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 in a modified manner. But this would

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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. 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 homœopathy 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 hæmorrhoidal 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,

but they have also this in common that both are exclusively caused by external local influences on the skin, the itch by acari, and prurigo chiefly by want of cleanliness, lice, discharges, scratching, dust, and other cutaneous irritants. The treatment of both will consequently be in many cases the same; for even the acarus itch generally requires some subsequent treatment after the acari have been killed, for even on those parts of the skin where no acari existed (their chief seat being betwixt the fingers and on the wrist) we find secondary and sympathetic eruptions (papulæ, vesiculæ, or impetigo).

In the dispensary I generally use for killing the acarus soft soap, which I direct to be well rubbed into all the affected spots for three successive nights and only washed off the following morning. If this does not suffice, then I order a watery solution of styrax to be used in the same way. This is cheap, it leaves behind it no penetrating odour, nor does it cause any permanent stain on the linen. In very obstinate cases these rubbings must be repeated after a week or a fortnight, but this is generally because the first rubbing was not performed with sufficient energy. At the same time I give internally Sulphur or Mercury. The choice betwixt these two remedies is rather difficult; the

common saying that the characteristic eruption of Sulphur is papular while that of Mercury is vesicular does not settle the matter, for in many cases both forms of eruption occur mingled together in one person and besides these not unfrequently pustules. In prurigo, and particularly in itch, the external form of the local eruption is of no great consequence; it often depends on purely external and accidental circumstances, and Hebra is not far wrong when says, "The exanthema of itch depends on the length of the finger nails." In most cases, but especially in old and neglected itches, I begin by giving Sulphur, from three to five drops of the tincture night and morning. If, after ten days, that is to say, seven days after the last rubbing-in, there is no diminution of the eruption, and particularly of the itching, then I give Mercurius solubilis, as much of the 3rd trit. as will lie on the point of a penknife in a tea

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spoonful of water every night and morning; at the same time, if the acari appear to be not all destroyed, I direct three more rubbings-in of soap or styrax. If the eruption is from the very first generally vesicular, or set thickly with vesicles and pustules, or if the patient has already been treated with sulphur ointment and baths, then I give Mercurius at once. I am unfortunately unable to give a precise differential diagnosis for the employment of Sulphur and Mercury founded on the essential differences in the local and general symptoms of both remedies, for the chief characteristics of itch are possessed by both remedies in equal degree. Among these chief characteristics (passing over the local peculiarities of the eruption) I include particularly the aggravation of the itching at night and in the heat of the bed and the general irritability of the skin, which, by scratching on one spot, spreads over almost the whole surface and is thereby aggravated to the utmost.

Under this treatment many cases are quickly and perfectly cured, and I have never observed that so-called metastases and bad effects occurred in those cured either immediately or later. Still very many cases remain uncured after a longer or a shorter treatment. This, however, I must attribute less to the insufficiency of the treatment prescribed than to the unfavorable conditions surrounding dispensary patients. For, apart from the circumstance that the frictions are generally performed in a very careless and imperfect manner, the living together of whole families in a confined space, and especially the sleeping of several children together or with their mothers, forms a constant source of new infection by the acari, so that it constantly happens that a child who has been freed from the acari by the rubbings-in, will be infected anew a few days afterwards by the bed or body linen. We must also take into consideration the numbers of those who do not return to report whether they have been cured or not. These certainly constitute disadvantages enough to explain the fact that the percentage of cures of itch patients is very small, and that the results of the treatment are apparently unfavourable. I have consequently often had serious