen, that the patient is mortified and surprised to find the discharge re-appearing at the very moment he thought all gone. Thus, on the third day, there may be no discharge, and on the fourth there is a good deal. But this generally subsides as rapidly as it appeared, if the patient will only be quiet, and abstain from tampering with it.

Whatever means be adopted, the complete extinction of the disease must be made a sine quá non. From the time of Jesse Foot-perhaps earlier-it has been an admitted fact, but not always acted on, that the cure, to be permanent, must be complete, before the surgeon remits the least in his exertions.

Finally, I may state, that, in some obstinate cases of leucorrhoea, I have used blisters with great success, but my observations are not yet sufficiently complete.—Med. Times and Gaz., May 21, 1853, p. 519.

DISEASES OF THE SKIN.

109.-ON DISEASES OF THE SKIN, WITH ESPECIAL REFERENCE TO THEIR CONSTITUTIONAL ORIGIN AND TREATMENT.

By THOMAS HUNT, Esq.

[The proximate causes of chronic eruptions may be either impaired or abnormal vascular action, or a vitiated state of the blood. In some cases we may have these combined. The following remarks apply to cutaneous diseases, uncomplicated with any disease of the viscera :]

1. There is a large class of cutaneous affections which simply depend upon impaired vascular action of the capillary system, or a generally languid circulation. These exhibit various forms of eruption, but in all of them the health appears tolerably sound, although it often happens that the bowels are torpid. Prurigo is the most common form of eruption, but lichen and ptyriasis occasionally depend on a similar cause. The distinguishing character of the eruption is that of dryness; neither serum nor purulent matter is contained in the papula. The general signs are a weak and slow pulse, a pallid skin, impaired appetite, and intolerance of cold and heat. The beat of the heart is generally feeble, and the respiration slow. In cold weather the extremities cannot be kept warm. Papular or scaly diseases, depending only on this state of the circulation, will sometimes yield to warm baths of fresh water, and warm aperients, with a generous diet. These failing, the chloride of arsenic I have found to be the best remedy. The chloride of arsenic is a preparation not much known to the profession, but it has long been used by a few practitioners under the name of De Valangin's "solution of solvent mineral." I had the pleasure of bringing this medicine before the notice of the profession a few years ago, in a paper published in the "Transactions of the Provincial Medical and Surgi

cal Association," in which, on the testimony of Dr. Webster, of Dulwich, and of other practitioners, I described it as a very eligible preparation. Since then, I have had the satisfaction of seeing it introduced into the London Pharmacopoeia under the cognomen "liquor arsenici chloridi." I have been of late so much pleased with this medicine, that for more than twelve months past I have never once prescribed Fowler's solution, which is certainly much more liable to decomposition, and is, therefore, in some degree, uncertain in its effects. It should be noted, however, that the dose of the liquor arsenici chloridi is not from three minims to ten, as it is described in our rudimentary works on pharmacy, but from ten minims to twenty, three times a day. I have found twelve minims about equivalent to five of Fowler's solution. It seldom or never irritates the bowels, especially if administered with or immediately after a meal. It is scarcely necessary to adduce cases illustrative of this simple plan of treatment, but these are the cases in which arsenic is most useful and best borne by the patient. After a time it infuses a sense of warmth into the extremities, and a general glow over the whole surface; when this is effected, the disease more or less rapidly subsides.

2. Increased momentum in the circulation of the blood, with or without local congestion, is a more frequent proximate cause of disease of the skin than the opposite condition. The more severe forms of lepra and psoriasis, as well as of lichen, are frequently (not invariably) associated with this state of the circulation, but the more usual form of eruption is eczema. When this disease becomes unusually severe and persistent, it will generally be found that there are symptoms indicative of increased vascular action, and some degree of congestion in the larger viscera. The pulse is remarkably firm and incompressible, and remains so after a very considerable amount of depletion has been practised, which, so far from reducing the strength of the patient, very usually increases it, rendering him more lively and active, and capable of an increased amount of labour without fatigue. I am the more anxious to note this, because it is becoming the fashion to decry depletion, aud many otherwise excellent practitioners use it with the extreme of caution, and appear to have no satisfactory means of measuring its amount, and adapting it to the case. It is indeed but in a small proportion of cases of skin diseases that active depletion is required. Very frequently tonics and a liberal scale of diet are the things most clearly indicated; yet there are numerous cases, especially in the order vesiculæ, in which the torments of the patient cannot be relieved but by a free abstraction of blood, a severe administration of purgatives and antimony, and a very restricted diet: and this system must be pursued without regard to any limits but those indicated by the pulse and the skin, and the general tone of the system. In these cases relief follows depletion, as a spring rises when a load is removed. The features, which are generally dull and heavy, and of a dingy hue, become bright and clear as the treatment proceeds, and the patient frequently remarks that he finds himself stronger on bread and water, than he was on meat and beer. During the earlier stages of the treatment the disease often becomes worse, every dose of medicine appearing, as patients express it, "to throw it out;" but it at length subsides rapidly, and gets well either spontaneously or under the influence of alteratives.

The simple principle of successful treatment consists in regarding the skin disease as not the thing to be treated, but simply as a sign of something wrong elsewhere, and when this is rectified by ordinary treatment the skin recovers immediately. The only difficulty in the diagnosis is-that the patient complains of the skin only, and requires to be questioned and cross-questioned before the real condition of the constitution can be ascertained.

It remains to be observed, that nearly all the forms of cutaneous eruption attended by the secretion and discharge of serous or purulent matter, will yield to this kind of simple treatment without arsenic, mercury, or any other powerful alterative. On this point I have seen no reason to alter the opinion I published six years ago, that, "by rectifying what is obviously wrong in the general system, we put the patient into a condition in which the local disease has a chance of getting well; and sometimes this is all we have to do; the vis medicatrix nature will accomplish the rest." These few words present the outline of all I shall have to advance in these papers; but as, by reason of their fewness, they have been overlooked by hasty readers, by whom I have been ignorantly charged with administering arsenic indiscriminately, and with holding it out as " a panacea in skin diseases," I deem it a duty I owe to my

self, as well as to the profession, to illustrate by cases what it was I wished to be understood by the phrase," rectifying what is obviously wrong in the general system," particularly as in that phrase is comprehended all that is requisite in the treatment of the ordinary forms of curtaneous disease.—Lancet, Oct. 1, 1853, p. 315.

110. THE PATHOLOGY AND TREATMENT OF DISEASES OF THE SCALP, POPULARLY KNOWN BY THE NAME OF RINGWORM. By Dr. WILLIAM JENNER.

[The difficulty of diagnosing eruptive diseases of the scalp, is owing partly to their similarity to each other and partly to the different names given by different authors to the same thing. Popularly, ringworm is looked upon with the greatest anxiety and annoyance, as the term is supposed to represent a very obstinate and contagious disease.]

What is popularly meant by ringworm was by some of the older writers on skin diseases expressed by the word tinea; but the technical name being found, as our knowledge advanced, to have no definite signification, gradually fell into disuse.

It has been recently proposed to employ this word tinea again, and to give to it a precise signification. Under the generic name tinea it is proposed to include all diseases of the hairs produced, kept up, or attended, by the development of parasitic plants.

In this genus are included the following species: Tinea favosa; Tinea tonsurans ; Tinea decalvans; Tinea sycosa.

It is to this genus tinea, and to these species of that genus, that I desire especially to call your attention; and I am confident that if you remember the names of the species of tinea I have just repeated, if you learn what I am about to tell you of those species, and observe well the things I shall presently show you, the remaining and more common diseases of the scalp will be mastered in a very few hours spent in the out-patient's room.

Tinea favosa most commonly affects the hairy scalp, but now and then it is found on other parts of the surface. It is characterized by thick, dry, yellow crusts, which, if small, are circular in outline and depressed in the centre, cup-shaped. Passing through the centre of each of these crusts, is a hair.

If the crusts are very large they have an irregular shape, but still they indicate their origin from distinct centres by the semicircular outline of the masses which project from their margin. These larger, irregularly-shaped crusts, are pitted on the surface, and, from their fancied resemblance to the cut surface of a piece of honeycomb, the disease has received the name of favus.

The margin of the large crusts rises considerably above the level of the cutis; internally, they seem as though half-buried in the substance of the cutis. Carefully detach the crusts from the cutis, and a distinct layer of epithelium is found below them; examine the surface of the smaller crusts, and you find a layer of epithelium cover them.

The hair, at an early period of the disease, can be pulled out from the centre of each little crust with great facility; subsequently it falls off from the diseased parts, and permanent baldness results.

The crusts, then, of tinea favosa are remarkable for their thickness, dryness, brittleness, and depressed centre. Tinea favosa is not a pustular disease, but it is said, by those who have seen much of it (it is a rare disease in London), to be often consecutive to eczema, impetigo, chronic lichen, and herpes circinatus; pustules are sometimes formed subsequently to the tinea favosa, in consequence of the inflammation excited by the crusts, and the injury inflicted on the scalp by scratching.

Tinea tonsurans is often mistaken for herpes circinatus of the scalp, with which it is now and then conjoined. It is characterized by pallor, decolorization, and brittleness of the hairs, and the presence of thin white powdery scales around the base of the hairs, and on the skin between them. The diseased hairs have been likened to "tow." 66 They are," Mr. Wilson says, "remarkable for their bent and twisted shape, and resemblance to the fibres of hemp in colour and apparent texture." Their XXVIII.-15.

brittleness is sometimes such, that every hair on the affected spot is broken off just above the surface of the skin.

In Tinea decalvans the hair falls out rapidly from one or more circular spots, leaving a smooth bald surface. There is no eruption of any kind,—no crusts, no scales.

Tinea sycosa is characterized by inflammation of the hair follicles. Sometimes the inflammation leads only to the effusion of serosity, and the exudation of lymph around and into the capsule of the hair. At other times, and more commonly, pus is formed, and then, when the pustule breaks, a brownish scab is formed on the surface. The usual seat of tinea sycosa is, the chin, upper lip, and sides of the cheek. I had a case lately under my care in which the pustules occupied the inner surface of the nares, that part from which the hairs spring that protect the orifice of the nose. Tinea sycosa rarely occurs on the scalp, and it does not spread circularly; so far as I know, the name of ringworm has never been applied to it. I mention it to you to-day, although I have no example of it among my patients to show you, because of its relation to the species of tinea of which we have examples before us. You will have remarked, then, from the characters of the species of tinea I have mentioned, that

Tinea favosa is especially characterized by its crusts.

Tinea tonsurans is especially characterized by decolorization and brittleness of the hair.

Tinea decalvans is especially characterized by baldness, not preceded or accom ›anied by an eruption.

Tinea sycosa is especially characterized by inflammation, tenderness, hardness, and suppuration of the hair follicles.

I told you that these diseases are arranged together in one genus, because in all a parasitic plant is developed in connexion with the hairs. Now, the plant present is different for each species of tinea; and the situation occupied by the parasite is also different in each species of that genus.

In tinea favosa, the parasite is the achorion Schönleinii. This plant has mycelium, sporule-bearing branches, and sporules. The sporules are round or oval, and their diameter varies, according to Gruby, from 0·003 mm. to 0.01 mm.

The vegetable growth is first perceptible between the layers of the epithelium, just at the orifice of the hair follicle; from this point it may spread downwards between the hair and its capsule, and upwards around and in the substance even of the hair.

Such of you that visited ward 4 during the time Jacobs was in the hospital, had frequent opportunities of seeing the mycelium, the sporule-bearing branches, and the sporules of the achorion Shchönleinii. You will recognise it in these very excellent drawings of Robin.

In tinea tonsurans, the parasite is the trichophyton tonsurans. This plant is composed of spores only; the spores, however, are occasionally somewhat elongated, and arranged in a linear series. They are round or oval, and their diameter varies

from 0.003 mm. to 0:01 mm.

The primary seat of the trichophyton tonsurans is the root of the hair; subsequently, it extends up into the substance of the hair, and even outwards, according to Bazin, on to the skin between the hairs. I have under the microscope some hairs removed from the head of one of these children. You will see in one specimen the spores in the hair follicle; and, in another, the hair split up with the spores among the fibres, as figured in this plate by Bazin, and in this more highly magnified drawing by Robin.

In tinea decalvans, the parasitic vegetable is the microsporon Audouini. This plant is formed of branch filaments, on which the spores are developed. The spores are very small-from 0.001 mm. to 0.005 mm. The seat of the growth is the outside of the hair; it forms a sort of sheath around the hair, from the surface of the skin upwards, from 1 mm. to 3 mm. Gruby first described this plant, and its relation to tinea decalvans; and Robin says, he can confirm the accuracy of Gruby's description. In tinea sycosa, the parasite is the microsporon mentagrophytes. It is also composed of filaments and spores; but the spores are larger, and the filaments broader. than those of microsporon Audouini.

The seat of the growth is the hair follicle between the hair and the capsule.

I have told you the names I would have you employ to signify the diseases I have described and demonstrated to you; but you ought also to know the names employed by the writers on skin diseases most popular in this country, to signify the same things.

Tinea favosa, then, is called Porrigo favosa by Willan and Bateman; Favus by Dr. A. T. Thomson, Simon, and many other writers.

Tinea tonsurans is called Porrigo scutulata by Willan, Bateman, and Dr. A. T. Thomson; Herpes tonsurans by Cazenave; and Trichinosis furfuracea by Mr. Wilson.

Tinea decalvans is called Porrigo decalvans by Willan and Bateman; Vitiligo of the hairy scalp by Cazenave.

Tinea sycosa is called Mentegra by Willan and Bateman; Sycosis by Mr. Wilson. As to the etiological relation of the parasite to the disease, it appears, that the spores of the vegetable growth require for their development a peculiar nidus. I say so, because all persons who mix with children suffering from tinea do not have the disease. But if a soil highly favourable to their growth exists, then a spore having found its way on to that soil develops and forms other spores, and so the parasite spreads over the surface of the individual more or less rapidly, according to the more or less favourable nature of the soil.

[As tinea commonly appears amongst strumous and dirty children, we must first in the treatment enforce cleanliness, then strengthen and improve the general health of the patient, and then endeavour to destroy the parasite. The two first intentions are to be fulfilled on common principles, the last by a series of remedies termed 'Parasiticides.' Corrosive sublimate and acetate of copper have been much used, but there are many serions objections to their use, ore of which is, that the hairs have to be forcibly removed from the affected parts.]

It is highly probable that, if sulphurous acid be employed as a parasiticide, epilation will be found to be altogether unnecessary to its complete action. This agent was first introduced to the notice of the medical officers of the hospital, by Professor Graham, as a possible remedy for cholera, at the time that disease was said to have its origin in the presence of an entophyte in the intestinal canal. It was first employed by myself to check fermentation, and to destroy the torulæ cerevisia and sarcina Goodsirii.* When lecturing on this subject, some time since, I expressed myself thus:-"Considerable benefit may be anticipated from the employment of sulphurous acid in all diseases attended with the development of parasitic plants. I would especially mention porrigo."

The case I am about to read to you, of Hyman Jacobs, proves, that, in regard of tinea (porrigo) favosa, these anticipations have been fully realized; while the case of the girl now in the room, and who is still under treatment, renders it highly probable that the beneficial effects of this parasiticide will be as manifest in tinea decalvans as they are in tinea favosa.

In some forms of thrush, too, I may mention that it acts most rapidly, one application of a solution of sulphite of soda (a drachm to an ounce of water) sufficing to remove the disease from the mucous membrane of the mouth in twenty-four hours. The secretions of the mouth being acid, the salt is decomposed, and sulphurous acid is set free; in this, as in all other cases, the sulphurous acid is the active agent in the destruction of the parasite.

Hyman Jacobs, aged 27 years, a Jew pedlar, a native of Amsterdam, and resident in London fifteen months, was admitted into the hospital on March 21, 1853.

He was, as most of you remember, a man of cheerful disposition, dark complexion, rather short, muscular, inoderately stout; in fact, he looked generally in robust health. His habits were those of his class; he slept in the low common lodging-houses, fared badly, rarely eating meat, and, judging from his appearance, was not very cleanly in his person.

He affirmed, and I believed him, that he was temperate in regard of the use of alcoholic liquor. His general health, he said, had always been good.

The scalp affection was of nine years' duration at the time he came into the hos

* Several medical men have lately administered the hyposulphite of soda, instead of the sulphite; but the latter is the preferable salt, and for this reason, that when the hyposulphite is decomposed by the hydrochloric acid of the gastric juice, not only is sulphurous acid generated, but sulphur is precipitated, a substance it is very undesirable to have in the stomach in some of these cases.