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sons of iEsculapius, who favour that fortunate locality with the benefit of their learned services. If our article shall call forth a second advertisement of similar character we shall wish the latter all success for the sake of those interested, but as we have been rigidly careful to make no statement in the course of our remarks which will not bear the strictest investigation, we stand in no fear of criticism, and however many exploded vagaries may be trumped up in maintenance of theories long since discarded, we, at least, shall assuredly not cry peccavi. And as we do not understand that the echoes of the Madeiranese outcry were so distinctly audible in this country as to disturb Dr. Ireland's well-earned nocturnal repose with their thunder, or to distract the attention of the editor of the Edinburgh Medico-Chirurgical Journal from his important labours, we take our leave of the subject of Madeira, satisfied with having spoken the truth, and with the consolatory assurance that as any counter-statements must be destitute of foundation in fact, so remote provincial vituperation is impotent of harm.
ON THE TREATMENT OP SOME SKIN DISEASES.
By Dr. Clotar Muller.*
The Leipzic Homoeopathic Dispensary, with which I have been connected as ordinary medical officer for a long series of years, has brought under my observation a rich array of exanthematic diseases. In some kinds of these diseases I believe I have observed in my frequent treatment of them a certain steadfastness in the occurrence of certain results. I therefore do not hesitate to give a resume of my observations and deductions respecting them with all caution. These will doubtless be comparatively few in number if I confine myself to what seems to me the necessary limits. Not that the number of cures effected was so very small, although these must be regarded as not very numerous compared with the number of cases treated, owing to the difficulty of exercising any control over the patients frequenting a dispensary. But in conformity with the special object of this communication I must pass over all those curative results even of a striking and decisive character which only occurred in single cases and were not confirmed on the occurrence of analogous circumstances. In like manner no notice can be taken here of all those cures where the curative medicine was chosen not exclusively or chiefly with reference to the exanthematous symptoms, but with reference to the general morbid phenomena, whether these were the consequence or the cause of the skin affection. For in the great multiplicity of these morbid symptoms, which may be present in the most various forms of exanthemata, the skin symptoms themselves have little or no influence on our selection of the drug, and it would be incorrect to infer that the same remedy would again be useful in the same form of skin disease if the general morbid symptoms that determined the selection were not likewise present. In the present short communication, I repeat, I shall confine myself to the few constant curative results obtained in certain forms of exanthemata, in which that which determined the selection was found in the skin symptoms themselves, and, consequently, I was able to repeat the curative experiment with the medicine in the same cases of skin diseases, and others may now test the matter for themselves.
*Internationale Hom. Presse, iv, 1. VOL. XXXII, NO. CXXVIII. APRIL, 1874. P
Limiting myself thus, I shall not enter into the question of the constitutional or local nature of skin diseases, nor as to whether Hahnemann's psora theory should be accepted fully or with limitations, or entirely rejected. But I may be allowed to make a few general observations on this latter point suggested by a postscript by Dr. SiissHahnemann to Dr. E. Blake's paper translated in the first volume of the Internationale Horn. Presse.
Whether Hahnemann, if he had become aware of the existence of the Acarus scabiei, would have treated the itch with external remedies cannot be determined by the views he has enunciated in his writings respecting parasitical diseases. In this I quite agree with his grandson; but the question is rather an idle one. It is, however, certain that a knowledge of the acarus would have caused Hahnemann to modify his psora theory as far as regards the nomenclature of those skin diseases which he believed to constitute the prominent signs and essential symptoms of the psora dyscrasia. If he specially reckoned the itch among these, and, indeed, frequently used the terms "psora" and "itch" as synonyms, he would certainly, on recognising the essential character of the acarus itch, have either excluded it entirely from the list of psoric symptoms or only admitted it iu a modified manner. But this would assuredly have in no way militated against the psora theory itself, or against the maxim that skin diseases are of a constitutional and not a local nature. For in a certain and strictly scientific sense the acarus itch does not belong to the cutaneous diseases or exanthemata at all, but can only become such in consequence of neglect or long duration, like the affections caused by the head and body louse. If, in consequence of our present knowledge of the acarus, we will accustom ourselves to separate the idea of the acarus itch completely from psora and to substitute for the latter some dyscrasia more in accordance with our present pathological views, such, for example, as scrofulosis, then no valid objection can be raised against Hahnemann's psora theory and its main consequences. No one will deny that the skin diseases of the so-called scrofulous are of a completely constitutional character, that their imprudent suppression by* external desiccating remedies is frequently attended with danger and is always useless in respect to the cure of the dyscrasia. Moreover, it is well known that the scrofulous dyscrasia finds its chief subjects in the children or descendants of syphilitic parents, and hence may be regarded as an outcome or development of syphilis or sycosis, therein agreeing with Hahnemann's dictum respecting the three sources of all chronic diseases.
If then, according to my view, we are not justified in rejecting Hahnemann's psora theory as an obsolete idea or even as an absurdity, and in asserting that the homoeopathy of the present day ignores it, so, on the other hand, the orthodox followers of Hahnemann's homoeopathy should guard themselves against asserting too much and obstinately holding to the letter of his doctrine. I will not here speak of the antipathy to the local treatment of the acarus itch, i. e. of the destruction of the skin vermin by the direct application of remedies, for such one-sidedness and obstinacy can Only be accounted for by a deliberate shutting of the eyes to undoubted facts. But, besides the acarus itch, there are evidently other skin diseases which, at least at their commencement, and ere they have lasted too long, are of a purely local nature and may certainly, and without any injurious effects, be removed by external remedies or by the knife, and I do not here refer merely to warts, callosities, corns, horns, certain encysted tumours, &c., but also to exanthemata strictly so called. Certain cutaneous affections, as favus, condylomata, prurigo, lupus, &c., can hardly ever be removed, radically and permanently, without the aid of external remedies, and the danger of producing more serious diseases by cures of this kind is, on the one hand, exaggerated and merely supposititious, and on the other, if it really exists, as it does in all constitutional and particularly in exuding skin diseases, generally owing to other causes and processes. For when, after the sudden disappearance of an exanthema other disturbances of the health ensue, this is not always a proof, as some partizans of the psora theory allege, that the former supposed constitutional malady is now driven to another organ and has undergone a dangerous aggravation, but even when the latter disease stands in causal relation to the suppressed skin disease this relation is usually limited to the imprudent and sudden suppression of a secretion to which the organism has become habituated. In illustration of this I may refer to the precautions with which in former days issues that had been kept long open were healed up, because it too often happened that after the sudden suppression of the accustomed suppuration evil effects were observed. No one will seriously contend that the artificial suppuration kept up by the pea was a constitutional (psoric) affection, which after its suppression in the arm flared up in a worse form in an internal organ. It is precisely the same case with many of the so-called metastases after the removal of skin diseases. Hence it follows, in my humble opinion, that though it is doubtless very irrational and blameable to suppress quickly skin diseases, especially such as exude freely, even though they may be of purely local nature, by means of external desiccating remedies, still, it is not correct to infer that the diseases that subsequently occur are direct metastases, i. e. new and more dangerous forms of the dyscrasia that was previously confined to the skin.
In what I have said I do not mean to curtail too much the number of skin diseases depending on constitutional dyscrasia, far less to account for the danger of rapid curing merely by the suppression of accustomed secretions. On the contrary, I think there can be no doubt that besides the scrofulous and syphilitic exanthemata there are many other real constitutional skin affections whose appearances and disappearances stand in direct alternating connection and in direct causal relation with often dangerous maladies. In this category we must reckon some apparently unimportant eruptions without any discharge, as, for example, the usually dry insignificant baemorrhoidal eruption round the anus, &c. All I contend for is that here as elsewhere in medicine we must draw distinctions and not estimate all exanthemata alike. Just because I would wish to see the Hahnemannic psora theory maintained, and not heedlessly sacrificed to the prevalent hypermaterialism, I am anxious that it should be rightly understood and kept within its legitimate bounds. I hope these few lines may serve as my humble contribution to this object.
Scabies and Prurigo.
These two exanthemata are certainly far from being identical, but they not only frequently occur simultaneously,