nestles between the "gathers" or "pleats" of the shirt, or between the folds into which about the waist the shirt is compressed by the waistband The nits of the pediculus are also to be found in the same situations, but occasionally a large cluster of them is to be found at some other part of the shirt.

It should here be explained that the three varieties of louse that infest the human skin vary considerably in their habits. Thus, the pediculus capitis, or head-louse, although it feeds on the skin, dwells on the hair of the head, and also deposits its eggs on the hair-the pediculus corporis, as we have seen, also feeds on the skin, but it dwells on the underclothing, and deposits its eggs on the underclothing-the pediculis pubis likewise feeds on the skin; unlike the other two varieties. it also dwells on the skin, but it deposits its eggs, as the pediculus capitis does, on the hair. It is because the bodylouse dwells on the underclothing, and also deposits its eggs on the underclothing, that prurigo is so obstinate a disease. Even when, for the sake of cleanliness, efforts are made to destroy the pediculi which are ** generated " by it, the means are generally limited to applications made to the patient's skin, and are therefore futile.

Many practitioners acquainted with our views as to the nature of prurigo, have said, "Well, if the disease be due to the cause you attribute it to, I suppose a warm bath ought to cure it." A warm bath, however, has not even the slighest influence in abating the disease, and the reason of this is that the moment the patient resumes his clothes the process of hatching the ova that are sprinkled over the inner surface of his shirt recommences, and he becomes speedily as bad as ever. On this being pointed out to advocates of the warm bath, they have generally modified their proposal by suggesting that while the patient went into the warm bath his clothes should go to the wash, and that after his bath he should put on clean linen. This is a very simple way of dealing with the thing, but unfortunately it is not so easily to be disposed of.

It is well known that the lowest forms of animal life are, speaking generally, much more tenacious of existence than their superiors in the zoological scale. It will not, therefore, appear extraordinary if we assert that the process linen undergoes in the wash" does not suffice to destroy efficiently the ova of pediculi attached to the linen; but, whether this may seem likely or not, we have ascertained that the going to the wash does not disinfect the linen. The patient, whatever means may be taken to destroy the pediculi, has thus a constant supply of the disease (so to speak) stored up in his wardrobe. Every time he puts on a clean shirt, he puts on, if one may say so, a fresh supply of prurigo-that is to say, he clothes himself in linen studded with ova which only require the genial warmth of his body to mature them into the parasites on the presence of which prurigo depends.

The only way to destroy the ova in the clothes is to bake them, and this unfortunately, with the class amongst which prurigo is most common, is not an easy thing to arrange, since the poor, when affected with prurigo, are invariably treated as out-patients. If, however, there be practical difficulties in the way of radically curing prurigo by the adoption of means that would suffice to cure cases of many years' standing in the short space of half an hour, we may at least seek for the most manageable palliatives.

A due appreciation of the tenacity of life displayed by the pediculus, of the nature of the substances which are really calculated to destroy him, and of the rapidity with which lotions applied to the surface of the body evaporate and disappear, to say nothing of the difficulty of efficiently applying them to the skin, which being always rather greasy, causes them to run off it like rain from a duck's back-these considerations will explain how it is that the local applications" which "have been praised" are, as Sir Thomas Watson says, "in most cases used in vain." He mentions vinegar, lime-water, decoctions of dulcamara, lotions composed of prussic acid in an emulsion of bitter almonds, a dilute solution of creasote, decoctions of stavesacre and digitalis; continuing this list, he mentions ointments con taining mercury, tar ointment, and a hundred others;" he then tells us

how, in a case which had withstood other treatment, he succeeded by the use of aconitine ointment, and how Mr. Gabb had found a weak dilution of the liquor soda chlorinatæ very serviceable.

Now, by the above list, which may be taken as comprising all the local applications most in favour for the treatment of prurigo, it will be found that lotions are more in fashion than ointments, and this circumstance accounts to us for the general condemnation with which Sir Thomas visits the whole batch. Amongst the lotions is mentioned a decoction of stavesacre. Now, we have found stavesacre a most valuable external application in cases of prurigo, but we nevertheless endorse the opinion that the decoction is a most worthless preparation for the purpose. This we shall explain further on. But Sir Thomas also condemns ointments containing mercury." Now, if we were to agree with him in this, we must needs give up all that we have advanced, for everybody knows how justly mercurial ointment (in the shape of white precipitate ointment) is prized by poor mothers as a sovereign remedy against vermin in their children's heads, and every one knows, too, how speedily mercurial ointment will exterminate crab-lice. However, Sir Thomas modifies his censure, in so far as it refers to mercurial ointment, by the following remarkable note, which it is important to our argument to quote, and which runs thus :—

"Since the republication of these lectures in America, I have been favoured by Dr. Bowling, of Adairville, in Kentucky, with an account of a plan of treatment which he has found eminently successful against this distressing malady, and which ought, therefore, to be made generally known. I extract that portion of Dr. Bowling's obliging letter which relates to this subject:

I have, in the last fifteen years, prescribed for a great number of cases of prurigo senilis, and I can say, with a most rigid adherence to truth, that I bave not failed in a single instance to effect a permanent cure. I direct that the affected be sponged for a minute or so with good apple vinegar, and then be allowed to dry. After this they are to be smeared over with the citrine ointment (unguentum hydrargyri nitratis). The applications are to be made twice a day. The cure is usually effected in a week. I have never known the constitutional effects of the mercury to be developed in this treatment, save in a single instance, and then but very slightly.""

Although we are unable to appreciate the use of Dr. Bowling's apple vinegar, we cordially agree with him in his statement that the application of dilute mercurial ointment is one of the very best remedies in cases of prurigo, and that the smearing over of even the greater part of the surface of the body with such an application as citrine ointment is not apt to cause, even after a prolonged use of the remedy, any of the constitutional effects of mercury.

We understand, too, Sir Thomas Watson's success in the treatment of prurigo with an ointment containing a small quantity of aconitine," although we believe the aconitine had little to do with the cure. The fact is that greasy substances of any kind are more or less efficient remedies in cases of prurigo, and this for the same reason that olive oil or lard, per se, is a cure for the itch. The pediculus, like the acarus, breathes through spiracles or little apertures in its exoskeleton, which communciate with its respiratory apparatus. These minute orifices getting clogged by the grease or oil, the insect is speedily asphyxiated.

We have said that, although decoction of stavesacre is useless, stavesacre itself is an efficient remedy. The powder of the stavesacre seeds has long been employed for the destruction of head-lice, and an ointment of the powder has been long known as a very excellent remedy for scabies.

We made trial of the ointment sometime since in a large number of cases of prurigo, and found it decidedly more efficacious than lard used alone. But the ointment, being anything but an elegant preparation," owing to the coarseness of the stavesacre powder with which it was prepared, we made inquiry as to whether the powder could not be ground finer, and found that, owing to the large quantity of oily matter contained in it, it was impossible

to reduce it to anything finer than a coarse meal (for the same reason linseed when ground becomes linseed-meal). We accordingly had the oil removed from a small quantity of the meal by percolation with ether, and found that the meal was then capable of being reduced into a fine powder. We employed this powder in several cases of prurigo, and found it quite inert. On inquiring what proportion of oil had been extracted from the meal, we found that it amounted to as much as one-half (by weight) of the meal. On making trial of this oil suitably diluted with olive oil, we found it a much more efficient remedy in cases of prurigo than either olive oil or lard, and even more efficient than mercurial ointment. It was plain from these experiments that the efficacy of the stavesacre depended on its oily constituent, and this accounts for the impotence of a decoction of the seeds.

As to the internal remedies for prurigo, "sarsaparilla, alkalis, arsenic, iodide of potassium, opium," they are utterly useless if the cure of the disease be the object aimed at. The arsenic and iodide of potassium may operate, perhaps, in a trivial degree; since, at all events they are taken up into the circulation, are noxious to insect life, and in a very diluted form must reach the pediculi, which, as we know, feed upon the blood. Moreover, arsenic, after its administration has been continued for a long time, gets deposited in small quantities in a metallic state in the tissue of the skin; but the effect of these substances must be very inappreciable, unless they be taken in such quantities as to impair seriously the health of the patient. Opium, it is true, may relieve the distress of prurigo by deadening the sensibility of the patient to the irritation of his skin, but it was never pretended that, for this disease, opium was anything better than a palliative.

Before we dismiss the subject of prurigo, it may fairly be expected of us that we should substantiate our general statement as to the extreme commonness of this disease in public practice. On this head we have to say that, of a thousand consecutive cases of skin disease of all kinds, we found one hundred and sixty-six to be cases of prurigo such as we have described it, the number of cases of scabies in the same enumeration being only one hundred and forty-six; so that, if this calculation be taken as a standard-and it must be conceded that a thousand cases afford a sufficient basis for casting a fair average we must conclude that prurigo is a commoner disease even than scabies that it constitutes as nearly as possible one-sixth of the number of cases of cutaneous disease that are met with in public practice, and that with scabies it constitutes about one-third of the total of skin disease in this country. So that, if we take only two of the animal-parasite diseases of the skin (and we have others yet to deal with), we can account for one-third of the persons who suffer with skin disease, and the majority of this third are persons afflicted with the most severe, the most "incurable," and one of the most chronic of the affections to which the human skin (at least in this country) is liable.-Medical Times and Gaz. June 6, 1868, p. 600.

87.-IODIDE OF SULPHUR IN THE TREATMENT OF PORRIGO FAVOSA.

By Dr. DANIEL DONOVAN, Jun., Skibbereen, Co. Cork.

[The following cases illustrate the beneficial action of iodide of sulphur in porrigo favosa, commonly known as scald head.]

John Riley, aged 18 years, William Riley, aged 7 years, and Patrick Riley, aged 5 years, three brothers, were admitted into the Skibbereen Workhouse Hospital, February 27th, 1868, suffering from porrigo favosa in its most aggravated form. The eldest had been affected for eight years-the second for six years, and the youngest for about twelve months; their heads were covered with mouldy-looking honey-combed crusts peculiar to this disease. In some places where the crusts had fallen off. the integument presented a red-glazed looking appearance, studded here and there with yellow pustules,

and totally devoid of hair; their general health was good, and neither of them had any indication of a scrofulous diathesis.

During two months succeeding their admission into hospital various plans of treatment were adopted, such as the use of sulphur and citrine ointments, corrosive sublimate and nitras argent. solutions, and also painting the diseased surface from time to time with tinct. of iodine. Temporary relief was occasionally afforded, but the disease invariably returned in as bad a form as ever. On the 21st May, the following treatment was adopted, and produced quite unexpectedly a speedy and permanent cure. After softening and detaching the crusts by the application of linseed-meal poultices, an ointment composed of iodide of sulphur, 3i., adeps. Ziss., intimately mixed together, was ordered to be well rubbed into the diseased patches night and morning. This treatment was continued regularly, and on June 10th, a fortnight after it had been first adopted, a marked improvement had taken place; the formation of fresh scabs was arrested, the red patches of skin had almost disappeared, and hair began to grow from several portions of the scalp which were previously bald.

The three patients were discharged cured from hospital, June 30th, as there were no indications whatever of a return of the disease, and their heads were uniformly covered with hair.

If the iodide of sulphur treatment should prove equally beneficial in most other cases of porrigo, it would supply a very simple means of arresting this disease, instead of having recourse to the internal use of arsenic and iodine, and the application of caustic and poisonous lotions to the skin: the use of which remedies in the case of children, is attended with considerable risk, especially in country districts where one must often rely upon ignorant and careless people to administer them, and therefore must be very guard d how he intrusts to the hands of such persons medicines that might prove fatal, if not carefully given in the prescribed dose, or not used as otherwise directed.

It is not many years ago, before the true nature of porrigo was discovered, when the barbarous plan of applying pitch caps to the scalp was adopted on the Continent, and in some parts of Ireland where the disease was tolerably prevalent. These pitch caps consisted of strips of stout calico, spread with Burgundy pitch, or some other adhesive material, and after being firmly applied to the scalp, they were forcibly torn off in a direction contrary to the growth of the hair, so as to tear the hairs out from their roots; this plan was adopted under the erroneous impression that the disease originated in a morbid condition of the hair bulbs, and not unfrequently either scalped the victim or produced death. In this case, as in many others, microscopic and chemical research have come to the aid of medicine. The microscope has determined that porrigo favosa depends on the formation of low vegetable growths of a fungous nature (achorion schönleinii) in the deeper layers of the epidermis and upon the surface of the cutis, attacking the hair follicles, and causing alopecia in most cases. Chemical researches have discovered that sulphurous acid in a fluid or gaseous form, and the sulphites, especially the hyposulphite of soda, and the compound resulting from the union of iodine and sulphur, have a sort of special capacity for destroying the vitality of such vegetable organisms when they come in contact with them, and we thus have a rationale to follow out, when applying these remedies to the treatment of porrigo favosa, instead of having recourse to hap-hazard modes of treatment which generally produce more harm than good, and invariably aggravate the sufferings of those who are the victims of the disease under consideration. Medical Press and Circular, July 15, 1868, p. 69.

88.-NEUROTIC RELATIONS OF HERPES.

Our readers will peruse with much interest the valuable suggestions of Dr. Handfield Jones in another page of this journal. While those observations are fresh in their minds, we will shortly narrate a case that bears upon

the important question of nerve-influence in the development of disease, and may be taken as a living diagram of the phenomena. A healthy young man, a banker's clerk, perceived on Saturday evening a tenderness in his left groin, and discovered a lump which turned out to be a swollen lymphatic gland. The gland was situated just below Poupart's ligament, midway between the anterior spine of the ilium and the spine of the os pubis. It was not particularly painful; and he knew of no cause that could have given rise to it, unless, perhaps, a blow from the corner of a ledger in walking past his desk.

Forty-eight hours later, namely, on Monday evening. his attention was attracted to an itching sensation over the great trochanter of the same limb; and at bedtime he discovered an oval red blotch about two inches long by one in breadth. At the present time (Wednesday) this blotch is evidently a herpes, composed of a cluster of about forty angry-looking papulæ, not as yet arrived at the stage of vesicles; the patch is red and angry, possibly on account of pressure or friction by his clothes, the seat of the patch being the most prominent point of the hip. With the exception of a single non-herpetic pimple three or four inches above the blotch, there is no evidence of other eruption.

Looking at the two lesions, the tender gland and the blotch of herpes, what is the significance of the appearances? The gland first made itself evident: perhaps a slight blow with the corner of the ledger may have disturbed its healthy condition. The same nerve, the external cutaneous, supplies both points of interest. Was the cause one which affected both organs simultaneously? Or, was the affection of the skin a reflex irritation? Probably the latter. The first motive may have been the blow; the second the bruised gland; the third the irritated nerve; the fourth the reflection of the irritation on the neighbouring skin; a nerve paresis. Dr. Handfield Jones's case tended to show a neuralgia of one nerve, with a cutaneous manifestation of weakened nerve-force in a neighbouring nerve. Ours tends to a somewhat similar conclusion, namely, the reflex relation between a subcutaneous organ and a neighbouring part of the skin; between the deep and the superficial. The subject is a mine of pathological wealth.-Journal of Cutaneous Medicine, July, 1868, p. 220.

89.-NOTES ON ACNE ROSACEA.

By Dr. H. S. PURDON, Physician Belfast Dispensary for Diseases of the Skin, Assistant Physician Belfast Charitable Infirmary and Institution, &c.

The nose is the common seat of acne rosacea, the integument being of a deep violet colour, covered with elevations which slowly suppurate. The affected skin is thickened and infiltrated, and in chronic cases the alæ are pendulous, granulated, and liable to ulceration, in many instances the superficial veins are enlarged and varicose.

Mr. E. Wilson considers acne rosacea to be an eczematous affection, and Hebra states that "accumulated sebaceous matter often sets up an inflammation of the follicles, which would naturally be termed a folliculitis, but is generally called acne." This observation endorses the statement of Dr. Ross, who looks on acne rosacea as due to a determination of blood to the capillary vessels-a hyperæmia-which leads to inflammation of the sebaceous follicles, which pustulate, but do not mature readily.

Hardy considers acne to be a purely local disease, and, according to Mr. E. Wilson, Gutta rosacea originates in debility, most frequently assimilative, next nutritive and sometimes nervous, is chronic in duration, and possesses close sympathies with the digestive and reproductive organs."

In gutta rosacea, as well as the other forms of acne, the tongue is generally covered with a white, creamy fur, especially in the morning. When such is the case, the best treatment to commence with is the administration of the sulphates of iron, magnesia, and quinine given in infusion of calumba. This mixture will have the effect of cleaning the tongue, gives tone to the stom