scalp adjacent to the first, or elsewhere, and two or more may coalesce to form an irregular figure. The patches persist some months, or a year, and gradually become covered with hair, so that complete recovery takes place.

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The Pathology is still quite obscure. The disease has been ascribed to a wave of nerve influence," but no other indications of such nerve influence are perceptible. Histological examination of the skin has shown atrophy of the hair follicles, and round cell infiltration of the outer root, sheath, the surrounding skin and subcutaneous tissue.

The Diagnosis presents no difficulties, as ringworm is rarely so completely bald, and the stumps of hairs have a different appearance.

Treatment.-This consists in such tonic treatment of the general health as may seem indicated, and the application of local stimulants, and irritants— such as ammonia liniment, or tr. cantharidis in water (1 to 8), or acetum cantharidis, or tr. cantharidis 3ss, carbonate of ammonia gr. xl, and sp. rosmarini, 3ss, with water to 8 ounces, or linim. myristica of Guy's Hosp. Pharmacopoeia (ol. myrist. exp. 3j, ol. olivæ 3iij). One of these should be rubbed in every night, to the extent of producing slight redness only. The faradic brush and occasional blisters may also be employed.

UNIVERSAL ALOPECIA AND CONGENITAL ALOPECIA.

In the former the hair falls from every part of the body, scalp, eyebrows, axillæ, and pubes, so that not a hair is left. As a rule, no cause can be assigned, and the cases are incurable. In the latter, the nails are wanting as well as the hair. These cases may be hereditary.

SYCOSIS.

This is a chronic inflammation of the skin of the beard and hairy parts of the face, beginning in or around the hair follicles. The infiltration is deepseated, pus forms in the follicle, and the hair is loosened. If the pus escapes it dries up into an adherent crust. The pustules may be at first isolated, but the intermediate skin is involved, and considerable infiltration takes place, the part being red, irregular, nodulated, with pustules and adherent crusts.

A somewhat similar condition arises from the action of the parasite of ringworm, and this is known as parasitic sycosis. But the non-parasitic affection is the more common. It may be confounded with eczema, but in this there is more itching, the lesions are more superficial, and generally extend beyond the limits of the hairy parts. Sycosis occurs exclusively in male adults. Treatment. The disease is most obstinate, but may be cured by perseverance. The hair must be cut close, the crusts must be removed by softening with poultices, or oiled lint, and the hairs must be removed.

Epilation may be begun with the hairs that are loosened by inflammation, and only subsequently, if necessary, it may be extended to others. The

inflammation may be allayed by the use of lead and zinc ointments, applied thickly on rags. As the hair grows it must be constantly cut, and epilation steadily persevered with. When the infiltration has subsided, and the pustules are less numerous, the hair may be shaved. Months of steady treatment may be required.

VEGETABLE PARASITES.

There are three forms of fungus which invade the hair and skin-Trichophyton tonsurans, Microsporon furfur, and Achorion Schönleinii. The first is the contagious element in ringworm of the head, ringworm of the body, Burmese ringworm, and parasitic sycosis; the second is the fungus of tinea versi color; the third is the fungus of favus.

THE TRICHOPHYTON TINEÆ.

TINEA TONSURANS.

(Ringworm of the Head.)

This disease is the great scourge of schools, and allied institutions, among the poorer classes. It is frequent in children, rare in infancy, and not easily caught by adults. It spreads by contact, and by the use of hats, caps, brushes, combs, and towels in common.

It generally first appears as a round patch, on which the growth of hair is much thinner than elsewhere. On close examination the skin is seen to be pink, perhaps a little swollen, and covered with minute branny scales. Besides the thinly scattered long and healthy hairs are seen a number of broken stumps of hair, opaque, black or dark brown in color, twisted and bent. If an attempt [be made to extract one of these broken hairs with a pair of forceps, it will almost certainly break off short; if then placed under the microscope, and moistened with a drop of liquor potassæ, it will be seen that the natural structure of the hair is unrecognizable. The substance is quite opaque, the fibrous and epithelial markings absent, and the shaft seems to be converted into a mass of fungus spores (conidia). The mycelium tubes running in a longitudinal direction may also be observed in hairs that are less completely affected.

The patch spreads by the implication of hairs at its circumference, and fresh patches form in other parts of the scalp, As they enlarge they become more completely denuded of long hair, though they nearly always present a considerable quantity of the short stumps which have been described; and these may be surrounded and mixed with scabs, crusts, or sebaceous matter, or with a fine whitish powder, of which probably the fungus elements form a

part. Sometimes the inflammation is much more decided; the hair follicles inflame, coalesce, and a red or pink swelling occurs, which is soft and boggy to the touch, discharges pus from a few points, and tends to become quite bald from the loosening and falling out of the hairs. This condition is known as kerion. In most cases, however, the inflammation does not reach any considerable degree. The patches spread slowly, some may heal in the centre, as they extend at the edges, the patches may coalesce, and nearly the whole scalp may be affected. Sometimes, on the other hand, one or two patches persist without improvement, but without spreading. The disease may last years, but eventually dies out, and the hair is perfectly restored, except possibly over patches of very severe kerion.

There is some difference of opinion as to the exact way in which the disease begins. Probably the spores invade the hair close to the scalp, and push down toward the bulb. The hair in the follicle is thus weakened or destroyed, and as it is forced outward by the newly-formed epithelial plates, it breaks off. The newly-formed epithelium is, in its turn, invaded, as soon as it gets into the horny condition. It has been shown by Dr. Thin and myself that the fungus only invades the hair itself, and cannot be found in the root-sheath or the structures of the hair follicle.

Treatment. In order to be successful, this requires to be carried out with the greatest pertinacity, and even then six, nine, or twelve months may elapse before the disease is perfectly cured. The difficulty lies in the fact that the spores multiply in the hair follicle, and are therefore, to a large extent, protected from the parasiticides employed. The first thing is to cut the hair quite close, and remove all crusts and scabs, by soaking with oil, and subsequent removal and washing. The extent to which hair is removed may vary with circumstances. Complete shaving is best; but where it is desirable to save appearances, a fringe of hair may be left all round the head, or with a single patch the hair may be close cut or shaved for an inch or more round it. Parasiticides must then be regularly and constantly used. The patch should be washed clean with soap and water night and morning, and the ointment or paste well rubbed in.

The following are some of those most commonly employed: Mercurial applications, such as ung. hydrarg. ammon.; oleate of mercury, from 3 to 10 per cent.; carbolic acid in the form of the glycerine, or the same with a larger amount of carbolic acid; sulphur ointment; creasote; tincture of iodine; thymol or turpentine; or some of these may be combined together, as sulphur 2 and carbolic acid 1 in 16 of lard or vaseline, or iodine 1 and creasote or oil of cade 3 parts. Boric acid 3ss, with sulphuric ether 3ss in sp. vin. rect. 3xx, is recommended by Dr. Cavafy and Dr. Alder Smith; Dr. Harrison suggests an ointment composed of caustic potash 9 grains, carbolic acid 24 grains, in 1⁄2 oz. each of lanolin and ol. cocoæ. Kerion

may be treated with weak lotions of lead or boric acid, and gradually subsides; it should never be incised.

In order to test the effect of treatment the hairs must be examined from time to time, but no case can be considered cured until a good crop of hair has grown over the whole scalp, and even then a very careful search must be made for still active disease, which may be shown by a broken and twisted hair, or a small, brownish, scaly spot.

During the treatment of ringworm great care should be taken to prevent its spread to other children. The patient should use a separate brush and comb and towels. The head should be covered with a cap, which may be freshly lined with a piece of tissue paper every day, the old piece being destroyed.

TINEA CIRCINATA.

(Ringworm of the Body.)

This occasionally coexists with tinea tonsurans, but often occurs alone. The same fungus, Trichophyton tonsurans, invades the epithelial scale and downy hairs of the skin, and produces a circular patch, from half to one inch in diameter, slightly raised above the surface, sharply defined, pink in color, often papular, and covered with fine scales. If the surface be scraped with a scalpel, and the scrapings be placed, with a little potash, on a glass slide, the mycelium and spores of the fungus will be seen. The patches increase by extension at the circumference, and may, as they spread, recover in the centre. Occasionally a few vesicles form on the surface from the irritation of the parasitic growth; thus in part justifying a former name, herpes circinatus. They occur on the face, neck and arms most frequently, are, as a rule, few in number, and may be solitary. Tinea circinata is easily cured, by the use of ung. hydrarg. ammon., oleate of mercury, tincture of iodine, sulphurous acid in solution (1 to 2 or 3 of water), a weak carbolic acid glycerine, hyposulphite of soda (1 in 8), or some other not too strong parasiticide.

TINEA MARGINATA.

(Eczema Marginatum. Burmese Ringworm.)

This depends upon the same fungus as the above, but consists of much more extensive, more inflamed, and more obstinate lesions. It is confined to adult males, and occurs chiefly about the inner side of the thighs, genitals, and groins of those who are constantly sitting, such as horsemen and cobblers. It begins in spots or rings, which, spreading at the margin and recovering at the centre, unite together, and ultimately extend on both sides symmetrically. It forms a broad yellowish or brownish-red band, which runs in a curved or gyrate form along the inner side of the thigh and scrotum to the inner side of the buttocks, and over the groin and lower part of the abdomen. The persistent use of parasiticides is required.

TINEA SYCOSIS.

(Ringworm of the Beard.)

Parasitic sycosis is not so frequent as ordinary sycosis. The follicles are inflamed by the presence of the fungus, and suppurate, and the hairs become loosened; induration and swelling of the intermediate skin also occur. It differs from ordinary sycosis in that it first attacks the hairs, and loosens them early it spreads more rapidly, and produces deeper infiltration. Microscopic examination shows the fungus, in which the mycelium is more abundant than the spores. The Treatment consists of epilation, and the

use of parasiticides.

FAVUS.

In this disease, rare in England, the fungus attacks the epidermis and the hair follicles: it may at first form patches like those of ordinary ringworm, but soon there appears a small, bright yellow, circular disc, with a depressed centre, and a gradually thinning margin. This, the "favus cup," is caused by the fungus elements separating the layers of the epidermis and lifting them up, except at the central point where the hair follicle joins the skin. This characteristic lesion may occur on the scalp, or on any other part of the body, the forearm for instance, determined by contagion; and it is conveyed not only from man to man, but to man from domestic animals-rabbits, dogs, cats, and others. When numerous cups have formed, they become aggregated together, and form a thick, continuous yellow crust, with an irregular honeycombed surface, giving off an offensive odor resembling that of mice. The hair sacs are destroyed, the hairs fall out, and baldness results; moreover, the favus masses often become a nidus for pediculi, and eczema and impetigo complicate the original lesion. If the masses are examined under the microscope after soaking in potash, the mycelium and spores (conidia) of the Achorion Schönleinii are seen. The conidia are larger and more raised than those of the trichophyton, and the mycelium is shorter and more jointed.

Treatment. This must be conducted on the same principles as that of the other fungous diseases. The crusts must be softened by oil or poultices, and removed; parasiticides must then be perseveringly employed, and the hairs must be steadily epilated. The disease is, however, very obstinate, and after apparent cure often breaks out again. It is well to care for the general health by good food and tonic medicines.