indurated and infiltrate a portion of the underlying tissues and thus become a tubercle. When a pustule forms, it develops to its acme, the pus is discharged, a small crust forms and it heals spontaneously. Successive crops are continually making their appearance, so that it may happen that the patient is never entirely free of the disease for years.

Acne occurs in both sexes about equally, and as a rule, first makes its appearance at puberty. At this time the whole cutaneous system undergoes a greater or less disturbance, the hair in various portions of the body begins to grow, and the sebaceous glands are prepared for a greater functional activity than they have hitherto possessed.

The causes of acne are varied and Among those which hold a first place, however, may be mentioned disturbances of the gastro-intestinal tract. Constipation especially is a very fruitful cause of this disease, as also dyspepsia and allied disorders. These are conditions very often found more especially in young women. Besides this we have uterine disorders, such as dysmenorrhoea, amenorrhoea and genitourinary disturbances. Renal troubles act as exciting causes of acne, at times. There seems, also, to be a certain tendency to the disease, in certain families, so that it would almost seem as if some hereditability was attached to it. In addition to the internal causes, a few of the principal ones having only been mentioned, we have external agencies producing the so-called acne artificialis. Tar and similar agents are the active agents in its production, whilst the internal use of certain remedies, notably iodide of potassium, produces an artificial acne generally classified under the medicinal eruptions.

The diagnosis of acne is not very difficult. It must be distinguished from

From

eczema, syphilis and small pox. the first mentioned disease it is easily distinguished by the absence of itching, and from the fact that eczema of the face is rarely papular or pustular in character. The history, moreover, would serve to distinguish the two very easily. The papular and pustular syphilo-dermata must be examined a little more closely, especially the acne form syphiloderm, which sometimes occurs upon the forehead, as the corona Veneris. The history, the presence of other lesions, the tendency of syphilitic lesions to group, and the length of time the lesions exist, if carefully considered will make the diagnosis clear. As to variola, the history would be sufficient. The chronic nature of acne, the comparatively short period of time between successive crops, the locality attacked, the age of the patient, the inflammatory nature of the lesions, the absence of subjective symptoms, and the anatomical seat of the disease (the sebaceous glands), should never be forgotten. It is an uncommon thing to see acne in a child before puberty, or in a person beyond the forty-fifth year.

The treatment of this disease should be constitutional and local. The gen. eral measures employed should be such as will tend to bring the patient to as normal a condition as is possible by therapeutic means. The condition which is most common and most constantly demands attention is the constipation which exists. To overcome this the diet, in the first place, should be so regulated as to insure the greatest amount of nutrition with the least amount of labor on the part of the stomach and arranged so as to preclude the condition of constipation or a tendency thereto. To make the bowels more regular, fluid extract of cascara sagrada, or the aperient mineral waters

are useful.

An occasional dose of calomel will be of benefit. The following aperient mixture given by Duhring gives excellent results: R. Magnesiæ sulphatis, jss; ferri sulphatis, gr. xvj; acidi sulphurici dil. 3 ij; aquæ, 3 viij. M. Sig. Tablespoonful in a tumbler of water. This should be taken about twenty minutes before breakfast or, if necessary, before supper also.

Besides the general remedies indicated in the case we have some which do good occasionally. Sulphide of calcium, in quarter grain doses four times a day, is sometimes indicated in the suppurative form. Arsenic is useful in the indurated forms or where the papules are imperfectly developed and may be given in two or three drop doses of Fowler's solution in wine of iron or in one drop doses of a one per cent. alcoholic solution of bromide of arsenic thrice daily after meals.

The local treatment is to be either soothing or stimulating according to the indications which are present. In the greater number of cases the latter plan must be adopted. Soothing applications and lotions and bland ointments should be employed where there is a high grade of inflammation. The methods of stimulating are numerous. Sapo viridis, pure or diluted, may be applied at night, following this with a bland ointment. The pustules should be opened and their contents squeezed out. Hot water cloths applied at night and followed in the morning with cold douches and frictions are valuable. Sulphur is a very good remedy to apply, and may be prescribed in ointments or lotions in strength varying from twenty grains to two drachms to the ounce.

The following lotion recommended by Bulkley is good: R. Sulphuris loti, 3j; ætheris, 3 vj; alcoholis, iijss M. Sig. Apply as a lotion. Sulphuret

of potassium may be used as also Vleminckx's lotion. Where more active stimulation is required, biniodide of mercury or corrosive sublimate, or protoiodide of mercury, or ammoniated mercury can be used.

The surgical treatment is often of greater value, more especially in the indurated and tubercular forms, and care should be taken to cut well into these lesions passing through the centre and applying warm cloths so as to induce free hemorrhage. In conjunction with this, the sulphur and mercury ointment mentioned in the "Talk" on Comedo will prove serviceable.

One point which should not be forgotten, is to examine male patients for urethral stricture. If such exists, bougies should be introduced or other means employed to enlarge the calibre of the urethra at the part of constriction. In a number of cases the beneficial effects of this treatment will be observed in an amelioration of the skin trouble.

The prognosis of acne depends, in a great degree, upon the cause producing it. It has a tendency to be chronic and is generally stubborn to all treatment to a greater or less degree. There is a tendency to spontaneous recovery at about the twenty-sixth year, but if the cause of the disease be corrected and appropriate local treatment instituted success will be pretty fair.-St. Louis Medical and Surgical Journal.

Peculiar Skin Disease of the Feet.

Before a recent meeting of the Montreal Medico-Chirurgical Society, Dr. R. J. B. HOWARD exhibited a boy, twelve years of age, of healthy family. He has angular curvature, involving the lower dorsal region, first noticed when he was three and a half years old. His

feet were first affected in his sixth year. A small "scurfy" spot appeared first on the right foot, and has spread steadily, healing at the centre. When he came to the dispensary, it appeared as a lupiginous patch about four inches across, on the right ankle and instep; smaller similar patches existed on the outside of the right little toe and left great toe, at metatarso-phalangeal joint. The patch is covered with a crust or scab of a somewhat papullary appearance. Not tender or painful at any time and never ulcerated. Dr. Howard brought the case for diagnosis. He thought it was due to some derangement of the spinal cord at the seat of the curvature, as nerves from this region supplied the skin of the feet.-Maryland Medical Journal.

[In all probability an affection of the trophic nerves, such as are met with in some diseases of the cord.]

A. H. P. L.

Disorders of Perspiration.

garded as diseases, for they are never conspicuous unless in the presence of some derangement of the internal organs of the body.

Idrosis simplex. This disorder of the function of perspiration is the most common, and is divided into subacute and chronic. An attack of subacute idrosis usually terminates in a week or two, and is more often partial in its appearance than general; and in two or three days after its existence a crop of vesicles show themselves about the neck, trunk, and abdomen, and usually pass to the armpits and inner parts of the thighs. This form is attended not only with feverishness, but with disorder of the alimentary canal. The only treatment this form requires is a correction of any disorder of the stomach and bowels and the prevention of its sudden arrest, lest its untimely disappearance be followed by a congestion of some of the internal viscera. This variety is also known by the name sudatoria miliaris. Chronic idrosis differs

Dermatologists have given to these three disorders of perspiration, distinctive names. They have named augmentation of perspiration, idrosis, ephidrosis, and sudatoria; and they divide this into idrosis simplex and idrosis maligna. A diminution of the secretion of perspiration is called anidrosis, and an alteration of the secreted perspiration is known by the term osmidrosis. Anidrosis refers to that condition of the perspiratory fluid which is manifested during the continuance of febrile diseases, and osmidrosis relates to the character of the odor which the perspiration gives out during the existence of certain diseases of the body. These two varieties of morbid perspiration are evidently to be more respected as symptoms than re

feature that it is not apt to be accompanied by either constitutional disturbance or the appearance of miliary vesicles, but is prone to be very chronic, and in some instances will and does thus continue, independent of any other affection, in a general form for five or ten years; but its rule is to be partial, and confine itself to either one side or the other of the body, generally to the hands and feet.

I was once consulted by a female patient, who informed me that she only sweated on one side-the left side-and she had not sweated on the right side for years. The scalp, perineum, groin, and axilla are attacked by it; and in consequence of the acid character and disagreeable odor of the perspiration which belongs to idrosis, it becomes a

source of great annoyance to the patient. The perspiration is sometimes. so profuse as to keep the inside skin. of the hands and the soles of the feet in a softened, corrugated condition --like that which the skin will present after being kept in warm water for a long time. The sweat in extraordinary cases of idrosis is blue, green, yellow, and sometimes black or red; but this is a rare abnormal condition, and has received the names hæmidrosis and chromidrosis. Idrosis maligna is the name which was given to the sweating sickness of the sixteenth century.

The Treatment. There is no doubt, then, in many cases of simple idrosis, that the disease owes its origin to a chronic inflammation of the perspiratory tubes themselves, and is therefore a purely local disease; but in other cases it is evidently symptomatic of some derangement of the general system. Notwithstanding this, it is usually an obstinate disease, and requires tedious treatment for its cure. The first duty in the treatment is to regulate the secretions of the alimentary canal. For this purpose, a dose of blue mass should be given, followed by the following mixture: B. Sodii sulphat., 3j; acid. sulphuric dilut., 3 iss; aquæ carui, 3 viij; ext. gentian. fld., 3j; Fowler's solution, 3 j. M. Sig. - Shake well. Dose, a tablespoonful before each

meal.

This should be continued until the arsenic shows its effect in producing puffiness of the eyelids and slight swelling of the face. At the same time, the following will be found very useful: B. Resorcin, 3 iss; tinct. aconit. rad., gtts. xxxij; liquor ammoniæ acet., 3ij; syrup aurant. cort., aquæ distil., āā 3j. M. Sig.-Shake well. Dose, a teaspoonful every every three hours.

The dose of tinct. aconite should

be increased gradually to fifteen drops a day.

It is reported that extract of aconite cured a case of chronic general ephidrosis which had lasted for six years independently of any other affection, and which, after resisting various remedies, did yield to the power of this drug given in the beginning, in doses of onehalf grain three times a day, and gradually increased until sixteen grains a day were given, and so continued until the disease was cured. In cases needing a tonic treatment, this formula will probably be found to be very serviceable: R. Tinct. ferri perchlor., 3 ij; liquor strychniæ, gtt. xxxvj; liquor ergotæ, 3 ss; syrup. simpl.; aquæ distil., āā 3 iij. M. Sig.-Shake well. Dose, a tablespoonful three times a day.

Local treatment is not to be neglected in cases of idrosis of the hand and feet. As an application to the hands, I have found the following most effectual: R. Pure Carolina pine tar; alcohol, āā, 3 j. M. Sig.-Shake well and apply with

a camel's hair brush to the hands twice a day, and keep them protected by cotton gloves.

Should this fail, a mixture of : B. Acid. tannici, grs. xxx; glycerinæ, 3j. M. Sig. Shake well and apply two or three times a day to the hands or feet.

Should this also fail, chloride of lime and tannic acid may be tried: R. Calcis chlorin., 3 iij; aquæ distillat., Oj; solue et cola, et adde, acid tannici, 3 iij. M. Sig. Apply to the hands or feet two or three times a day.

The following will be found a good application to the hands and feet: R. Richardson's styptic col., j; carbolic acid, grs. xx. M. Sig.-Apply three or four times a week.

A strong solution of alum may be tried, and for the feet, a strong brine

foot bath ought to be tried every night at bedtime This, or whatever course of treatment is adopted, must be continued patiently, and with perseverance.

The Various Forms of Eczema in Children. PROFESSOR GRANCHER (Journal de Medecine. Here we have four little eczema patients presenting very different appearances. The first has a simple impetiginous eczema of the face which appeared quite recently and which, despite its apparent severity, will disappear quite rapidly. It amounts to very little. The second case (æt. 7) is more complex. The affection commenced when the child was 5 months old, and appeared upon the cheeks and eyelids. It has since continued almost constantly. The child has had for years the appearance of wearing a sort of dripping mask. She formerly contracted varicella, a complication which made the case a very interesting one. It was observed that the eruption of the varicella was much more confluent upon the parts originally attacked by eczema than elsewhere. During convalescence from varicella, the child's eczema greatly improved. It then contracted a light form of whooping cough, followed by severe diphtheritic angina, and, following these affections, the eczema completely disappeared.

scarlatina.

Before the eruption appeared the eczema suddenly took its departure. The scarlatina rash was very abundant and was strongly marked on the eczematous regions. The pruritis disappeared for 10 days, and then the eczema returned with all of its former symptoms.

Another patient, who had been attacked three times before with eczema, followed by a scarlatinaform desquamation, came to hospital with an acute attack, accompanied by intense fever which gave way rapidly to treatment. These four cases, so different, yet all of them attributed to "eczema" show how difficult it is to fix upon the true characteristic of the malady.

A Guiana gentleman consulted the greater part of the European dermatologists for an eczema of long standing which covered his face with a veritable. mask of vesico-pustules, and had extended to his arm. Various methods of treatment brought no relief. Certain topical applications ameliorated the condition of the arm to a certain degree, but the facial eruption remained stationary. Cod liver oil was prescribed, and the patient was soon able to take 12 teaspoonfuls a day. A month later there was a considerable amelioration of the trouble, and two months afterward the cure was complete. The patient has continued well for a long time, and compensates for the defect in his nutrition by taking a certain quantity of cod liver oil from time to time. The interest of the case centres wholly in the fact that it was cured by internal nutritive medication, and it is impossible not to see in it a demonstration that skin diseases are not local maladies so often as is supposed. Most of them are referable to a defect in nutrition and get well when that defect is remedied.—