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of attack, behavior, etc., and then treat accordingly. Common acne, to be sure, is easier to treat than its congener, Acne rocascea, the former being prevalent in earlier life and oftener in the female than in the male, while the latter is a disease of middle life, more especially and oftener in the female than male. The critical period in women with tendencies to this complaint, is likely to aggravate it as well as also to develop it in others who have never had the trouble. These facts considered give hints as to the means to be employed for its removal. In those who inflame the mucous membrane by alcoholic stimulants, developing "whiskey-blossom" in middle life, the special indications are suggested, hygienically, by our knowledge of such habits, while the local treatment will be the same, circumstances being equal. I order the skin-affected with acne, mild or severe, to be bathed in water as intensely hot as can be borne, at bedtime, followed by a wash consisting of one grain of corrosive sublimate to two ounces of soft water. This I order to be repeated two or three times weekly. I also give internally one grain sulphide of calcium twice daily in pill or powder. The powder triturated with sugar of milk is preferable. I often give Rhus toxicodendron in stubborn cases and such other treatment as special cases seem to demand. The bowels should be kept open by the use of saline aperients. If the skin is harsh or fissured I use Cosmoline ointment.

R. Cosmoline zi.

Sub-Nitrate of Bismuth zi.
Attar of Rose, drops ji.

M.--Apply lightly night and morning.

It is not intended in this paper to discuss the subject of skindiseases scientifically and elaborately, but rather to call attention to the distinction between disorders arising from causes without (parasitic) and those manifestations that have origin from within, or from some faulty condition of the glands.

Take for example Herpes Zoster. There is a diminution in the uric acid, while the urine is ammoniacal and decomposes rapidly. In all such maladies constitutional treatment is clearly indicated; so with the whole family of Exanthemates.

The

specific and irritable quality of bodily fluids in measles, scarlet fever, small pox, etc., seems to act on the principle of a ferment. The skin, the strainerage outlet of the irritative material, is thus reddened by the irritable quality it is exhaling in vapory form. The exhalation of temperature, too, is easily accounted for, as also is the increased rapidity of pulse; the chemical forces are for the time in advance of the normal vital forces; nature in the same ratio manifesting disturbance and danger. Summarizing in a general way we may marshal, by way of conclusion, a few remedies; not alluding, however, to parasitic skin-diseases, as we have mentioned treatment for such before. Nor is it intended to give a digest of accidental acute affections of the skin-either expressive of constitutional causes, as erysipelas, measles, scarlet fever, etc.; or of those skin-disorders expressive of poison conveyed from without, as poison ivy, poison sumac, etc. These are so classified that our libraries afford ample information; whereas this paper is intended, if possible, to show that a few fundamental principles which are understood and adopted, will carry the practitioner smoothly over ways seemingly rough.

The remedies of prominence and value in the mastering of skin-disease and that stand the crucial test-observation and experience, I will now name:

FIRST, internal remedies. Sulphide of Calcium in non-inflammatory diffusive skin-diseases, or as corrective in all indolent forms of cutaneous affections, including boils, sties, tubercles of skin, acne, etc.

Arsenicum, either in form of triturations-one grain to twenty grains of sugar of milk and this given in doses of one to three grains in water three times daily; or liquor potassiæ arsenitis, three, five or seven drops in water, or added to syrup of Yellow Parilla and Yellow Dock Compound, a favorite and valued remedy, expressing itself energetically through the skin, three or four times daily.

The Iodides of sulphur, arsenic, potassium, etc., are valuable remedies in the chronic skin-disorders, studied and used as indicated, as is Iodoform and Iodine tincture.

Bromides of potassa, soda, etc. in acute and sympathetic conditions of the skin, are remedies of standard worth; while Aconite, Veratrum viride, etc., are adjuncts never to be forgotten as indicated. Rhus Toxicodendron, in acute and sub-acute skin-diseases, characterised by burning and itching of skin, has merit.

Spiritus Nitri Dulcis is a remedy of decided value when scanty secretion of kidneys is associated with discoloration of skin, furfuraceus tendencies, dryness in sections of the body, as about knees, elbow joints, etc. In this form of tetter the green osier (Cornus Circinati) is a remedy of value, both in form of ointment and added to the compound syrup of yellow dock and given internally. The sweet spirits of nitre is also a topical application of no mean order in irritation following bee-stings, ivy-poisons, etc.; reduced one-half or two-thirds in soft water and used freely. Ammoniated water is also a remedy of merit. In Urticaria the sweet spirits of nitre internally and externally is my first remedy, and usually the only remedy necessary.

SECOND.-External Remedies. Soda, bicarbonate or supercarbonate (applied topically) is a remedy that attention has been called to of late as pre-eminently useful to allay the pain of burns and scalds. I have tested a saturated solution of this and found it to act nicely, although the mixture of sweet oil and lime-water is not to be forgotten. After the pain has subsided in burns and scalds, the alkaline treatment should give way to carbolised olive oil; and here it is well to suggest to younger members that as the cutaneous absorbents are sensitively active in these cases, all applications necessary as dressings should be prepared with this fact in mind, that unnecessary medication be not forced upon our patients. Belladonna Ointment was accidentally applied to such a case coming under my observation, and a large proportionate surface was denuded, with alarming results. Ten to fifteen drops of carbolic acid to a pint of pure salad or olive oil is enough, in such cases used locally.

Moth, Liver Spots, and various discolorations of skin, are

primarily due to disturbances within, and as a rule require constitutional treatment, aided by topical applications; corrosive sublimate-one grain to the ounce of alcohol, rubbing the part briskly as the remedy is used-is often effectual; its effect being enhanced by the use of hot water before the application is made, applied as hot as can be borne.

Subnitrate of Bismuth in indolent forms of skin-disease (eczema, etc.,) and in infantile scald-head, in form of ointment, is often of value.

Chrysophanic Acid in chronic forms of skin-affections, nonirritable, yet characterised by break of texture, I have tested to a certain extent, but it is so unpleasant to use, as to effect, staining the skin and soiling clothing, and in my hands not superior to other remedies, for instance Compound Pix Ointment, mentioned before, that I have set it aside.

Oleate of Zinc. What little experience I have had with this remedy pleases me. Dr. Shoemaker, of the Hospital for SkinDiseases in Philadelphia, gives it the preference as a remedy for excessive sweating, as in hyperidrosis, osmidrosis, and used around axilla and genitalia, removing odor, etc. With parts weeping and itching, swollen, rawness of surface, and the like, it acts in a masterly way. "The oleate is a pearl-colored powder, to be dusted over the surface to which it clings, neither falling or brushing off."

There are remedies not mentioned in this paper equally as good, no doubt, as the few mentioned. I speak of those that I have tested and found serviceable; and when properly used with hygiene of skin and general hygiene enforced, diet carefully arranged, skin kept clean, hot water, sometimes alkaline and hot, not lukewarm or warm merely, but hot as can be borne, and if too much surface is involved, used only at bedtime, followed by appropriate topical applications, will cure our curable skin-disorders, even the worst.

VACCINATION:

CONSIDERATIONS AND STATISTICS.

By JOHN KAYE, M. D., Philadelphia, Pa.

We hear and read a great deal in these days about the various schools or sects in medicine, and like the votaries of all sects and creeds in the past history of the world, each thinks, feels and acts as though the school which he has selected, is the only right one. This is all very well, provided he does not allow his love for his adopted child to absorb his mind and to run away with his feelings so as to disqualify him for rendering an impartial judgment.

When any man or body of men attempts to uphold any notion in medicine, or in any of the collateral sciences, he or they should be guided by facts, particularly when the prosperity, the health and the lives of the community are involved.

Perhaps no art so largely and so directly affects the welfare of mankind as that of medicine in its varied branches and specialties. Yet, if we are to believe history, there is none that has been and still is cursed with more false theories, and more false conclusions based upon false hypotheses, resulting in disastrous effects on the human family. What makes the picture still more glowing is, that it is not the ignorant, not the so-called pretender to medical skill, not the so-called quack or Irregular, from whom "scientific men" seem to be so anxious "to protect the dear people," who have been the cause of this state of affairs. They, themselves, the teachers of schools and colleges, and the professed leaders of scientific investigation, have either been deceived by accepting dogmas on authority and teaching and upholding the same; or, being convinced of the fallacy of many of the practices of their time, they have acted from considerations of policy, either for money and popularity together with peace and quietness, or else from cowardice, the fear of persecution and the ostracism, almost sure to follow anything called "irregular." Nor is that feeling, that fear of persecution, that fear of being ostracised, as it were, without some cause, even at the present

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