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intractable form at the menopause in women. There is a radical change in bodily habit at this period in life, which sorely taxes the energy of the dermic functions. With unfavorable idiosyncrasies, or if you please, tendencies, various forms of disturbance are manifest. It is clearly necessary to give constitutional treatment to the patient of a sustaining character; and local care bestowed on the parts immediately affected, including pressure with the bandage equally distributed, will often suffice for complete restoration.
It will be rank folly for us to imagine that soothing salves or ointments, poultices or washes will be of more than temporary benefit in such cases. True, there are several forms of parasitic skin-disturbances that are treated almost specifically with topical applications; but such are self-limited in character and often sure to get well without any care.
Erysipelas is a manifestation of skin-disorder that requires early to be well handled; and while some of its forms may start per se as affections of the surface only, yet if the circulating fluids contain a superabundance of broken-down material, this will be found to be as a fuel to feed the fire that has been kindled. It appears to me that iron administered internally in the form of Tinctura Ferri Hyd., and tincture of Veratrum viride properly applied externally, while the line of demarkation was held in limit by painting with the IronTincture, gave the most satisfactory average results.
Leprosy, the dreaded scourge of Asiatic countries from remote antiquity, has invaded this country together with the Chinaman. We may thus be recompensed for the syphilitic scourge which the Europeans have conveyed to the islanders. of the South Sea. It will be high time for us to engage in the study of this new exotic, and ascertain how it may be successfully combatted. Our School of Medicine has achieved many triumphs, but this would exceed them all.
The Clustered Lichen is a disorder that attacks its patient. at every period of life. Individuals exposed to the heat of a fire, those of a nervous and irritable temper, and children of a bilious habit, are most liable to it. A stimulating diet, use of alcoholic drinks, every thing in short which induces a rise in
the temperature of the blood, seems to aggravate the itchiness characteristic of this eruption. When it assumes the chronic form, it is not so easily cured, and will often disgust the patient and physician alike. Dr. R. E. Kunzé who has given study to this complaint, has set forth his views and observations with great ingenuity and distinctness. He treated cases on what he calls "the double shotgun style-a kind of doubling-up of compounds and come-arounds." He finds a solution of calcium sulphide very serviceable to allay the tormenting itch of lichen, prurigo, etc. He defends his treatment in forcible language, striking blows in return for having received them. It new becomes necessary, he remarks, to explain why, in the treatment of Lichen, we have had recourse to such complicated prescriptions.
Chronic diseases as a rule need something more than simple medicine, all the objections notwithstanding. Even Homœopathists use Warburg's Tincture, one of the most complicated conundrums of simples and compounds ever conceived by the fertile brains of mankind. It is employed in fevers and is composed of thirteen simples and one compound known as Confectio Damocratis; which is in turn composed of thirteen simples and another compound called Trochisci Kyphi, a composition of the ancient Egyptians consisting of fifteen ingredients, according to the older writers [fifteen according to Pliny and sixteen according to Plutarch]. We then have in this celebrated mess, therein called Warburg's Tincture, no less than seventy-five ingredients, which has of late been so much extolled, and is not used by the so-called quacks of our community, but by the pretenders of the Allopathic or Homœopathic Schools of Medicine. Eclectics are privileged characters, not bound by a Hippocratic oath, and may use simples or compounds without infringement of their Code of Ethics, if their judgment so demands it. There is not a plant in the Materia Medica of the universe which is not a compound medicine; and nearly every chemical which we use is a combination of some form or another. The air we breathe, the food we eat and the most simple plants we use for medicine, are compounds of Nature. Few plants possess a simple
property, but many properties are commonly blended together in the same plant. Simple medicines are one thing and simple medication quite another. There is a certain school of medical men who give medicine it is said to amuse their patients. We, on the other hand, give remedies which are intended to disabuse the minds of our confiding patients, that we pursue any similar mode of practice.
Several years ago the late Dr. Fraser, a member of this Association, published a monograph in which he prescribed hot water for a large number of maladies. Since that time the same idea has been taken up by a physician of the Massachusetts Medical Society, and of course Dr. Fraser will be sedulously overlooked, which is the common penalty that we undergo. It is certain that hot water comes in for a large share of glory in the modern treatment of all affections of the skin especially those in the acute form. Cold water, however, may be better adapted to individual cases. But the water treatment must be considered in the long run the most sure and satisfactory.
In concluding this brief introduction, I will remark that we may all profit by devoting a reasonable part of our time to the observations and study of this class of maladies.
FUNDAMENTAL PRINCIPLES IN THEIR TREATMENT.
By V. A. BAKER, M. D., Adrian, Mich.
The classification, division and subdivision of skin-diseases is a stumbling-block to most practitioners of medicine. Writers on these maladies are usually verbose and fail to make their subjects clear, pithy and practical. They say too much and usually leave the reader impressed with the necessity of classifying, in a mistified sort of way. He may wish he had the astute nosologist who describes the multitudes of these diseases, to name the particular one for him that is at
the moment under consideration, so that the prescription may be made out "scientifically." All physicians in general practice have applicants for repairs of the cutaneous covering of some part of their bodies. Such cases need the investigation necessary to classify, as to acute or chronic, parasitic or nonparasitic. If we are called upon to prescribe for common itch (Scabies) we should know that parasitic multiplication is the cause (Acarus Scabiei), and that parasiticides are the remedies. I will merely remark in passing that I have never found any way better than the old method-simple sulphur ointment-ziij. to ziv. of which may be rubbed well into the surface twice daily for two or three days, wearing an old garment next to the body which can be burned when the process ends. At bedtime the third day a hot bath of soap and water completes the work if thoroughly done. The parasites known as head-lice ((Pediculus Capitis) and body-lice (P. Corporis) are successfully combatted by a tincture or strong decoction of Cocculus Indicus, which may be used as a wash to parts. This remedy will also destroy fleas and all surface-parasites so far as my experience goes, and I have used it many years. The knowledge of this remedy was communicated to me by the late Dr. Rosa, of Watertown, N. Y., a member of the Eclectic Medical Society of that State, who for many years consulted with and had charge of the poor of Jefferson County. It was his sole reliance. If the physician classifies his skin-diseases as parasitic or non-parasitic, he will treat them accordingly; and it is as a rule simple enough for the whole class of skin-maladies. I was much annoyed till late years by occasionally meeting with a case of Favus that I could not treat satisfactorily, but for fifteen years past I have had no trouble thanks to hot water, alkaline treatment, elm poultices (made wet with alkaline water) often enough to remove crust and expose surface, then following with Ointment Picis Composite.
R. Cosmoline ziv.
Oil Tar, Fl., zij.
Citrine Ointment zj
M.-Apply night and morning, using twice a week the alkaline wash.
R.-Bicarbonate of Soda zj.
M.-Apply thoroughly at bedtime with a well-cleansed fine
A cap or special pillow may be improvised till the patient is cured. If the system is morbidly impressed I give Calcium Sulphide j.; water, zvi.; M.-sig.-A teaspoonful three times daily before meals. After the mixture has been well shaken a little essence of Gaultheria may be added. I have not met any cases, even the most stubborn, that have not yielded to this treatment.
The practitioner who is mindful of fundamental principles will apply them in the treatment of skin-diseases, whether the cause be a parasite or whether the disturbance be due to alteration in the secretion of the glands of the skin. Cleanliness is an imperative necessity, whichever cause is to be combatted, and especially is it a necessity in all parasitic skin-disorders; for frequently we meet with cases of stubborn form that are modified so soon as the skin is placed in a proper hygienic condition.
A few words on skin-affections expressive of general causes: Let us begin with Comedones This common condition of the skin when slightly in advance of normal is rather unsightly and often mentioned as "grubs," "worms," This is simply a retention, or, if you please, an inspissated condition of the secretion. Not being duly execreted it becomes less fluid, thickening sufficiently so that when squeezed with the fingers a slender thread-like mass is ejected corresponding to the follicle which retained it. The blackened end which is first to appear under pressure, is little harder than that which follows, its dark color being due to contact with dust, and its hardness to dryness from contact with the air, etc.
Again, acne, a disorder of the sebiparous follicles, no matter as to division and subdivision, so far as serves our present purpose, viz.: the simplifying of treatment. We need, of course, to bear in mind the fulfilling of indications; to make each case a study as to the time that it has existed, its vigor