the very nature of the work in which it is engaged, and from the wide sphere of its operations, would be interested in this matter, might be induced to turn its attention and use its influence in this direction, to the furtherance of this object. The closer and more intimate the relations between nations, the less likelihood will there be of war; the more numerous the threads which hold communities together, the less will be the probability of rupture. The establishment of an International Medical Degree will be one more link in the chain of civilization which binds nationalities, increasing the intimacy of their relations to each other, and putting farther and farther away the probabilities of war, or if war does come, tending to alleviate many of its horrors. It would be a freemasonry of science. Represented in this light, the effort to establish an International Medical Degree would doubtless be actively and warmly seconded by the members of the Peace Congress. Viewing the matter in its various aspects, it seems not improbable that the effort to found such a degree would find a cordial and numerous support throughout the world. To the individual physician the possession of such a degree would be of inestimable value, and it would unquestionably be ardently sought after. It would confer upon the holder a freedom of action which he could acquire in no other way, and would indelibly stamp his educational qualification as equal to any in the world; it would give to the youngest practitioner the highest standing possible to attain, and make him instantly, by force of his own genius, a world-wide authority in medical matters. To communities such a degree would be scarcely less valuable than to the graduate. It would enable invalids who so desired to bring to their assistance medical men from any quarter; and in times of epidemic or war, medical aid could be summoned, if needed, which, under the State law, or national system, would be illegal, although doubtless under such circumstances it would be tolerated. With the institution of an International Medical Degree we would see a mighty scientific brotherhood start into existence in which truly the principles of liberty, equality and fraternity could be legitimately carried out; a great republic of science would be born into the world, covering a territory co-extensive with civilization. A power for good would leap forth, before which the mightiest of kingdoms or governments would dwindle into insignificance. Cannot the Medical Association of Georgia initiate a movement which may ultimate in so great a result? Can we not secure for our grand old State the credit and the immortal glory of sowing the seed which will bring forth fruit of untold blessings to humanity? Gentlemen, members of the Medical Association of Georgia, it is given to you to say whether this shall or shall not be. Your attention has been directed in this channel from a desire to do away with these purely local ideas which confine our educational schemes to the narrow limits of a State or a country, from a desire to broaden our philanthropy until it embraces the whole profession of the world, from a desire to elevate our estimate of medicine until we can look upon the profession as a unit, whether in Russia or in the United States, whether in Canada or Australia. It is not to be denied that this proposition savors of Utopia, but it is no more ideal than the postal union, no more impracticable than extradition or any other international treaty. May we, before we return our trust to the Great Giver, be able to look upon one medical profession wide-spread as civilization, whose members will not be limited in the exercise of their functions by any geographical or governmental boundaries. May we live to see the day when suffering humanity can summon to its assistance skilled physicians of any nationality who will be free to exercise their profession untrammeled by local laws, begotten of a narrow, contracted, erroneous interpretation of the duties and requirements of the medical profession. When that day arrives a new era will dawn upon medicine; then will the profession assume an importance now not dreamed of; then will it become a power of enormous social influence; its now heterogeneous elements will then be aglutinated into one harmonious whole, working together for their common good, and for the welfare and advancement of civilization and of humanity. Gentlemen, members of the Medical Association of Georgia, the duty assigned to me by your constitution has been performed. The problem which was suggested at the beginning of this address is solved, and in an International Medical Degree we have a qualification far removed from the influences of illiteracy and ignorance, and unattainable by the charlatan and the quack. We have the means of insuring to communities physicians possessing the highest attainable degree of medical knowledge and expertness, and we have the power of giving to persons having the requisite qualifications such evidences of the fact as shall pass unquestioned and unquestionable over the world. LECTURES ON DISEASES OF THE SKIN. DELIVERED AT THE ATLANTA MEDICAL COLLEGE DURING THE SESSION OF 1885-6. BY HENRY WILE, M. D., LECTURER ON DERMATOLOGY, ATLANTA, GA. LECTURE III. GENERAL SYMPTOMATOLOGY—SUBJECTIVE SYMPTOMS—OBJECTIVE: SYMPTOMS, PRIMARY AND SECONDARY-GENERAL CHARACTER ISTIC FEATURES. Reported Stenographically for THE ATLANTA MEDICAL AND SURGICAL JOURNAL BY W. Kay Tewksbury. Disease of the skin, like disease of other organs, manifests its presence by means of symptoms, and these may be subjective or objective. Subjective symptoms consist of disturbances of the sensory functions of the skin and are appreciated by the patient. The sensory functions are interfered with, being increased or diminished to varying degrees, or may be altogether obliterated as in certain anæsthetic conditions. The subjective symptoms that are commonly encountered are those of itching, burning, pain or formication. These symptoms, when present, the patient becomes cognizant of, and they may give evidence of their existence in the form of excoriations or scratch-marks which are produced by the patient in efforts to get relief. Objective symptoms, on the other hand, are local manifestations due to structural changes in the cutaneous tissues, and therefore visible to the eye of the observer. They are, as Kaposi aptly says, "the characters which a diseased process has drawn upon the skin." They vary as to types, intensity and mode of development. These symptoms, also known as elementary lesions, may be primary or secondary. Primary objective symptoms are those which characterize the direct formation and development of cutaneous diseases, or they are the visible, tangible forms in which diseases first appear. Such are the macule, papule, tubercle wheal, vesicle, bleb and pustule. The macule or spot is a non-elevated abnormal discoloration of the skin, due to the presence of an abnormal amount of blood or pigment, or to a want of one or both. Its color and form are manifold, and in size it may vary from a pin-head to a silver dollar and larger. When due to the presence of an abnormal amount of blood, it constitutes a simple hyperæmia of the skin, as in the erythemata. Hyperæmic spots may also be the result of a congeries of blood-vessels, as in nævus vasculosus, or ordinary mothermark. Macules may be due to hemorrhagic infiltrations, as in purpura (scurvy), and these differ from those resulting from simple hyperæmia by not disappearing on pressure with the finder, for in the former the cutaneous tissues become stained with the coloring matter of the blood. A want or diminution in the amount of blood may contribute to the occurrence of pale, white spots, as in maculæ atrophica (macular atrophy.) As a result of an increased deposition of pigment, a variety of processes may occur, giving rise to macules, according to the nature, location of the pigment and the manner of its distribution, e. g., in lentigo (freckle) and chloasma. Then again, by reason of a want of pigment, partial or entire, there may occur certain colorless conditions of the skin and hair, e. g., albinism, vitiligo, canities. Macular lesions may be congenital, as in nævus, acquired as in chloasma, or artificial as a result of tattooing. They may be temporary as in roscola, or persistent as in vitiligo. The papule is a pin-head to pea-sized solid elevation of the skin, having a consistence according to the nature of its contents. It is the result of numerous processes, and varies in form and color according to location and composition. It may be due to a retention of sebaceous matter in a sebaceous gland, or its outlet, as in milium, or to a circumscribed inflammation of the papillary layer of the corium, as in papular eczema, or to a dense, sharply defined cellular infiltration of the corium, as in papular sypiloderm. Then again, collections of epidermal tissue, enlargement of the papillæ of the corium, follicular and peri-follicular inflammation, and finally new formations in the tissue of the corium may lead to the formation of the papule. The tubercle is a lesion having the characteristics of the papule, and presenting almost the same pathological significance, but differing in size, varying from the size of a pea to that of a hazel-nut. It may be deeply seated in the subcutaneous tissue, so that it can only be detected by palpation, but as a rule it projects from the surface. Wheals are elevated pea to silver dollar sized, flattened, pink or pinkish-white, evanescent efflorescences. They are due to serous exudations into the papillary layer of the corium ann rete, and are characterized by their rapid development, appearing suddenly, it may be in a moment, and having as a rule a short existence, quickly fading away. The lesions of urticaria and those resulting from irritation produced by the stings of insects may be cited as examples of wheals. They are always attended with itching or burning sensations, and by rubbing or scratching the lesions are increased in size and become at once more promi nent. The vesicle is a pin-point to pea-sized elevation of the upper layers of the epidermis, resulting from a serous, occasionally bloody exudate, which is usually at first clear, later becoming cloudy. As the exudate accumulates it lifts up the epidermal layers and causes an elevation. The covering of the lesion may be |