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fication depends neither on the appearance of the disease nor the physiology, nor the effect of therapy, but on the anatomy. This is the favorite mode of classification now-a-days, not only of skin diseases, but of other forms. Virchow's division of tumors after this rule, is Dow everywhere adopted, and Hebra’s of cutaneous diseases is rapidly gaining ground. It certainly simplifies the matter wonderfully, for skin diseases have long ago been removed from the opprobria they once were. Why should we call a disease which is to-day papular, to-morrow vesicular, and the day after pustular, each time by a different name, observes Hebra time and again, when all the time it is the same disease? A scabies is now one or the other, according as the surface is scratched. In almost all cases, pustules are only the effects of scratching, and consequently, nearly the whole file of pustular disease is swept away. Scabies presents at the clinic in every variety of appearance, among the fearfully degraded poor which this land produees. In all cases, the treatment is the so-called "cure salve.” We were led into the room a few days ago, to witness its application; a half-dozen men and boys, perfectly naked, were drawn up in line, and the old nurse, a regular major domo, took his position before them, with a large pot of the semi-solid salve at his feet. A small quantity was presented to each for the hands, then the forearms, arms, abdomen, lower extremities, &c., and finally, for the back, the company then faced to the right, standing in company file, when each officiated for the man before. It was a singular sight and ludicrous in the extreme, each man of a dark mahogany color, toiling with might and main, for the discipline is strict, on the back of his neighbor, who in turn labored upon the one before. ' After the friction, each individual is laid in bed and rolled in a blanket from head to foot, and there he lies for two days. He is then inspected; should he not require another application, he is now rubbed off with fine clay. Prof. Hebra insists strongly that he shall not bathe for four or five days, as the concomitant eczema is always aggravated thereby. After this latter friction, he is dismissed -cured of his scabies. Should the eczema require treatment, he is furnished with ol. cadini, a preparation of tar, which he is instructed to use. The Professor has tried all the various plans of treatment, but always returns to the all-healing salve. Its composition is the following: Sulphur, tar, each six ounces; soap, fat, each one pound; chalk, four ounces. Of course, in private practice, other finer preparations are employed. Eczema is treated according to its form. In a most exquisite case in the acute form, which occurred a few days
ago, wherein the entire trunk was covered with vesicles on an inflamed base, pulverized starch was applied, and in four or five days the cure was complete. Incrustations are softened and removed by the application of clothis saturated in cod liver oil; when either the oil is continued, or preparations of tar united with it, or alone maintained, or in obstinate forms, caoutchouc glove or stocking is worn.
Prurigo, he pronounces an incurable disease. The intense itching may always be mitigated, and the papules may even disappear for a time, but they always inevitably and unexceptionally return. The best treatment of obstinate cases is, maceration by fourteen day baths, application of the so-called smear soap and futty inunctions. Sometimes tar is of decided efficacy. Prurigo is a disease of the horny tissue, like ichthyosis and lichen pilaris. In children, it is best treated by warm baths of an hour's duration, and subsequently, appli. cation of spiritus alkalinus. Syphilis in all its forms and ravages, is a daily visitor. The treatment is the mercurial inunction generally, commencing with the forearms for one day, the arms for another, and so on over the body, to avoid eczema, until its effects are obtained. As to whether a soft chancre may produce general contagion, the question is, still, after manifold experiment, sub judice. The mercurial treatment is only employed for existent symptoms.
To attempt even a synopsis of therapeutics, would be a task as useless as endless, for Hebra's work, the first volume, has been already *translated into English, is within your possession. Had we time and permission, we would gladly translate the condensed work of Dr. Neumann, Docent of this department, which contains everything that the general practitioner requires.
The baths of the Hospital are conducted on a scale which merits notice. A long row of chambers on the ground floor are divided into small apartments, containing the requisites of baths, simple, medicated, steam, douche, &c., with every facility for use, the great peculiar feature is the treatment by continual baths. In cases of extreme burns, and in cases of many forms of disease which have obstinately resisted all treatment, resort is had to the continual bath. A rope bed is stretched along the center of a long tub, and arranged by pulleys so that it can be elevated or lowered at pleasure, and the patient, naked, of course, with the head on a pillow above the surface, passes a portion of his life under water. Day and night he remains in his watery couch, eats there, amuses himself there, sleeps there, and is only elevated for the
*Both volumes have been translated and published by the Sydenham Society-the socond was issued last year.
insertion of a vessel under him to receive discharges. It has proved of the most decided efficacy in burns, relieving the intense pain, sparing the agony of the change of dressings, and materially abbreviating the cure.
It has been found, however, that in very extensive burns, the mortality is undiminished. A few weeks ago a case of universal psoriasis was exhibited, whose history was nine months of aquatic life. The surface, before the bath, was so stiff that the slightest motion was attended with extreme pain. At one time, during the long treatment, at the solicitation of the patient, who was weary of the monotony, he was removed and the body was enveloped in cod liver oil, but the disease returning in all its former violence, soon induced him to petition a return to the bath, which was granted. He is now nearly well.
Our old friend, carbolic acid, plays quite an important part in dermatology. It is used in many cases where the disease depends on parasitic formation, e. g., herpes tonsurans, pityriasis versicolor, favus, &c., and has been found of peculiar efficacy in hastening the absorption of the indurated bases of ulcers, chancres, &c. It is generally applied in solution with glycerine or alcohol, to indurations; pure petroleum is the application to pediculi capitis, vestimentorum, or pubis, equally efficacious and far less dangerous than mercury. Even these foul cases of plica polonica, where the hair is matted into a mass from the product of seborrhea, pediculi, eczema and dirt, from extraneous sources, until a cap of nearly an inch thickness is formed, and which is regarded by some of the credulous as a charm against disease, yield readily to the continued application of coal oil, and frequent ablutions, without even cutting the hair of women, which is, in general, for no disease, seldom or ever removed.
The rapidity and accuracy of diagnoses, seem at first but little less than miraculous; patient's histories, to their profound amazement, are revealed to them from the commencement of their disease to their appearance here. 1. There are no diseases in which their subjective symptoms are so little needed. 2. Very seldom is a question necessary, or when desired, it seems only in corroboration of a previous statement. 3. The type of the affection is written upon the body in characters which utterly set at nought any equivocations or direct falsehoods from the patients themselves. 4. Characters, too, which, like the hieroglyphics of archeologic love, have been and are being deciphered by the priests in the temple of science, and their discoveries likewise, but in a far higher and nobler manner appropriated to the benefit of their fellow man.
NEW YORK CITY, APRIL 10, 1869. DEAR JOURNAL: After the bustle and excitement of the past winter at the various schools, male and female, of our city, we are once more enjoying a period of comparative rest. The numerous lectures, clinics and operations of the winter course, are over, and the dissecting rooms closed for six months. The college halls present a deserted appearance indeed, after having been so crowded for the past half year with the several hundred students who have recently been among us. To each and to every one who is this spring commencing the real strug. gle of life, we would wish a hearty God-speed, and extend the right hand of fellowship. May bright success and happiness be theirs. And yet, we never attend a medical commencement, and see the enthusiastic young student, with beaming eye and high hope upon his brow, receiving his coveted diploma, without a feeling of sadness creeping
And this, because we can not help looking forward into the mysterious future, and picturing to ourselves how many of these, now so bright and buoyant, will, ere many years have flown, fall by the wayside, overcome by the turmoil and strife, and be trampled and forgotten, long ere the goal of their ambition is attained. Many a noble man has closed his weary eyes in death, no longer able to keep up the struggle, and sunk into an unknown grave, no hero on the pages of the world's history, but none the less a martyr to the glorious science that he loved so well. And yet, notwithstanding the hardships, and the difficulties, and the disappointments, that so often await those of our profession, we would never offer a single word of discouragement to any who have entered into it or who contemplate its adoption from proper motives; but would the rather say to them, if you would succeed, be enthusiasts in the profession of your choice. None is nobler, none more God-like. Enthusiasm, as in all other things, so in our calling, to a certain degree, is the soul of success. Not sentimental fanaticism, which is the dream of success, but a living, an energetic enthusiasm, which is the realization of success. Words, like men, often lose their reputation, from evil connection; so, by associating the word enthusiast with the teaching of the false and sickly doctrines of the day, it has lost caste. Yet, what is enthusiasm, but the earnest life-devotion to an end, the absorption of a man's being in some idea and purpose? Until the mind and the heart have become interwoven with the purpose, and thus separated from all ulterior objects and influences, no great end has ever yet been truly accomplished. Listen! And as you tread the memory vaults of the illustrious dead, every
reverberation speaks of the deathless energy and passionate devotion -a life-long enthusiasm. What could be more grand than our lifework—to relieve human suffering and to prolong human life? It is ours to soothe the brow of anguish; ours to drive the demon pain away; ours to raise the prostrate sufferer; ours, relying upon a Higher Power!
But pardon us, dear Mr. Editor, we meant not thus to wander, but such was the current of our thoughts.
The spring courses of lectures are now quietly progressing, and the younger men of the profession have once more an opportunity of ventilating their views upon the various branches of our art. The lectures, for the most part, are not delivered by the regular professors, but by their assistants, or by those who have been fortunate enough to secure positions as summer lecturers. Many of the regular professors, however, still appear at the clinics, which are again in full and active operation; and the course this season is particularly fine. We never lack for material in this city. Tho following is the programme for each day, (the clinics being held at the three medical colleges, New York, Bellevue and Charity Hospitals, and at the New York Eye, and Cosmopolitan Eye and Ear Infirmary :)
Monday-Two surgical, three eye and ear, one venereal, one skin diseases, one obstetrical, and one medical. Tuesday-Three surgical, three medical, two eye and ear. Wednesday-Two medical, and one eye and ear. Thursday-Two surgical, one eye and ear, one medical, and one obstetrical. Friday—Two surgical, one eye and ear, one medical, one skin diseases, one obstetrical. Saturday-Two medical, one eye and ear, one children's diseases, and one surgical.
Amidst such a variety, it would seem that the student ought to acquire much practical information, and so do those who make a proper use of their eyes and ears. In its facilities for the practical study of disease, New York city is rapidly distancing all competitors.
Week before last, the mortality of this city amounted to four hundred and eighty-three, of this number, two hundred and fifty-five died in tenement houses, one hundred and two in public institutions, and one hundred and twenty-six in private houses and hotels. The health of the city, on the whole, is good. The excitement in relation to smallpox is abating. Great vigilance, however, is exercised at the quarantine and emigrant landing, on account of the prevalence of this fearful disease in several of the European cities. It is spreading widely in Montreal, and is still on the increase in California The Medical