first cannot be accomplished perfectly, as when the patient depends upon an occupation which is in part a cause of the eruption. Even here, however, we have reason to believe that if all else were quite right the occupation might be harmless to produce trouble; thus, many washer women, plasterers, &c., have no skin difficulty, and the individuals affected often carry on the occupation for a long time without ill effects, until some systemic cause arises; and, furthermore, they may return to the same occupation when restored to health and remain free from the eruption. Not even an outline of the treatment which is of service can be given here, for it must vary with each case. When there is an acute inflamed surface the coverings must afford protection and be non-irritating, whereas in more chronic forms very considerable stimulation may be required to remove the disease. In like manner the internal treatment must vary with the conditions present. Arsenic is very commonly required, but is not universally beneficial, and should only be administered by medical advice. In the more acute forms of the eruption it will often be found to do positive harm, increasing the disease. When given medically, arsenic is perfectly harmless; it does not remain in the system, and there is no such thing as a chronic arsenical poisoning occurring from its use as a drug.-Lichen much resembles eczema in many of its features; but the characteristic of the eruption of lichen is, that it is always composed of separate red points, or papules, which may run together somewhat, but which never coalesce to form the moist surfaces seen in eczema. There is no exudation or oozing in lichen, unless it has been very greatly scratched or torn, when there may be some inflammatory exudation; but this has a strong tendency to cease and to dry up, whereas in eczema the tendency is the other way. We may have a papular eczema which resembles lichen very closely, and the diagnosis between the two may sometimes be in much doubt. Lichen as a rule attacks the extensor surfaces of the body like psoriasis (see LEPRA), whereas eczema chooses the softer skin of the flexor surfaces, as at the bend of the elbows, knees, &c. The causes of lichen and its treatment are much the same as those of eczema.-Prurigo is another papular eruption belonging to this group. Here the papules are larger, more apt to be of the color of the skin except when scratched, and consequently may often be felt by the finger when hardly visible externally, as small shot-like elevations beneath the skin. Its favorite seat is over the front surface of the lower legs and thighs, also later the forearms, arms, and body. It is rare in this country, but not very uncommon in Germany. It is well nigh incurable, and the itching attending it when fully developed is most intense. It is not contagious, and is most common among the poor and ill cared for.-Herpes, hydroa, pemphigus, and pompho lix are affections of the skin characterized by the formation of large vesicles and bullæ, or water blisters, filled with a clear fluid (serum). They differ somewhat from each other, but possess the feature in common of more or less flattened elevations of epidermis containing a yellowish fluid, with comparatively little inflammation around. The most common form of these lesions is herpes zoster or zona, popularly known as "shingles," which has already been described as a neurosis, because its defi. nite cause is the inflammation of the nerve (and its ganglion) distributed to the affected region. Pemphigus is a more dangerous affection; here the blisters are apt to be much larger, even up to the size of half a hen's egg; they appear irregularly over the surface, are always attended with great debility, and the patient may die of the disease. The real cause of pemphigus is unknown; it is undoubtedly due to nervous disorder, and the one remedy which has most control over it is arsenic administered freely. There are five affections belonging to this class which are characterized especially by the production of pus: these are sycosis, impetigo, ecthyma, furuncle (see BOIL), and anthrax (see CARBUNCLE). Sycosis is an inflammation of the bearded face, characterized by the presence of small pustules around the hairs, with more or less inflammation between. It consists of a deep-seated inflammation around the follicles, so that when the pus or matter reaches the surface it has traversed the length of the hair follicle, and the hair stands loose as in a well of pus, and can be extracted almost without pain. The disease commonly called "barber's itch," or parasitic sycosis, is really a tinea or ringworm of the beard, caused by the presence of the vegetable parasite trichophyton tonsurans, as described under the first group of diseases; sometimes this causes much inflammation, and the condition is very similar to true sycosis. This latter, however, is quite a different disease, not at all contagious, but due to internal causes and closely allied to eczema. Impetigo is a pustular eruption affecting any portion of the body, made up of separate small collections of pus or matter on inflamed bases; these, if not irritated, last but a few days, dry into a crust, and disappear, leaving no scar. Older writers gave the name of impetigo to many cases which are now recognized as a pustular eczema, the pustular element resulting from a low or scrofulous state of the system; this form of eczema takes the name of E. pustulosum or impetiginosum. Ecthyma is much the same process as impetigo, except that its elements are larger, more inflamed, with a larger and deeper base and crust, and generally leave a scar. The eruptions caused by scabies or "the itch," and also by pediculi, may be impetiginous or ecthymatous. Furuncles or boils and carbuncles are but the same process, only a still deeper and larger amount of tissue is involved, and there is a central slough or portion of dead skin, the "core," after the re repute for this purpose. Purpura rheumati ca, or peliosis rheumatica, is characterized by hæmorrhages in the skin; but it exhibits also certain rheumatic elements which go to place it rather as a papular erythema, and it is little influenced by ergot, but generally controlled by quinine. Hamatidrosis, or bloody sweat, is a very rare affection, but has been sufficiently attested to be believed in by dermatologists. It consists in the oozing from the pores of the skin of a bloody-colored fluid, which comes from rupture of or transudation from the blood vessels connected with the sweat glands. It is due to intense nervous prostration, and is related to purpura and treated by the same remedies. VI. HYPERTROPHIC AFFECTIONS. In this class are included 21 diseased conditions, grouped under the different elements of skin af fected, and each characterized by hypertrophy or unnatural increase of the portion of the skin forming its seat. Lentigo, or freckles, consist of deposits of pigment of varying size in the deeper layers of the cuticle, next to the papillæ, and cannot therefore be removed by measures which simply affect the outer hard layers. Freckles appear to be owing to the action of the sun, but it is thought that this is not always so, because they are also found on parts of the body which are not exposed to sunlight, and many are troubled with them quite as much in winter as summer. Chloasma, or moth (called also liver spots), is similar to lentigo, but the moval of which they heal. All these states characterized by the presence of pus are indicative of greatly lowered vitality, and powerful tonics are always demanded.-Several forms of ordinary inflammation of the skin are recognized by dermatologists under the name of dermatitis. These are: 1, dermatitis calorica, where the irritating agent is heat or cold (see BURNS AND SCALDS, and CHILBLAIN); 2, dermatitis venenata, or inflammation produced by poisonous agents, which may be vegetable, as in the case of poison ivy and poison sumach (see SUMACH), or from various agents and dyes, as in certain highly colored woollen goods, socks, &c., or by croton oil, tartar emetic, arnica, megereon, or mustard; 3, dermatitis traumatica, where the inflammation is due to mechanical injury. The state of the skin varies in these cases according to the nature and the severity of the inflammation, and the treatment is based on surgical principles, being soothing and protective. The treatment of burns with bicarbonate of soda is now accepted as of great service, and consists of a solution of a few teaspoonfuls of the bicarbonate in a pint of water, kept continually applied. V. HÆMORRHAGIC AFFECTIONS. This group comprises purpura, hæmatidrosis (or bloody sweat), and scorbutus (see SCURVY). Purpura, or "the purples," is characterized by the appearance beneath the skin of small purplish spots of various sizes and shapes, more often round, caused by the effusion of blood or of its color-staining is in larger patches and is of a deeper ing matter into the texture of the skin. These spots may be slightly raised at first, but as a rule are on a level with the skin, and present the peculiarity as distinguished from other eruptions that they do not disappear at all on pressure. Other red eruptions, due to conges-parently indelible. The seat of the pigmentation or inflammation, are caused momentarily to disappear or to become much less marked when the finger is pressed upon them and quickly withdrawn; but with the stains of purpura and scurvy this does not occur. The most common place for purpura to appear first is just below the knees, or at the ankles; later it affects the forearms, and in severe cases much of the body may be covered. The spots usually appear in crops from day to day; and as the individual ones last about a week before they are absorbed, they may usually be observed in all stages, from the brighter red or purple ones of to-day, through the more brownish ones of yesterday, to the faintly marked greenish-yellow stains a week old. Purpura hamorrhagica is the same affection in a very much more aggravated degree, in which there are hæmorrhages from the mouth, nose, stomach, bowels, kidneys, &c.; and unless relief is obtained, the patient dies. The treatment of purpura should be tonic and addressed to the nervous system. Iron, strychnine, quinine, and cinchona bark are all of great service. Ergot is most to be relied upon for checking the hæmorrhages and really arresting the disease, and should be given in very full doses; turpentine is also of great brown. It is seen especially on the forehead and cheeks, also on the chin, and sometimes on the lips, as a brownish discoloration, with sharply defined edges, level with the skin, smooth on the surface, without-scales, and ap tion is the same as in lentigo; the causes are still somewhat obscure, though it seems certain that both disturbances of the liver and diseases of the female sexual organs can give rise to it. There are many lotions, &c., advertised surely to remove these moth patches; suffice to say, that they do not accomplish their end, and if the discoloration is removed, it is quite likely to return if the cause is not removed as well. Most of the remedies for the removal of these pigmentary diseases contain mercury, which is perfectly safe if used under proper medical guidance. Another hypertrophy of the coloring matter of the skin is the so-called mole, nævus pigmentosus, the pigment birth marks or mother's marks. These consist of brownish patches of various size and shape, often quite large, which may be more or less raised above the level of the skin. When hairs grow from them, they take the medical name of nævus pilosus. There is another form of nævus, called also mother mark by the laity-namely, the vascular nævus, vulgarly called claret stain or port-wine mark. This may at times cause a hideous deformity in the large extent of deeply colored skin, occupying, for instance, a large part of the face. It is due to an enlargement and multiplication of the capillary blood vessels, | life; children are occasionally born with it. It which otherwise should be invisible. There should always be treated when it first appears, are many foolish popular opinions in regard to and that faithfully and persistently; for it is the causation of these so-called birth marks, only in childhood that we can hope to arrest and many foolish popular prejudices against the diseased skin formation, and cases long negtheir removal. One will often be told that his lected seldom if ever return to perfect health. mother while pregnant was frightened by a Hypertrophies of the connective tissue emmouse, for instance, and that as a result the brace several very interesting diseases, which brown stain came on the child; or, that she may be briefly mentioned. Scleroderma, or spilled some claret, or in eating strawberries hide-bound skin, is a condition in which the skin or raspberries stained the corresponding part becomes hardened until it resembles tanned of her own person, and the red stain came on sole leather, when it contracts and binds down the child as a consequence. Such stories be- the part with a vise-like grip, to such a degree long to the age of mysticism in medicine, and as even to cause absorption of the muscles bewith more enlightenment will pass from the neath. More generally this occurs in patches popular mind. The prejudice against the re- or streaks, as down a limb; sometimes it inmoval of these deformities is quite as ground- volves the whole limb, and the member is hard, less. There is no sensible objection to it ex- stiff, and contracted; or again it may attack the cept the difficulties inherent in the procedure. chest, when the contraction of the skin so hinNo washes or mere local applications will be ders breathing that great distress and even of any use, and surgical interference is alone death may ensue. Sclerema neonatorum is of service. The smaller nævi may be excised, nearly the same affection in infants, where aland even the larger pigmentary nævi have been most the entire surface may become involved removed successfully piecemeal, without leav- in a process of hardening, beginning on the ing much scar. The vascular nævi, or claret lower extremities and extending upward. It stains, may also be removed surgically in sev- may appear early in infancy, or be congenital. eral ways: they may be treated by the intro- It is generally fatal. Morphea refers to cases duction of needles and the passage of an elec- where there is one or more spots of hardened tric current through them-electrolysis; or a tissue, somewhat resembling that of scleroderhot instrument may be employed to burn them ma, but having certain differences from this: superficially. Other methods have been pro- the edges of the patches are usually sharply deposed and employed with varying success; as, fined, and may be readily detected by the feel; making multiple cuts across the vessels in such there is a purplish or lilac border around each a way as to cut off the circulation, or accom- patch; and there is not the tendency to extenplishing the same end by repeated pricking sion over a larger surface, or to contraction of with a bundle of needles dipped in carbolic the affected portion of skin, resulting in deacid, much as in the process of tattooing. All formity or annoyance, shown in scleroderma. methods of removal of these deformities are In all these three affections the diseased skin followed by more or less scarring, but if well has a hard, brawny feel, and cannot be pinched done the disfigurement is much less than that up as can healthy skin. The causes of these occasioned by the original disease; the last alterations are suspected to be nervous in oriprocedure is perhaps attended with the least ci- gin, while the real essence of disease may lie catrix.—The next group, of six diseases, where in the lymphatics. Not very much can be acthere is hypertrophy of the epidermis and pa- complished medically, though some cases yield pillæ, has its chief interest in ichthyosis or the fairly well to electricity. Elephantiasis Araso-called fish-skin disease. The resemblance bum has already been described in a separate to fish scales (ix0uç, a fish) is more fancied article, in connection with leprosy, which latter than real, though some cases exhibit a very was formerly called elephantiasis Græcorum; curious checkered scaling strongly suggestive the two diseases are entirely distinct from of a fish. The skin is harsh and dry, seldom each other. (See ELEPHANTIASIS.)- Hyperperspires, and the patient is continually sensi- trophy of hair, hirsuties, sometimes is the cause tive to cold, and in winter may suffer very of great annoyance, especially on the face, arms, much. In some cases the epidermal thickening and neck of ladies. Occasionally it attains rebecomes very considerable, and may even stand markable proportions, as in the cases of the up in masses which have suggested a resem- so-called bearded women, where the entire face blance to spines; and such cases have been ex- will be covered with a beard as perfect and hibited under the name "porcupine men." complete as a man's. Such cases have been Mild cases of this very curious affection in one observed medically with great care, and the or another form are not very uncommon. The subjects are found to have the attributes of disease is well nigh incurable, although much women, and a recent instance of some note was may be done to mitigate the suffering of severe the mother of several children; usually, howcases, or to allay the annoyance of lighter ones, ever, it is asserted that females with such by means of alkaline and steam baths and the beards appear quite masculine in the voice, subsequent and continual use of greasy matter form, &c. These cases are of course only medito the skin. It is a disease of childhood, and cal curiosities, and no attempt at relief could rarely if ever develops for the first time late in be reasonably made. But when hair grows to a moderate extent on the face, especially about the chin and upper lip, medical skill can offer relief from the deformity. Many remedies are advertised under the name of depilatories for the removal of these obnoxious growths, but from the nature of the case they are and inust be useless for permanent relief. The hairs reach down through almost the entire depth of the skin, and are firmly imbedded in the hair follicles. At the bottom of each follicle there is a minute projection, known as the hair papilla, from which the hair is believed to take its growth. As long as this papilla and the bottom of the follicle remain intact, and possessed of nutritive power, hair will be formed, which is pushed to the surface and beyond by the newly developed portion beneath. When the hair is extracted, this papilla is still left; and if the person be in health, a new hair is formed and soon appears at the surface. This is observed practically when the hairs are extracted in the case of ringworm. It is useless therefore to attempt to get rid of these encumbrances by simply pulling them out, for the follicle is stimulated thereby, and greater growth ensues. The "depilatories" which are warranted to remove the hair consist of corrosive substances, such as quicklime and baryta; and the directions are to make them into a paste with water, to apply this to the skin for a few moments, and then to scrape the surface with a dull instrument, as a paper-cutter. Now, what has been done? Exactly the same as is accomplished when a man shaves, except that the paste softens the hairs more than the soap does, and the shaving is therefore done with a blunt instrument instead of a sharp razor. But neither prevents the regrowth of the hair, although the paste perhaps softens it to a little distance below the surface, and it does not grow again quite so quickly. Certain diseases, as sycosis and others, reach down and destroy the whole follicle and the papilla, and may be followed by baldness; and this method must be imitated medically if permanent removal of superfluous hair is desired. Occasionally one sees on the chins of ladies small black marks where they have attempted thus to destroy the follicle by thrusting a hot needle into it, and a small portion of soot from the blackened needle has been deposited beneath the skin, forming an indelible tattoo. The plan has been proposed, and successfully carried out, of introducing a fine three-cornered needle into each follicle, deep enough to penetrate the papilla, and then by a few rapid twirls causing its destruction and an inflammation of the follicle, which effectually precludes the new formation of hair. The same may be accomplished by introducing the needle and then attaching it to the negative pole of a galvanic battery, while the positive pole is held in the hand; electrolytic action then takes place around the needle, the hair is loosened, and the follicle is so altered as to cease to produce hair. Both of these methods are successful in only a certain pro portion of the hairs operated upon, because of the great difficulty of so introducing the needle and completing the operation that the papilla and bottom of the follicle shall be destroyed. Both procedures are moderately painful. VII. ATROPHIC AFFECTIONS. This class comprises those diseases which are characterized by atrophy of one or more elements of the skin. The most interesting are those in which the pigment of the skin undergoes changes or is found unnaturally distributed. These cases are known as albinismus and leucoderma or vitiligo. Albinismus is the term applied to those cases popularly known as albinos, where the pigment or coloring matter of the body is deficient, and as a consequence we have a white waxy skin, white or very light-colored hair, and pink eyes from the want of coloring matter in the eyes. (See ALBINOS, and COMPLEXION.) Leucoderma or vitiligo is characterized by the presence of pretty sharply defined patches of whitened skin surrounded by a surface somewhat darker than natural. These light spots are generally of a roundish outline; they appear small, and gradually enlarge until a considerable surface may be affected. They usually come quite symmetrically, as on the backs of the hands or fingers, or on both sides of the neck. They are generally worse in summer than in winter; they may disappear entirely and return again, and are very rebellious to medical treatment. Alopecia or baldness may be due to many different causes. When the falling of the hair is owing to acute sickness, and when it falls early in syphilis, it grows again quite readily. The hair also grows well after eczema of the scalp when the disease is cured. When, however, it is the result of seborrhoea, or of pityriasis capitis, it is much more difficult to cause a new growth of hair; and in persons with hereditary tendency to baldness it is almost impossible to prevent its loss. The various hair restoratives are based on the idea of stimulation to the scalp; but as there is often some cause for the falling, such as nutritive debility. their effect is necessarily transient. General tonics and measures calculated to improve the health will often do more to arrest the falling of the hair, and promote its regrowth, than any advertised nostrums. There is reason to believe that the use of very fine white flour instead of that made from the whole wheat is one cause of the prevalence of baldness. Alopecia areata is a peculiar affection where the hair falls only from localized patches, which then appear smooth, white, and shiny.—Trichorexis nodosa is a curious alteration in the hairs, whereby small node- or knot-like swellings are formed, like beads, on the hairs especially of the face, at which nodes the hairs have a great tendency to break, leaving a frayed-out, brush-like end. Sometimes there will be many of these minute swellings on the hairs. It is not a parasitic disease, but is due to altered growth of the hair. The treatment is by repeated shaving for a time, with the subsequent application of an oily sub stance. VIII. NEW FORMATIONS, OR NEOPLAS- | Two forms of lupus are now well recognized МАТА. In this group, in which there is a new and described: lupus vulgaris and lupus erydevelopment of disease elements not caused by thematosus. The former appears first in the inflammation, 14 distinct diseases are included. | form of separate rounded tubercles, or collec-Keloid relates to a fibrous growth in the skin tions of soft, red, pulpy tissue in the skin, which much resembles that resulting from a generally grouped together, forming larger or wound or a burn. The peculiarity of the true smaller masses, which inay become covered keloid is, that it has a tendency to spread or with scales, or may ulcerate and be raw or increase, and there arises a reddish elevation, crusted over. The most common seat of lupus firm in structure and irregular in outline, with is on the face, though no part of the body is finger-like prolongations reaching out from it. exempt from its ravages; when occurring on Little can be done for these growths, and the the nose, it almost always results in very serigeneral medical opinion favors non-interference ous deformity. It is an exceedingly chronic with them, as they give but slight annoyance, and rebellious disease, not infrequently recurand if left alone will not cause further harm; ring as often as removed by treatment. The moreover, attempts at removal by caustics or treatment offering the most immediate results the knife have very frequently been followed is that by surgical interference, in the way of by recurrence of the growths, and even their scraping or scarifying the surface; another increase.-Fibroma is the name given to cir- plan often very serviceable is the destruction cumscribed growths of fibrous tissue in the of the tubercles by boring them thoroughly skin, giving rise to small tumors of various with sticks of nitrate of silver. A certain sizes, generally round, often pedunculated, but amount can be accomplished by milder means, frequently also sessile. Sometimes only a sin- and the disease can sometimes be removed by gle tumor will be found, but sometimes they ointments and plasters. Internal medication multiply to an amazing number; and over 3,000 has comparatively little effect upon it, although growths of this form, of various sizes, have it may in a measure check its new development. been counted upon a single individual. They Prominent among the remedies used internally are perfectly harmless, and give no annoyance may be mentioned cod-liver oil, which appears except by their presence; they can be com- to control the lupus process to a slight degree. pletely removed surgically, and without much Arsenic has been lauded by some, but its claims difficulty, except of course when their number have not been verified by most dermatologists. is very great. Occasionally this overgrowth of Lupus erythematosus is so named because in the fibrous structure of the skin attains enor- many cases the disease is so superficial that mous proportions, and the tumors may weigh it appears almost as an erythema alone, with many pounds.-Xanthoma, xanthelasma, or viti- none of the separate tubercles described as ligoidea is a new growth characterized by the belonging to the first variety. The most comdevelopment of yellowish or light fawn-colored mon seat of this is also the face, and when patches of limited extent in the skin, most com- completely and characteristically developed we monly about the eyelids. The surfaces of these have surfaces of dark red or pinkish skin, of patches are generally slightly raised, but some-varying size, generally tending to a circular times the elevation may be considerable. The surface of the diseased portion has a soft velvety feel, and may be pinched up, showing a moderate amount of thickening. They cause little or no annoyance, and advice is sought chiefly for cosmetic reasons. They can be removed by excision, and if but a small portion is cut out at a time the resulting scar may be trifling. Strong evidence has been adduced to show that this state is due to disturbances of the liver action, but high authorities also maintain that there is no such connection.-Lupus (Lat., wolf), the next neoplasm, is one of the most important diseases in this group. The name was given to the affection because of its great tendency to destroy or eat away tissue, which in severe cases is a marked and terrible feature. The disease, however, is not nearly so frequent in this country as in France and Germany, nor is it so severe. Many cases which formerly would have been called lupus are now recognized as epithelioma or rodent ulcer, and many others are found to be forms of syphilis. It must here be mentioned that lupus as properly understood has no connection with syphilis, and that the term syphilitic lupus is wrong. form, and covered with a moderate amount of rather thick, greasy scales, which are quite adherent. These patches do not tend to ulcerate and destroy tissue as do those of lupus vulgaris, but they always leave more or less of a scar. This is one of the most rebellious of diseases of the skin, and very few internal or external remedies have any very certain or powerful in fluence over it. More recently better results have been obtained by cutting or scraping the surface than from any other means. Scrofuloderma is a term applied to a diseased portion of skin occurring in conjunction with and dependent on that ill defined and yet common state of the system called scrofula. (See SCROFULA.) The skin is dark red, more or less raised in tubercles or masses, which may ulcerate and become covered with crusts; or the tissue may break down and give exit to an unhealthy pus, and a reddened puckered scar result.-Rhinoscleroma designates an exceedingly rare disease affecting the nose, wherein a greatly hardened tissue takes the place of the normal structure, which by its continued growth may greatly disfigure the nose, and occlude the nostrils. It is readily destroyed with caustics, |