pital. He had been in many hospitals, but had never derived any marked benefit from treatment. When Jacobs came under observation, his condition was as follows:

Cerebral, circulatory, respiratory and digestive functions healthy in all particulars. The whole of the scalp, excepting the margin, was covered with the crusts of tinea favosa. The largest crusts were of a greyish yellow colour, of the consistence of dried putty or mortar, and brittle. Their thickness generally was considerable. Where thickest, the surface of the crust was below the level of the cutis; so that it looked, at the first glance, as if the latter had been partially destroyed by ulceration. The surface of these crusts was very irregular; it had a pitted, worm-eaten, or eroded appearance. At the edge of the large, irregularly-shaped crusts, were many small circular crusts, depressed in the centre. A hair passed through the centre of each of these small crusts. When the crusts were forcibly detached from the scalp by mechanical means, the exposed surface of the cutis was very red aud raw.

The head itched much; and, though scratching gave considerable pain, it was evident, from the traces of blood on the surface, that he had been applying his nails to the part.

The odour of the head was very offensive, something like that emitted by mice, only, as one of you remarked at the time, sweeter and more nauseous. Scattered

over the trunk and extremities were a very large number of circular favus crusts. There were as many as forty on the back alone. The smallest of these appeared, when seen through a lens, to be constituted thus: in the centre was a hair, around and touching that a brownish-yellow crust, and around that again a dusky-red halo; the diameter of the whole not exceeding two-thirds of a line. On the back no crust was more than one-fourth of an inch in diameter; on the leg there was one one-third of an inch in diameter. These crusts were circular, raised about a line above the level of the cutis, hard, dry, and appeared as though made up of concentric rings of pale, greyish-yellow, and brown colours alternating. The surface of these crusts was readily detached, and then a cup-shaped cavity was exposed, filled with a brimstone yellow powder. The base of the crust being removed, the surface of the cutis, from which it had been detached, was raw.

We saw, you may remember, the mycelium, sporule-bearing branches, and sporules of the achorion Schönleinii, when portions of the crusts, or of the yellow powder, were placed under the microscope.

No treatment was adopted for some time after the man's admission. On April 13th his state was exactly the same as when he entered the hospital. Rags, wet with a solution of sulphurous acid, were now ordered to be kept constantly on the scalp; the head to be covered with an oil-silk cap.

On April 18th, large quantities of crust had separated from the scalp, and those that remained attached had entirely lost their yellow hue; they were now of a dirty brown colour. All itching of the scalp ceased shortly after the application of the sulphurous acid. No sulphurous acid had been applied to the crusts on the trunk and extremities, and they had still the characters they presented on the man's admission into the hospital.

A piece of lint, wet with sulphurous acid lotion, was applied to one of the largest crusts on the leg.

On the 22nd April a mere trace of the favus crust remained on the scalp; but the surface of the cutis was red, and there was an inflamed papula near the vertex. Thinking this condition might be partly due to the acid, which was a very strong solution, I ordered its use to be discontinued for twenty-four hours. The crust on the leg to which the sulphurous acid was applied on the 19th, had separated; the exposed surface was red, but not raw. Two favus crusts which were seated in the vicinity of that to which the acid was applied on the 19th, were observed to be turning brown; subsequently they dropped off spontaneously. The effect of the sulphurous acid gas on these two patches is of great interest, as illustrating the mode of action of the solution. The crusts on the scalp turned brown shortly after the acid was applied to them, and before they separated from the cutis.

On the 29th April the lotion was discontinued, and zinc ointment applied to the scalp.

On May 2nd the head was free from crusts, but the scalp was still red, and several inflamed papulæ were seated on it.

On May 9th the skin of the scalp was here and there more natural in hue, and one or two papulæ had suppurated; the pus was healthy in appearance, and there was no trace of the parasitic plant to be detected by the microscope.

On the 18th, the head continued free from favus; the scalp was much less red; the hair was growing. As the crusts on the trunk and extremities were still in the same state as on the patient's admission into the hospital, he was immersed, about nine in the evening, for half an hour, in a full-sized tepid bath, containing sixteen ounces of saturated solution of sulphurous acid; no friction was employed. During the night all the crusts save three fell from the surface.

On the 20th he was again immersed in the acid bath, and the next day no trace of a crust was to be found on the trunk or extremities. My notes say :-"No fresh crusts on head; a small pustule occasionally appears, and dries up in two or three days, and then disappears entirely; the skin of the head generally is much paler and more healthy in aspect."

31st. The scalp was still paler than at the previous report. There were only two small pustules on the scalp. By the microscope, no trace of the parasite could be detected. The skin generally appeared healthy; and, on June 2, Jacobs left the hospital, at his own desire, to return to Holland.

I cannot conclude without expressing my confident belief, that a very great advance was made in pathology when the vegetable nature of the diseases I have to-day referred to, as well as of some others, was demonstrated; and my equally confident belief, that the foundation for a very great advance in therapeutics was laid when Professor Graham introduced to notice the power of sulphurous acid to destroy vegetable life, and explained how it could be given internally without injury to the patient.

Note. The solution of sulphurous acid I have used is made by passing a stream of the gas through water till the latter is saturated. Of this saturated solution, two ounces may be added to six ounces of water, to make the lotion.

The saturated solution of sulphurous acid I have employed has been either prepared in the Birkbick Laboratory of University College; or procured from Button's, Holborn; Hopkins and Williams, New Cavendish-street; or Burcham's, Albanystreet. Med. Times and Gazelle, August 20, 1853, p. 181.

111.-ON EPIPHYTES AND ENTOPHYTES.

From a Review of DR. ROBIN's "Natural History of the Parasitic Vegetables which grow on Man and on Living Animals;" and of DR. BAZIN'S "Researches into the Nature and Treatment of Tinea;" by DR. E. A. PARKES.

[It may be observed that all the vegetables which grow on living beings are low forms of Algæ, or Fungi.]

Most of these plants are composed of simple cells, or of cells placed side by side; the unicellular algae being distinguished from the unicellular fungi by containing chlorophylle or some analogous substance, and usually one or more colored vesicles. The more highly formed algae are composed of interlaced filaments (Trichomata), simple or ramified, cylindrical or flattened, and containing colored molecules; and of a reproductive system-viz., vesicles (sporangia, conceptacles) and spores (sporidia). The fungi are represented by filaments, at first simple, then ramified, and formed by a single elongated cell, or, more rarely, by several cells placed end to end (mycelium). The reproductive system is constituted by spores, which are seated on a receptacle, either at once or by the mediation of certain special structures, or are contained in a distinct vesicle (sporangium).

It would lead us too far to go into the minute anatomy of these plants, nor shall we attempt an account of the various genera and species which are found on the lower animals. We shall content ourselves with enumerating those which are found on the bodies of men.

The conditions of growth of the parasitic plants on human bodies are the same as in all other cases. Whenever the normal-chemical processes of nutrition are impaired, and the incessant changes between the solids and the fluids slacken, then if the parts can furnish a proper soil, the fungi will appear.

The soil on which these plants grow is for the most part composed of epithelium or cuticle, acid mucus, or exudation; acidity, although favourable for their growth, is

not indispensable, since some of the cryptogamia grow in an alkaline or neutral ground, as on the ulcerations of the trachea. On the skin, and in the buccal and pulmonary cavities, the plants are exposed to atmospheric air, and many of the fungi absorb oxygen, and emit carbonic acid. In the intestines, the nature of the gas is somewhat different; but some species grow here also. Humidity and warmth are important conditions of growth, and these, of course, are always to be found in connection with the animal body.

An useful division of the subject for our purpose is afforded by the anatomical seat of the cryptogamia on the skin, or on the mucous membranes of man.

A. CRYPTOGAMIA ON THE SKIN.-Ten varieties have been noted in this locality. We shall enumerate them in the order in which they are given by M. Robin.

1. Trichophyton tonsurans (Malmsten).-Syn. Trichomyces tonsurans; Mycoderma of the Plica polonica; fungus of the hairs in Herpes tonsurans; fungus of Porrigo scutulata; Achorion Lebertii; fungus of the Teigne tondante (Bazin); Rhizo-phyte (Gruby).—This fungus was discovered and described in 1844 by Gruby, in the disease called by the brothers Mahon Teigne tondante;' by Cazenave 'Herpes tonsurans;' by Erasmus Wilson Trichoses furfuracea' (one of the diseases called ringworm and porrigo scutulata in this country). It exists also, as pointed out by Günsberg, in the plica polonica, although the two plants were formerly described as different.

The tricophyton is formed by oval transparent spores, which give rise to articulated filaments. Its anatomical seat is in the interior of the roots of the hairs. The hair and fungi simultaneously increase; the former seem larger than usual, are paler in color, lose their elasticity, soften and break off when they have risen some one or two lines above the surface of the scalp; in the short cylinder then left the fungus grows still more rapidly, so that the normal structure of the small stump of hair soon becomes indistinguishable. Sometimes the hair breaks off before emerging from the skin, and the fungus, epidermis, and sebaceous matter fill the ends of the piliferous conduits, and form the little prominences which can be seen by the naked eye in this disease, and give the skin a rough, anserrine appearance. The sporules and mycelium of the plants can sometimes be seen, in the form of a white powder, on the roots of the broken hairs; sometimes the cutis becomes congested and thickened, and then the plant is mixed up with scales of epidermis, with fatty and albuminoid granules, with pus, &c.; and crusts are formed of greater or less thickness, in which the growth of the fungus can go on.

MM. Robin and Bazin adept unreservedly the opinion that the trichophyton is the cause of the disease known under the various names above given; and each author relates examples of the contagion of the disease by transmission of the spores. Bazin has made the very important observation that the same disease will attack horses, and can be communicated from them to men. But both Robin and Bazin, however, admit that there is some condition of the hairs (dependent, no doubt, on constitutional causes) which is essential for the growth of the plant, as sometimes the disease disappears—i. e., the fungus dies-without treatment.

The diagnosis of this disease is extremely easy. The usually round bald patches, with the little elevations caused by the swollen roots, and the dryish scales of epidermis covering the skin more or less, and accumulating round the elevations, are very distinctive marks. Occasionally, when the cutis is more congested, and the crusts are thicker from abundant cuticle and exudation, some doubt may exist, but then the trichophyton can be usually found in the crusts.

The treatment of this species of ringworm has been long one of the most difficult points in dermatology. Its principles, however, are now well understood, and few cases resist the proper measures. The essential point is to apply to the roots of the hairs a preparation which may destroy the trichophyton; if this can be done, the disease is cured. It is first of all necessary to remove the hair; this is in part generally accomplished before the case comes under treatment, by the course of the disease; if it has not been sufficiently done, epilation' can be accomplished by a chemical agent, or by extraction with pincers. M. Bazin recommends the ointment given below, or the oil of cade, which appears to be the best depilatory known, or with these means epilation with the pincers may be combined. The removal of

* Lime and carbonate of soda, of each one part, lard 30 parts.

the hair permits a "parasiticide" solution to be applied to the hair-follicles, within which are the prolific spores of the fungus. For this purpose M. Bazin recommends either a solution of bichloride of mercury (1 part to 250 of water), or an ointment of the acetate of copper (1 part to 500 of lard). We have used also, with excellent effect, a solution of the pernitrate of mercury, about 1 part to 30 or 40 of water; this is, however, a very powerful remedy, and is to be cautiously used, as it easily blisters the scalp. We have used also an ointment composed of sulphate of copper (1 part), alum (3 parts), and lard (20 to 30 parts according to the age of the patient). Probably, however, a better parasiticide agent than any of these is the sulphurous acid, which we have seen Dr. Jenner employ lately in a case of favus, with astonishing results, and which doubtless would be equally successful in tinea tondens. Chlorine water might also possibly answer the same purpose.

With respect to the name of the most common disease in which the trichophyton tonsurans appears, the term used by Cazenave (herpes tondens) is extremely unfortunate; no doubt vesicles are sometimes seen, and sometimes the cryptogamic disease succeeds to true herpes circinata of the scalp, but in many cases there are no vesicles at all throughout the whole course of the disease. The term used in this country, porrigo scutulata, is inconvenient, as it is applied with greater justice to favus. The old term of tinea is, after all, by far the best, and the specific affix tondens expresses well one great feature of the disease, the baldness arising from the brittleness of the hairs.

[The second species, which has been little studied, is the Trichophyton sporuloides. The 3d is the Trichophyton ulcerum. M. Lebert has described a fungus in the crusts covering an atonic ulcer of the leg. The 4th is the Microsporon Audouini, present in the disease termed Porrigo decalvans by Willan. The 5th is the Microsporon mentagrophyta, found in a case of mentagra. This disease is easily cured by epilation, and subsequently using a lotion of bichloride of mercury. The 6th, the Microsporon furfur, has been discovered in the Pityriasis versicolor of Willan. The 7th, the Achorion Schönleinii, is the most important, being the fungus of Favus.]

Schönlein was the first to suggest that the honeycomb, or yellow favous crusts in the so-called porrigo lupinosa (Willan) and porrigo scutulata, were constituted by a vegetable growth. This has been repeatedly confirmed, and many excellent descriptions have been given of the disease, now called indifferently favus, tinea favosa, or porrigo scutulata; but none, we think, better than that which is contained in the work before us.

M. Robin believes he has discovered that the primary seat of the achorion is in the depth of the hair follicle, against the hair, and, as well as we can understand the description, outside the layer of epithelium which covers the root of the hair, and which forms "the inner root-sheath" of Kölliker. In this observation, however, he has been anticipated by Wedl, who has pointed out that by using a concentrated solution of liquor potassæ, to make the parts transparent, the fungus is found in the follicle round the hair at the place where it passes through the epidermis. In addition to this, the plant is found in depressions on the surface of the skin, forming the yellow honeycomb-like masses which give the specific name, favus, to the disease; and which, from their frequent buckler-like shape, suggested the term 'scutulata.' The development of the achorion in this situation is described by Robin after Remak and Lebert. A cuticular elevation is seen, beneath which is a small favus; when the cuticle is raised, a drop of pus sometimes issues; hence the error of those who have considered this disease always pustular; generally, however (Robin, Simon, and Hofle), there is no pus or liquid of any kind; the plant grows, and the cuticle over it (supposing it has not been forcibly detached) finally separates, leaving the favus exposed to the air.

M. Robin does not notice the important statement of Simon, that at first there is at the point where the favus is about to form, only an increased secretion of epidermis; he notices briefly the fact, that sometimes the under surface of the favus is coated by cuticle, which separates it from the compressed and attenuated derma.

The structure of the favus is given at length by both authors, but it is scarcely necessary to do more than notice that Robin, in addition to the mycelium, the spores, and the receptacles of the achorion, describes a finely granular amorphous layer, which forms the external coat of the favus, and is the representative of the amorphous stroma' which often accompanies the mycelium of algae and fungi. In the

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favus, also, as we shall presently see, another aud distinct fungus can sometimes be found.

M. Bazin describes the favus under three heads, which are fundamentally identical, and different only in respect of form.

1. Favus urceolaria dissemina: this corresponds to the porrigo favosa, Favus dispersus, Teigne alveolaire, of other authors.

2. Favus scutiformis: this is the porrigo scutulata, or favus confertus.

3. Favus squamosa; a form usually called scutulata, but distinguished chiefly by the irregular distribution of the achorion, and by the furrowed masses formed by the fungus, the hairs, epidermis, and exudation.

The treatment of favus recommended by Robin and Bazin is epilation, and the application of the corrosive-sublimate solution, or of acetate-of-copper ointment (1 part to 500 of lard), to kill the plant still remaining adherent to the hair follicle. We suspect that the sulphurous acid employed by Dr. Jenner will be found a more effectual application than either of these two. [The remaining species of this division are unimportant.]

B. CRYPTOGAMIA ON THE MUCOUS MEMBRANE.-The plants forming on mucous membranes, or in the contents of cavities lined by mucous membrane, are of less interest than those which grow on the skin, as in most cases they are decidedly only secondary. We shall merely enumerate them.

1. Cryptococcus cerevisia. Kutzing. (Syn. Torula cerevisia-the yeast-plant), in the bladder, stomach, intestines, &c.

2. Merismopedia ventriculi. Robin. (Syn. Sarcina), in the stomach, intestines, &c.

3. Leptothrix buccalis. Robin. (Syn. Alga of the mouth.)

4. Oscillaria (?) of the intestines. Farre.

5. Leptomitus urophilus. Montagne. (An alga, described as forming in the urine. It has as yet been scarcely studied.)

6. Leptomitus (?) Hannoverii. Robin. (Alga found by Hannover in the pharynx and oesophagus.)

7. Leptomitus (?) of the uterus.

8. Leptomitus of the uterine mucus.

9. Leptomitus of the eye.

10. Oidium albicans.

Robin. (Syn. Cryptogamia of diphtheritis and aphtha.)

Aphtophyte (Gruby).

11. Fungus of the lung. Bennett.

12. Fungus in the discharge of glanders.-Brit. and For. Med. Chirurgical Review, Oct. 1853, p. 416.

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112.—On the Treatment of Pityriasis Capitis.-[Mr. GEORGE DUPLEX, in a letter to the editor of the Lancet,' recommends the application, every night, of a little nitrate of mercury ointment softened with almond or olive oil. A few doses of alkali with a slight bitter may be also of service. He says:]

Many years ago I was frequently much teased by the apparent obstinacy of this affection but since I have adopted the above formula, I have always succeeded in relieving my patient in a short time. I also use occasionally a lotion of the nitrate of mercury dissolved in distilled water (much weaker in strength than the ointment), in cases where the trunk has been almost covered with the eruption; it need only be applied every second or third day with a sponge. I need scarcely observe that this disease is generally liable to return; but if the above remedies be immediately resorted to on its re-appearance, scarcely more than the application will be necessary for its removal.

[Mr. M. J. CONNOR, another correspondent, observes with regard to the peculiar obstinacy of a case under his care:]

After repeated applications of my own prescribing, and after having had recourse to old prescriptions, I almost gave up the case in despair, when it occurred to me to try cold water, and advised that the head should be washed in cold water every morning, at the same time recommending a mixture, with one drachm of sesquicarbonate of soda dissolved in six ounces of any bitter infusion; two tablespoonfuls to be taken three times a day. In a very short time the improvement was wonderful,