those cases where there is considerable swelling and varicose dilatation or extensive ulceration is Sulphur my chief remedy. In my lengthened experience of this very common affection in dispensary practice I have found no remedy equal to Sulphur in such cases. Though I have seen occasional curative results from Mercurius, Lachesis, Hamamelis, Graphites, and Pulsatilla, in ulcers of the legs, I always resort to Sulphur. It is remarkable how rapidly it often causes amelioration, and above all how quickly it removes the intolerable burning pain. And this it does under the most unfavorable external circumstances which permit of no release from a standing posture, in compositors, printers, cooks, &c., and even where any adequate cleanliness and bandaging of the ulcer is impossible. There is hardly any possibility of employing any of the external adjuvants that are of so much use in the treatment of ulcers of the leg; a horizontal position of the limb or strapping the ulcer with sticking plaster is never attainable. The utmost that

can be done is to apply linen rags spread with beef suet, and, perhaps, a cold water compress at night. Although in some cases under these unfavorable circumstances Sulphur 30 will display its power, I now almost invariably give from 3 to 5 drops of the undiluted tincture of Sulphur every night and morning, because I have seen the most rapid, marked, and certain effects from this dose.

I will not here detail the cutaneous symptoms of Mercurius that point to eczema, for these are given so fully and lucidly in our Materia Medica (vide Noack and Trinks' Handbuch, vol. ii), to which I refer the reader for each individual form of the disease.

Mercurius is not nearly such a sovereign remedy for eczema on the hairy parts of the head (tinea capitis), which is very frequent among children here and generally occurs in combination with eczema impetiginodes with swelling of the lymphatic glands. In this affection Rhus toxicodendron is the chief remedy, as it is also in most facial eruptions if they are of the eczema or lichen form and not too strongly complicated with impetigo or running on to ulceration. When this last is the case Mercurius and Sulphur are

again to be preferred, the former, especially in impetigo on and behind the ear. But I have seen no good effects from Rhus in favus. This disease is generally very obstinate, and requires a careful external treatment with frequent ablutions with soap and water and moistening of the scabs with oil. The best internal remedies are Spongia, Graphites, and Cotyledon.

Eczema rubrum of the face is also a very obstinate disease. Not only is the burning and itching of it extremely tiresome and the serous secretion often so copious that it trickles down the face (especially in the case of women after confinement and after weaning), but the relapses every six, eight, or fourteen days, are very difficult to be be prevented. At least I have never seen any decided effects from Rhus, Apis, Euphorbium, or Ranunculus.

In eczema scroti and pudendi, Aurum, Graphites, Rhododendron, and Petroleum are particularly recommended, but I must confess that I have never seen much effect from these remedies, and I have much greater confidence in Mercurius and Sulphur.

Lastly, I will mention that according to my experience eczema is one of those exanthemata, the sudden cure of which, whether it occur spontaneously or by the incautious use of external remedies, is not unfrequently followed by serious affections of internal organs, and we sometimes see chronic diseases relieved or even disappear on the occurrence of eczema. Hence, we require to be cautious in the employment of external remedies, especially in cases of the latter description. Whether this proves the true constitutional character of eczema or whether the metastases are only to be ascribed to the suppression of the profuse secretion that accompanies the eczema, the difference of which I have already alluded to above, I am unable to determine. In young children I have several times observed serious meningitis follow the spontaneous rapid drying np of moist eruptions on the face and head, but my impression is that this drying up has usually been rather the effect than the cause of the meningitis. I have not unfrequently observed

alternating exacerbations of asthmatic, cardiac, and pulmonary disease and chronic eczema of the legs.

Herpes.

The various forms of herpes, as phlyctenodes, circinatus, and zoster, are generally curable by Mercurius and Sulphur, and in some cases by Rhus, Ranunculus, Graphites, Arsenic, &c. Many of these exanthemata get well without medicine, as, for example, herpes labialis in acute diseases (generally inflammatory affections of the lungs) and herpes preputialis. On the other hand, herpes zoster is often a very disagreeable affection on account of the excessively severe burning pain, and the frequently persistent intercostal neuralgia. Rhus, Mercurius, Arsenic, Dulcamara, are particularly recommended for zoster, and their skin symptoms all present a certain resemblance to this peculiar cutaneous disease. However, I cannot say that I have ever seen any very decided curative action from any of these remedies. Whichever of these remedies I have given the affection would run its course, sometimes quicker, sometimes slower, sometimes with more, sometimes with less, burning pain. I have most confidence in Mercurius. I have seldom had to treat the secondary neuralgic pains, and never in any great severity (perhaps this may be owing to the remedies I have used?); Dolichos pruriens and Zincum are recommended for it.

Herpes of the fingers frequently occurs, that looks very innocent, but is attended with excessive itching; sometimes lasts long, and is apt to produce injurious effects on the nails and joints. I have generally found Ranunculus bulbosus in the 6th or 3rd dilution to be of service.

On the whole, the herpetic exanthemata, in comparison with the eczemata, are usually slighter affections, and frequently get well of themselves. So-called metastatic

secondary diseases are seldom or perhaps never observed after them. On the other hand, the pemphigus of newborn infants is often very obstinate and even dangerous. I

have seen some cases where new blisters constantly broke out, developing with extreme rapidity into raw exuding spots the size of the hand. What with the constant screaming, the refusal of food, fever, and complete suppression of the urinary secretion, the little patients were so reduced that death seemed imminent. I gave several remedies, such as Apis, Urtica, Cantharis, Lycopodium, the disease at length took a favorable turn, but I am unable to say whether any one of the remedies, far less which of them, contributed to the favorable result. Probably warm baths, and alleviation of the burning pain by supplementing the loss of the epidermis by the artificial aid of cotton-wool, dusting with starch-flour or the like, did most to promote the cure.

Urticaria.

In the case of dispensary patients, whose visits are almost invariably very irregular, it is very difficult to determine what effect the prescribed remedies have on the temporary or radical disappearance of the exanthema. The nettlerash appears on one spot of the skin and perhaps vanishes soon to reappear after a short time on the same or another spot. It is only in the case of chronic urticaria that it would be possible to establish the action of remedies with certainty were it not that the patients are too apt to cease attendance when they have obtained some alleviation, for they do not think the malady important enough to subject themselves to a lengthened treatment in order to obtain a radical cure. Moreover, the cure of nettlerash is to a great extent dependent on the avoidance of various local and general exciting causes, which is a matter of great difficulty with dispensary patients. In the chronic form that is liable to burst out after any dietetic error or after any overheating or mental excitement I have generally employed Apis, Clematis, Dulcamara, Copaiba, and Urtica, but without any marked result; in acute cases Aconite sometimes seemed to have a favorable effect, at all events on the troublesome itching.

Acne, Impetigo, and Lupus.

In that most obstinate affection acne, which in the form of acne punctata faciei so frequently attacks young girls and boys, I have for many years tried various remedies. I have sometimes seen decided good effects from high dilutions of Belladonna and Pulsatilla, but very often no effect at all. Latterly I have generally employed Sulphur, and direct the affected parts of the face to be washed at night with the undiluted tincture. When large pustules appear here and there I prescribe Antimonium tartaricum or crudum. Of all remedies Tartar emetic is most decidedly and markedly specific to impetiginous and erythematous eruptions. I may refer here not only to its well-known property of causing a pock-like exanthema when rubbed on the skin, but also to the various pustular eruptions caused by its internal administration which are recorded in our Materia Medica. Antimonium crudum alone displays a similar marked resemblance in its skin symptoms, and doubtless it would do this in a still greater degree were not its proving so imperfect and incomplete. This may also be the reason of its rare administration and neglect by us, which I regret much, as latterly I have frequently witnessed its extraordinary efficacy in affections of the skin and respiratory tubes. I have reason to think that Antimonium crudum is an invaluable remedy in all cutaneous affections where pustules, pocks or furuncular excrescences, or pimples and boils, arise primarily or secondarily, especially when at the same time there is severe, continued pricking itching of the skin, and after rubbing tenderness and soreness. These indications for Antim, crud. may occur in the most various forms of exanthema, in eczema, prurigo, scabies, acne, impetigo, ecthyma, &c., and in my opinion always furnish a particular indication. They may appear on any portion of the skin, but specially call for Antim. when they occur on the face or genitals. I may particularly mention an impetiginous eruption on the scrotum that is by no means uncommon and is very tiresome and obstinate. VOL. XXXII, NO. CXXVIII.-APRIL, 1874.