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THE FAIRCHILD PREPARATIONS
— O^1
THE   PURE  DIGESTIVE   FERMENTS,
       Active, Permanent  and Reliable.
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Especially Prepared as a Solvent for
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   PEPTONISING TUBES.

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For  the preparation of PEPTO-
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          the sick.
   PEPSINE IN SCALES.
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The most active, permanent and re-
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For administration where a fluid
 and agreeable form of pepsine is
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     tion of Junket -and
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EXTRACTUM PANCREATIS.
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Containing all the digestive ferments
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PEPTOGENIC MILK POWDER
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   PEPSINE IN POWDER.
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Prepared from the scales without the
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For the digestion of starchy foods.
Fairchild  Bros.  &  Foster,
    82 and 84 fulton st., new york. 
 
THE  MODERN   TREATMENT
ECZEMA.
HENRY G.  PIFFARD,  A. M., M.  D.,
Clinical Professor of Dermatology, University of the City of New
    York; Surgeon to St. Elizabeths Hospital; Consulting
     Surgeon to Charity Hospital; Consulting Surgeon to
       the Bureau of Out-door Relief, Bellevue Hospital;
         Consulting Dermatologist to the New York '
               Infant  Asylum,  &*c, <&V.
      1890.
GEORGE S. DAVIS,
   DETROIT, MICH.
f:$>
29^9/     \
 
WR

  1096
 Copyrighted by
GEORGE S. DAVIS.
 
PREFACE.
    In the following pages I have briefly pointed out the chief
clinical  varieties  of  Eczema;  have  sought  to exhibit  their
etiology, so far as I understand it; have indicated the principal
remedies found useful  in  the  treatment  of  the disease;  and
have detailed  the best manner of applying them, so far as
known to me.   That what has been written  may prove  useful
to others, is the earnest desire of
                                     THE AUTHOR. 
 
CHAPTER  I.
                     ECZEMA.

     Definition.—Eczema is an affection of the skin, of
internal  origin,  sometimes  made  manifest  through the
influence of external causes, and  characterized by the
presence of vesicles, pustules, papules, or other lesions.

     Description.—Many  cases  of  eczema  look  so
unlike each other, that it is often difficult for one not
familiar  with the affection to trace even a  form of re-
semblance.   These differences are due to the fact that
the disease may exhibit lesions quite dissimilar in char-
acter and appearance, and combined in ways and pro-
portions almost without  number.  The aspect, also, of
the individual  lesions varies, somewhat with  the  loca-
tion they occupy, the degree of  activity they present,
and the  period of time they have lasted.
     As the successful treatment of the disease neces-
sitates a proper appreciation of these  factors, it will
be  well  to  analyze  them  in advance, and to briefly
describe  the  essential varieties of the disease,  and
their principal  modifications.
     The varieties of eczema dependent on the primi-
tive lesion, are six in number, namely:  erythematous,
vesicular,  pustular,   nudose,   papular,  and   fissured.
These,  in their progress,  may exhibit infiltration or
scales, as secondary lesions.
      ** 2 
-- 2 --
     Those  dependent on  the activity of the process
are the acute and the subacute; while those that run a
brief  course may also be termed  acute, and  those  of
longer duration, chronic.
    Location influences the appearances presented by
eczematous lesions, and the principal modifications are
found in connection with the  eruption as seen on the
scalp, face, region  of  the head, hands and feet, geni-
tals, and  about the anus.
    An  acute  eczema on  the general  surface, com-
mences with a local  congestion or erythema  followed
in a few  hours by the appearance  of  one of the primi-
tive lesions mentioned.  If the lesion be vesicular, the
congested  surface is seen covered  with a  mass  of
minute but closely aggregated vesicles filled with clear
transparent  serum.  It often takes a sharp  eye, and
even  a lens, to distinguish  their separate contours.
The  lesion  consists  in a  large number of  separate
points, at which there is a  slight  elevation of the
cuticle by a serous or lymphy exudation  seeking an
outlet.  Rubbing, scratching, or  other violence from
without,  or the  pressure of the exudation from within,
soon  ruptures the thin epidermic covering, and  in
twenty-four or  thirty-six  hours,  the vesicles are no
longer seen, but instead, a raw and  exposed  surface,
covered  with exudation.  If  the  part be exposed  to
the air, the watery portions  of the exudation evap-
orate, and yellowish  or straw colored crusts remain.
As the exudation continues, the crusts  thicken, until 
                      - 3 —
they drop off or are purposely removed.  After a vary-
ing time (days or weeks, as the case may be) the exu-
dation  diminishes  in quantity,  the crusts cease to
form, and an attempt is made to cover the part with
a new layer of horny epithelium.   It may be  weeks
before this effort is entirely successful, and the affected
part presents, in the interval, a reddened surface cov-
ered somewhat  loosely with attached scales of small
size, the scales consisting of newly-formed epithelium,
which has not yet attained a normal character and con-
sistence.
     For practical convenience, the course  above de-
scribed may be divided into three stages, the first being
that of  congestion and vesicle formation, the second,
that of  exudation and crusting, and the third, that of
dryness and scaling.
     The pustular variety of eczema pursues the same
course,  and passes through the  same changes,  as the
vesicular, or  differs  from  it only by the appearance
of minute aggregated pustules  instead of vesicles in
the first stage, and more  or less purulent exudation,
with greenish crusts in the second.   The third stage is
identical in both varieties.
     The  nudose or  exfoliative form, as I have else-
where*  called it, differs from the preceding varieties
by the fact that neither distinct vesicle—or pustule—
formation is observed, but instead a rapid shedding or
    *Elementary Treatise  on Diseases of  the  Skin, 1879,
paae 149. 
                     — A  —
exfoliation of  the  horny layer over  the whole  or
greater  part of the affected  area.  The succeeding
exudation may be serous, sero-purulent, or purulent,
and crusts will form  as  already described.   The sec-
ond and third  stages of the nudose variety are not
distinguishable from the same stages in the preceding
forms.
    In  the papular variety an area of congestion be-
comes the seat of small aggregated or scattered pap-
ules,  with  little,  if  any, tendency to exudation.  If
scratched so as to wound the papules, a little  serum
exudes,  drying into thin  pellicles or  laminae.  The
papules after a time subside, and the  skin becomes
normal  without the appearance of  the distinct scaling
met with in  the forms already described.
    The fissured variety is characterized by a more or
less  reddened  surface  without vesicles, pustules or
epithelial exfoliation, but presenting small  cracks or
fissures  extending through the  stratum  corneum and
sometimes through  the stratum  Malpighii  as well.
Exudation is slight, crusting is absent, and the skin
returns  to the normal by simple closing of the fissures
and disappearance of the congestion.
    Eczema varies in different cases in respect to the
grade of inflammation present.  In one it may exhibit
great activity, and be accompanied with decided heat,
high color, and  other evidences of marked inflamma-
tory  action.  On the other hand, the natural color
may be  but  slightly altered,  the increase of local heat 
                     — 5 —
almost inappreciable, and the general process of a tor-
pid or sub-acute character.
    In some cases an eczema may run its course in a
few days or weeks, while in others it may be prolonged
for months or years, constituting  the  chronic form of
the affection.  Infiltration is a frequent accompaniment
of this condition.
    The location of an eczema influences to a  certain
extent its appearance, as well as leads to modifications
of the treatment.   For this reason we will here note
the most important variations of the former.
    In eczema of the scalp, especially  in  infants or
children, the exudation is  frequently profuse,  drying,
mats together the hair in a tangled mass, and offensive
to both sight and smell.   If, by chance, pediculi find
lodgment on such  a scalp, they multiply rapidly, and
by their irritation, aggravate and increase the trouble.
Furuncles and small abscesses may further complicate
the matter.
    On the face, in  infants, we usually  encounter  an
active form of inflammation accompanied with a good
deal of heat and pruritus.  The eruption assumes the
vesicular, pustular, or nudose  forms, and when it ex-
tends behind the ears, fissures often form.
    In adults, the  eruption may be purely erythema-
tous, without exudation.
    In adult males, the region of the beard  sometimes
becomes the seat  of eczema, which may  be purely
superficial, or, on the other hand, may descend into the 
— 6 —
hair-follicles  and involve the  root-sheaths in the in-
flammation.
    When the palmar and plantar surfaces are invaded
by eczema, the primitive lesions  are most frequently
vesicles or fissures.   The vesicles, however,  owing to
the thickness and strength of the stratum corneum in
this region, do not rupture easily, and may  go on for
several days increasing in size, often attaining a mag-
nitude four or ten times that  of  eczematous vesicles
on other parts.
    Fissures  form  by preference at the flexures of
small joints, and where the natural skin-lines are most
pronounced.
    The mons veneris may be the  seat of the vesicular
or pustular forms with involvment of the hair follicles,
but the  penis and scrotum more frequently present
the erythematous variety, and  if  the affection become
chronic, infiltration to a marked degree is usually met
with.
    Eczema about the anus is frequently marked by
radiating fissures of  greater or less depth.
    The inner aspect of the thighs is  the favorite
location  of the papular form,  and is oftened accom-
panied with diffuse infiltration  between the papules.
    On  the lower extremeties, below the knees, ecze-
ma is  frequently encountered  as a  direct  result  of
varicose  veins.   If  these latter  have given rise to
ulcers, a broad  and diffuse  zone of erythematous
eczema will almost  always surround them, with scat-
tered patches on neighboring parts. 
                     — 7 —
    From the foregoing it will  be seen that location
influences to a certain extent the form of the primi-
tive  lesion,  and that all parts are not equally pre-
disposed to the six varieties we  have noted; a fact
of importance when we  come  to the  question  of
treatment. 
CHAPTER II.
                    ETIOLOGY.

    It may be regarded  as almost axiomal  that the
better you understand a disease, the better you will be
able to treat it.  This is especially true as regards the
disease  under  consideration.   Occasionally  cases of
acute eczema will be  met with  that readily recover
under  the  simplest application, even  under the influ-
ence of  a non-medicated protective dressing.   Unfor-
tunately these cases are rare, and in the chronic form
it is often necessary to avail yourself of every possible
aid to recovery.
    A thorough  appreciation, therefore, of all the
causes of the eruption, both  actuating  and contribu-
tory cannot  fail  to  greatly assist the therapeutist in
the proper selection of the remedial agencies applica-
ble to a given case.
     It is true that very little is absolutely known as to
the etiology of eczema, but sufficient facts have been
observed in connection with  the  development  of the
disease to warrant certain inductions  that in practice
yield very satisfactory results.
     The  modern German writers, as a  rule,  give this
branch of  the subject  but scant attention, saying at
most that certain assigned causes of  the disease have
no real existence, other than such as  may be classed 
                     — 9 —
as external irritations of  a mechanical, chemical, or
thermic nature.
    The French writers, on the other hand, appear to
give an undue prominence to the constitutional causes,
and undervalue the influence of external  agencies.
The truth appears to the writer to be between the two.
Eczema  is a disease which arises as a consequence of
certain  derangements  or  peculiarities  of  internal
origin, and  often,  perhaps generally, brought to the
surface  and made manifest through some source of
external  irritation.  In   other  words, two  classes of
causes, predisposing and exciting, are  necessary for
the production of  the eruption in the vast majority of
cases.   No form of external irritation known to the
writer is capable of  exciting a true eczema in a per-
fectly healthy  individual.  Per contra, the  constitu-
tional  predisposition in  a given  case must be very
strong indeed  to be  alone capable of causing an out-
break  of the  eruption.   That this, however, some-
times occurs, is admitted, I believe, by most observers
who have taken the  pains to investigate these cases
from this standpoint.
  The  French writers  of the school of Bazin  and
Hardy attribute eczema  to certain diatheses to which
they give the names herpetic and arthritric.  The lat-
ter, they assume, is essentially the same as that which
gives  rise to sundry  joint affections of a  rheumatic or
gouty  nature.  The herpetic  diathesis they fail to
define with any degree of clearness.  Hardy combines 
                     --  IO  --
 the two under a single name, and regards the  " dart-
 rous " diathesis as  the predisposing -element of ecze-
 ma.   Of  this diathesis he  gives in  detail the main
 clinical features, but fails to  elucidate the rationale of
 its existence.
     Ten  years  since  the present writer* elaborated
 this subject and sought to give more  precision to  the
 somewhat vague  notions  of  his predecessors in this
 field.  The views he then  advanced he still holds, and
 they may be succinctly stated as  follows:
     Eczema depends on a constitutional derangement
 or diathesis, hereditary or acquired, and of  indefinite
 duration.   It is  characterized by the  retention  and
 accumulation in the blood of an undue amount of cer-
 tain   excrementitious   substances,  which  normally
 should be removed  by the kidneys as  fast as formed.
 This  accumulation may  be due either to deficient
 functional activity on the  part of the kidney, or, on
 the other hand, to excessive formation of the sub-
 stance in question, the kidneys acting  normally  and
 doing  their share of the work of purification.  The
 peccant materials  I believe  to be in the main  uric
 and oxalic acids, with probably other  less known pro-
 ducts  of  imperfect oxidation.  Urea represents the
highest degree of oxidation of the products of assim-
ilation and disassimilation, while uric  acid represents
    * Elementary Treatise on Diseases of the Skin,  New
York,  1875. 
                     —  II  —
a lower degree of oxidation.  Urea is extremely soluble
and  is  excreted by  the  healthy kidneys with great
ease and readiness.   Uric acid is extremely insoluble,
and is excreted with difficulty and in extremely small
quantities only, and any attempt to overtask the kid-
neys in  this direction, not infrequently, I think, leads
to that form of irritation which results in the so-called
"gouty  " kidney.  Oxalic acid, standing alone, is ex-
ceedingly soluble, but its  affinity for lime leads to the
formation  of  the very  insoluable  oxalate.  If this
latter enters into combination with  a  proteia com-
pound, as  is very probable, its excretion by the kid-
neys is well-nigh impossible.
    Carrying the matter still further back, we seek the
causes of  the  deficient oxidation of the nitrogenous
elements of the blood and tissues.   These causes will
be found, if we agree with  Ben Jones,* to  reside in
the liver, which organ he considers the chief seat of
the oxidizing process.
    To the liver, then, we must look for the primary
causes of  the trouble, and anyone  who  will clinically
investigate cases of chronic eczema from this stand-
point, will be surprised at the number  of patients who
will exhibit symptoms pointing to  this organ.   The
causes of  hepatic derangement capable of influencing
the functional activity of the organ, are doubtless mani-
    * Lectures on Some of the Applications of  Chemistry
and Mechanics to Pathology and Therapeutics. London, 1867. 
                     -- 12 --
fold, and  we  cannot undertake  their analysis here,
other than to refer to a  single one, which should not
be overlooked.  I allude to malaria.
     The late  Dr. L. P. Yandell, of Louisville, Ky.,
expressed the opinion that the majority of  cases of
eczema were the outcome of malaria.  We cannot go
to quite the same length that  he did, but neverthe-
less, are  convinced  that  very  many cases  are due
directly to it through the chain of causes just enum-
erated.
     The local exciting causes are numerous.   A stim-
ulating or slightly  irritating poultice or lotion may
provoke an outbreak of the eruption at the site of ap-
plication.   Undue exposure of a part to the effects of
heat, natural or artificial, may do the same.   Irritant
dust or other particles accompanying certain  mechan-
ical  operations  and  occupations, may induce a like
result.  Scratching and  certain applications  used in
the treatment  of  scabies, may also provoke a second-
ary eczema.   In many, and in the writer's experience,
in the majority of cases, however, it will be impossible
to ascertain the local cause that specially induced the
outbreak.
     The actuating cause sometimes appears  to be of
internal origin.   A  fit of  indigestion,  too generous
living, or  a  bottle of wine, in those strongly predis-
posed to eczema, often seems sufficient to precipitate
the eruption. 
CHAPTER III.
                  TREATMENT.

    In a disease which  may present so many differ-
ent phases as regards appearance or lesion; that may
occur in all shades of general  constitutional vigor  or
debility, that may be met with  in connection  with
almost every other organic or functional affection, it
is hardly to be expected that any one form of routine
treatment will meet with frequent success.   Such  an
expectation would be at variance with the known laws
of pathology, and with  universal experience  in  most
other forms of disease.
     In  eczema, treatment  will be successful  just in
proportion as every feature in  each individual case is
fully appreciated,  and its indications provided for.
     The  task that  the  physician has before him is
two-fold.  He  must  remove the  existing  lesions as
speedily and thoroughly as possible, and he  must so
alter the general  constitution or  habit of the  patient
as to diminish, and perhaps abolish, the tendencies to
relapse.   As a rule, the former  indication is the one
most easily and readily fulfilled, while the latter may
require months or years of constant  attention.  The
one may be likened to occasional skirmishes that take
place between two opposing  armies, while  the  other
more closely resembles the well  elaborated  campaign,
or the well-studied siege of a  fortress.  It  not unfre- 
                     —  14 —
 quently happens, moreover, that when the disease ex-
 hibits a chronic or persistent form, both  modes of
 attack must be brought into play before the  lesions
 will show the slightest indications of yielding.
     The best hopes for success lie in a comprehension
 on the part of the physician, of every detail connected
 with the causation and continuance of the eruption in
 a given case, combined with a knowledge of the ther-
 apeutic agents and agencies that experience has shown
 most effective against them.  It is these points  that
 the author desires to set forth to the best of his knowl-
 edge and ability in  the present  treatise.
     To fully display the various therapeutic agencies
 that may  be brought  into  play against the different
 manifestations of the disease, it is expedient  to  an-
 alyze and group them.  This we  shall  do under  the
 following heads:

                    Hygienic.
                    Etiological.
                    Diathetic.
                    Internal.
                    External.

     Hygienic.—In exceptional  cases  of  eczema  the
 patients  present  no obvious deviation  from  robust
 health,  and correct habits.  They  are  hearty  and
strong,  with good   appetite and  digestion.   Their
bowels  are regular, and their sleep natural and re-
freshing.  They  have  an abundance  of wholesome 
                     — '5 —
food, with plenty of fresh  air, and regular exercise.
In  fact, from a hygienic standpoint, they appear to
lack nothing.
     Naturally, under these circumstances, the physi-
cian has nothing to change, and he must combat the
affection  by other  means.  In  most cases, however,
this state  of  affairs does not  exist.   Among children,
both of the rich and the poor, insufficient or improper
food  may be the  chief  unhygienic  condition.  The
nutritive value of the mother's milk  does  not always
correspond with her social position  or  her bank ac-
count.  The nursling  of the poor  partakes of the
breast, and also of its parent's table,  sharing with the
the older  members  the customary beverage (tea, cof-
fee, or beer), and  testing its  early teeth on corned
beef and cabbage.   The  nursling of  the rich supple-
ments the maternal  font with  the various mother's
milk substitutes and patent foods with which the mar-
ket abounds.
     The  laborer's child of two  or three years, shares
the ordinary and common food  of  the  family, while
the child of the rich may be stuffed with  sweets and
confections of all kinds.
     The  child  of the poor lives and sleeps in  dark
and unventilated tenement-house apartments, to which
fresh air and sunshine rarely gain entrance.
    The  child of the  rich, on account  of  some sup-
posed delicacy, is often confined to the house for days
or weeks at  a time, during the colder seasons, for fear 
— i6 —
that exposure to the cold or wet  may bring  on some
serious or fatal ailment.  In the inclement season the
child  of the  poor is frequently insufficiently clad;
while its rich brother is usually clad too much.
    Among the adults of the laboring classes, ill-ven-
tilated sleeping apartments  appear  to be the chief
malgenic factor; while among the well-to-do, too free
indulgence  at  the  table, and especially  as regards
nitrogenous food, with too little bodily exercise, is not
infrequently the hygienic condition  that needs most
attention.
    If these facts are borne in mind, it is not  a diffi-
cult matter to suggest  the  requisite  changes  that
should be made in the patient's way of  living.  It is
much more difficult, however, to have your recommen-
dations carried  out in full.
    The diet of eczematous  infants is  almost  always
found lacking  in the  fatty elements.   The  mother's
milk will be found deficient in cream, and should be
supplemented in  this  respect by extraneous supply.
When cream is not conveniently attainable,  cod-liver
oil may be used instead, and, as a rule, little  difficulty
will be met with in giving it,  despite the taste usually
so nauseous, to adults.  Infants  and young  children
will generally  take  it  without  difficulty, especially
during the  colder seasons, when the  need  of it is
greatest.   Many children will be brought you who are
plump and apparently well nourished, but in  whom an
eczema  of  the scalp  or  face  will exhibit  most per- 
                     —  17 —
sistent tendencies until  the  patient's  diet  has  been
amended in the manner  suggested.  It may be taken
as a general rule, therefore, that cod-liver oil or some
other equivalent, is of the first importance in the treat-
ment or management of  eczema in children.
     It need not be urged that clothing should be suit-
ably adapted to the seasons.   Not unfrequently, how-
ever, it will be found that the fault lies  in excess rather
than  deficiency in this  respect, and children will be
brought you bundled up with flannels and wraps to
such an extent that the body is being  constantly kept
in  a sweat-bath,  a condition  by  no means to  be
desired.   Sometimes flannels are a cause of irritation,
and when such is the case, should be  separated from
the skin by a thin undergarment of muslin or linen.
     Fresh air and well ventilated sleeping apartments
should not  be  forgotten, and  regular and sufficient
exercise should be provided.   As a rule children need
no urging in this respect.  They will  romp and play
in-doors and  out, to a degree  (if permitted) that will
freely satisfy all  of Nature's  requirements.    With
adults, however, it is different.  Many, if not most
cases, of  chronic  eczema, will  be   found in those
who either  can not  or will not take sufficient exer-
cise.  Amendment in this respect is,  of course, neces-
sary.
     Bathing  sufficient to meet the requirements of
cleanliness should  be insisted on, but  too frequent or
profuse use of water is  not advantageous.  Eczem-
     ** 3 
— i8 —
atous lesions, especially those belonging to the second
stage of acute cases, are very intolerant of water.  An
eczema in which the surface is raw and discharging, is
always made temporarily worse by the application of
water, and  the reason  for this is  manifest:   The
stratum corneum being absent, the underlying cells of
the stratum malpighii  are exposed.  These cells are
soft and succulent, and readily absorb water when in
contact with it, due to  endosmatic action,  the  water
having a  lower specific  gravity than  blood serum.
The absorption of  the water causes  the malpighian
cells to swell, and some of  them perhaps to burst; the
result of  which is  manifested  by increased  redness,
swelling,  and  irritation.  Water, then, should  not  be
applied to an exuding eczematous surface oftener than
is  absolutely necessary.   The  irritant effects of the
water, however, may in a  measure be  controlled  by
the addition of a little  glycerin or a small quantity of
some neutral  salt,  and the  best for the purpose  is
probably the chloride of sodium  in the proportion of
an ounce  or so to the basin of water.  In subacute
and  chronic  eczema,  when the  stratum corneum is
present, though, of course, not in a normal condition,
baths are frequently of service.  A full bath at night,
with  a pound  of  carbonate of soda  added to the
water, will often exert  a sedative  influence and allay
the itching.  In other  cases, ten or twelve  pounds of
common salt to the full bath will exert a stimulant
action on  a sluggish eczema, and tend to promote  the 
                     — 19 —
cure,  and  sometimes  it will very decidedly control
the pruritus.
    Etiological.—Tt is  an old saying that when the
canse is removed the effect disappears.   However this
may be in mechanics and physics, it is far from always
being the case in medicine.   A striking  illustration of
this proposition came under notice a short time since,
in the case of  a nursling who had  been vaccinated
some  seven or eight months previous.  The vaccina-
tion had pursued its usual course, but as it healed,  an
eczema appeared  at  its site (deltoid insertion) com-
pletely surrounding the point of inoculation.   At the
time  of  observation it presented a circular patch of
moist  eczema about  two inches in diameter.   This
had existed, almost without change,  for  nearly seven
months.   Now, in this case, there can  be  hardly a
doubt that the vaccination  was the local etiological
factor,  the eczema corresponding  to  the  inflamed
areola about the vaccine vesicle.  In many cases of
eczema of the  hands  in washerwomen  and scullions
excited by too  frequent insertion of the hands into
strongly alkaline water, the affection will often persist
in the most annoying way, even  after discontinuance
of the practices which excited it.  Scabies  is some-
times the exciting cause of  an  eczematous eruption,
which  may persist  long after every  acarus has been
destroyed.   Many other local irritations  may excite an
outbreak of eczema, and just in  proportion as their
influence has been  prolonged, will the eczema  prove 
                     --  20  --
obstinate and unyielding, even after their direct action
has ceased.  All possible local causes, however, should
be sought for and remedied.
     Diathetic.—The diathesis underlying eczema is, as
we have already noticed, a general condition charac-
terized by deficient oxidation and sluggish action of
the organs concerned in this process.  It matters little
at which end of the chain we commence, as  the indi-
cations are clear, and fortunately we are in possession
of means by which  they may in  great measure be
fulfilled.
     The  blood  is  surcharged with excrementitious
principles that should  be carried out  more  rapidly
than the emunctories are at the moment doing,  and
the rational indication, therefore, is to stimulate these
organs to a  little extra duty.   If  the kidneys  are
in a normal condition they will readily respond to
-diuretics. Among these acetate of potash, small doses
of iodide of  potassium, squills, caffeine, and drugs of
similar action, have  appeared  to  the writer to yield
excellent results.  The excretion of  uric  acid may
be further promoted by the use of alkalies.   Of these
liq. potassae is perhaps the most effective, but it must
be used with discretion, and for short periods of time
only.
     There is one drug, however, that enables us to
fulfill the double indication for  an alkaline diuretic,
namely, the benzoate of lithia.  This may be given in
doses of  from three to five grains, preferably in water, 
— 21 --
and a short  time before meals.   A long continuance
of alkalies, however, tends to deglobulize the blood,
and consequently their administration should  be in-
terrupted from time to time, and hematogenic remedies
substituted.   A very convenient plan is to give some
form of iron with the alkali, and  my own favorite is
the benzoate of  iron,  mixed with the  benzoate of
lithia.   Iron is  unquestionably of  benefit  in  many
cases of eczema, and the possibilities  of its  require-
ment should not be overlooked.
     Sometimes,  in long-standing  cases  of eczema in
patients advanced in life, the kidneys will not be found
in a condition that will  warrant the throwing of any
extra strain  upon them.   If the patient be of a clearly
gouty constitution, the condition of the kidneys should
be  carefully ascertained, and stimulating  diuretics
avoided if  there be any  indications of cirrhosis of
these organs.
     Under  these circumstances depuration must be
sought through the medium  of the bowels and  skin.
Laxative mineral waters appear to be the best agents
to employ under these circumstances.
     The skin maybe stimulated to the performance of
depurative  functions to a slight extent by means of
the diaphoretic action of heat, as in the regular Turk-
ish bath, or  by means of suitable  home-made contriv-
ances, which are cheap and equally  effective.  It is
only in  long-standing and very sub-acute cases, how-
ever, that sweating should be  encouraged.   In acute 
                     -- 22 --
disease it will aggravate and tend to increase the area
of the eruption.
    The next  point  to consider  is  the  influence
exerted in any given case by the greater or less func-
tional inactivity of the liver.   In a very large propor-
tion of long-standing cases hepatic torpor is clearly
evident; sometimes as the result of old malarial  dis-
ease, and  sometimes, doubtless, from  hereditary pre-
disposition.   In  either case  this tendency  must  be
combatted and remedied, if possible.
    Among the drugs useful  in  this connection are
mercury and the other reputed cholagogues.  My own
custom is to commence with a good purgative dose of
calomel and  jalap, to be  followed  by repeated small
doses of the milder preparations  of the  drug.   Blue
pill,  or mercury with chalk,  or in trituration with
sugar of milk, are convenient and efficacious, and will
often be found of extreme  utility in the eczemata of
children.
    If, for any reason, it is not thought desirable to
give mercury, the vegetable chologogues, podophyllin,
irisin, and eupatorium may be employed.  My own
preference is in favor of eupatorium.   This I com-
monly prescribe in the form of fluid extract, in doses
of from ten to  twenty drops  in  water, night  and
morning.
    The diet of  eczematous  patients  is of  the  first
importance.  As a rule  you will  find  that  in  adults
their tastes are decidedly carnivorous, and that they 
                     — 23  —
eat a good deal of meat, with  a  very scant  quota of
vegetables.   Many of  them,  especially men,  are  fond
of the pleasures of the table, and indulge much more
freely  than  there is  any necessity for.  As  these
matters are under the control of  the patients himself,
no  pains should  be spared  to  impress on  him the
necessity for a change in his  habits.  It is not wise to
cut off the supply of meat absolutely, but it should be
very decidedly restricted, and a  larger  proportion of
bread, vegetables, and the various cereal preparations
substituted.
     Patients often fancy that diet of this sort will re-
duce their  strength, and  incapacitate them for the
amount  of labor that their  daily avocations necessi-
tates.  These fears  are groundless,  and on  trial will
soon be  dissipated.
     Direct internal treatment.—There are three drugs
which appear to  directly  influence  the  course of
eczema  when administered  internally.   These are
arsenic,  calx  sulphurata, and viola tricolor.   We will
first consider their various preparations and  modes of
action.
     Arsenic.—The  preparation  of  arsenic  most in
vogue is unquestionably the  liq. potassii arsenitis, or
so-called Fowler's  solution, named  after an English
physician who first brought it  into use as a remedy for
intermittent fever.  As now  prepared  it  contains  a
number of other ingredients, which  are unnecessary,
and I think, a positive disadvantage.   A much better 
                     — 24  —
preparation, it has seemed  to  me, is  the liq. sodii
arsenitis, which is a simple solution of  the salt in dis-
tilled water.  This  latter  preparation is somewhat
weaker than the former, containing one grain of  the
salt  in ioo  parts of solution, while the  liq. potassii
arsenitis  contains one  part of arsenious  acid to  ioo
parts of solution.  My own preference, however, is in
favor of arsenic in substance, rather  than  solution.
When given in this manner it should be administered
in a state of  minute  subdivision, which  can but be
accomplished by trituration with some  hard inert sub-
stance.  Thus far sugar of milk has proven the most
useful  medium  for  this  purpose.  Arsenious  acid
thoroughly triturated with  sugar  of milk in any de-
sirable proportion may then be made into pills or tab-
lets.   These  latter  are always  reliable, while  grave
charges of insolubility, etc., have been brought against
some of the  pills found in the market.
     The useful dose of arsenic in eczema varies within
very large boundaries, dependent, on  the one  hand,
on the age of the patient, and  on the other, on  the
condition  and character of  the eruption.  It may in
general be stated as between T^-0 and  ^ of  a  grain,
while in exceptional cases  as much as T^ of a grain
can be given with advantage to  the eruption, without
injury or inconvenience to the patient.   Naturally the   -
younger  the patient the smaller should  be the abso-
lute  dose, but it has been observed that children will
bear relatively larger doses of arsenic in proportion to
age than they do of many other drugs. 
                     —  25  —
     The  character  of the  eruption,  or rather the
acuity of the lesions influences the choice or rejection
of this drng, and regulates the size of the dose more,
perhaps, than anything else.  Arsenic is a stimulant to
the  skin,  exerts a  specific action  on  it, and is  itself
capable of producing various eruptions.*  Manifestly,
it needs to be handled with discretion.  As a general
rule, it may be stated that arsenic is absolutely contra-
indicated  or harmful  in acute eczema.   In sub-acute
and  chronic conditions  it  may sometimes be employed
to advantage.  In the first stage  of eczema  it is use-
less, as I have never seen it either  abort  or appear to
shorten the duration of the  eruption, when given at
this time.   In  an  acute eczema  in the  second stage,
with exudation and crusting, it will almost  invariably
aggravate  the eruption,  increasing  its  extent, and
adding to the severity of  the inflammatory symptoms.
     In the  second stage  of a sub-acute  eczema, how-
ever, where the action , though persistent, is sluggish,
arsenic in moderate  doses is certainly of service.  It
may be given on commencing, in doses of -^  grain,
which will generally permit of increase.   If, from any
cause  whatever,  acute symptoms  should set in, the
arsenic must be .suspended, and not resumed.
     In the third stage of  eczema without exudation,
but with a glossy skin covered with fine scales, arsenic
     * For  a detailed account of the eruptions produced  by
Arsenic see my  Materia Medica and Therapeutics of the Skin,
1881, p.  23. 
                     — 26 —
exerts its greatest influence for good.   Here the dose
may be larger, and the longer the eruption has lasted,
the larger the dose.  The initial doses should  be
moderate, but  rapidly  increased  until the  limit of
tolerance is approached.   Gastric irritation and swell-
ing of the eye-lids or  feet, indicate that too large an
amount of the drug is being given.
    During the administration  of arsenic the urine
should, from time to time, be examined for albumen;
and, if this is detected, the drug should be discontin-
ued, as the integrity  of the kidneys is of greater im-
portance than  the speedy cure of the eruption.
    In cases where the patches  of eczema are char-
acterized by great infiltration, arsenic has not,  in my
hands, proven very successful.
    Calx Sulphurata.—This  drug exerts  an unques-
tionable  influence  in eczema,  and  can be  used to
advantage in several different conditions.  In cases of
eczema rubrum,  especially in  infants and  children
with more soreness and irritation, calx  sulphurata, in
small doses (gr. fa to gr. fa for children), often proves
of great service.  Again, in cases of the second stage,
when the exudation  is  abundant and  purulent,  it
should be given in larger doses,  gr. fa for children, to
gr. \ for adults.   Thirdly, it  may be  used with very
manifest advantage when the patches of eruption are
greatly infiltrated, and the inflammation is of a sub-
acute character.  We have more than  once seen the
thickened skin in chronic eczema of the leg  appar- 
                     —  27  —
ently melt  down under  the influence  of this drug,
given in full doses, gr. %  to gr. %, three or four times
a day.  Its effects are frequently appreciated within a
week or ten days.  If they are not evident, however,
at the end of two weeks, it will not be worth while to
continue the drug longer, but use instead measures to
be mentioned later.*
     The preparation of calx sulphurata that I gener-
ally  prefer, is the tablet made from the trituration, as
I have  frequently been  disappointed in some of the
ready-made pills.
     Viola Tricolor.—Although of high repute in the
last century in the treatment of eczema, this drug has
received but little attention during the last half cen-
tury.   German dermatologists  profess to regard it as
absolutely inert, but Hardy and other French physi-
cians speak  highly of it.   My own experience with  it
has been large, and covers a  number of years,  and the
drug has certainly seemed to me to merit the encom-
iums of its advocates.
     The preparations that are most useful  are the
infusion and the fluid extract.  They should be made
from a good quality of  the  imported  herb, and the
fluid extract should  be made with very dilute  (25 per
cent.) alcohol.
     Viola tricolor has a  very decided  action  on the

     * For  a more  complete account of the uses of  calx
sulphurata, the reader is referred  to an article on the subject,
in the Jour. Cutaneous and Venereal Diseases. January, 1883. 
— 28 —
kidneys, increasing the amount of urine, and the total
quantity  of solid, excreted with  it.    It is possible,
therefore, that a part of its effects are  cue to its  de-
purative  action.   Other  diuretics,  however, do  not
seem seem to possess  all the powers exhibited by this
drug, and cannot completely fill its place.  Its useful-
ness in eczema has a very wide range,  but is specially
marked in the eczema caditis of children, the so-called
crusta lactea  or milk-crust  of  the   older writers.
Vesico-pustular eczema of the scalp and face, of mod-
erate severity  but with persistent  tendencies, is  of
frequent occurrence, and it is in these cases that viola
produces  the  most decided effects, as anyone may
ascertain who tests it.   To  obtain  the most benefit,
the dose should be selected with care  and judgment.
In  this respect it is  impossible to do more than lay
down a general rule, which may be stated as follows:
Too small  a dose will, obviously, be  without result,
while too large a dose will make the eruption, for  the
time, at least, very much worse, increasing the extent
and severity  of  the  lesions.   The more  acute  the
eruption, the smaller  should be the dose;  while  the
more sub-acute and indolent, the larger it should  be.
In acute cases a single drop of the fluid extract twice
or  three times a day,  is often sufficient for infants,
while five drops may be enough for  adults  in similar
conditions.  On  the  other  hand, if the  affection  be
indolent, the dose may be very considerably increased,
even up  to a  teaspoonful to  adults.   When viola is 
                     — 29 —
prescribed  the first  time  in any  given case,  it  is
almost impossible to predict its effects, and my custom
is to direct the  patient to increase the dose, if, after
three or four days, the eruption is  unchanged;  or, on
the other hand, if it should appear  to be getting de-
cidedly worse, to discontinue the drops for a few days
and  then  resume them in smaller doses and at less
frequent intervals.   In the dry eczema capitis of adults,
viola in twenty or  thirty-drop doses is very often of
great service.  In  fact, its  action  in  many respects
closely resembles that of arsenic, and the principals of
dosage are substantially the same in both.  It has this
advantage  over arsenic, however, that too large doses
never do more than temporary harm.  In eczema with
great infiltration, viola tricolor has  not appeared to me
to be of much service.
     The three drugs  here mentioned are the ones on
which I chiefly rely in the internal treatment of the
lesions of  the disease in  contra-distinction  to the
constitutional conditions which precede or accompany
them.  Both classes of treatment  may often be pur-
sued simultaneously;  and which should  be  predomi-
nant or entirely omitted is simply a question of judg-
ment.
     Eczema may occur in  connection with syphilis,
and very frequently  in combination  with that ill-defined
condition  to which we give the name of struma.  In
either case,  treatment  adapted  to  these  conditions
should be employed in connection with the special
treatment  of the eczema. 
                     — 3o  —
    I have never been able to perceive that  the co-
existence of syphilis and eczema has led to any modi-
fication of either disease, whether  the syphilis came
before or after  the disease, and syphilis  in  no wise
tends to prevent the  occurrence of eczema  in those
who are subject  to it.
    In  patients possessing a marked strumous  con-
stitution,  the ordinary anti-strumic  remedies,  such
as cod-liver  oil, iodide of iron, lime,  etc., should  be
freely given  in  conjunction  with  appropriate  local
treatment. 
CHAPTER IV.
               LOCAL TREATMENT.

    The local treatment of eczema  involves the em-
ployment of  various lotions, ointments, oleates, oils,
colloids,  powders and  soaps.  A very formidable list
of these might be given, but I shall  confine myself to
those  with which  I have had a favorable practical ex-
perience.
    Lotions.—The first of these is the well-known
black wash, which I prefer to use made in the propor-
tion of one part of calomel  to thirty or forty parts of
lime water.   The mixture should  be shaken  before
use, and  is applicable at the earliest  stage of the acute
form of the disease  when the primary  congestion is
present and  the vesicles  are about  to  form.   Even
after rupture and during the second stage, black wash
will often greatly modify  the intensity of the inflam-
mation,  and  relieve the  subjective symptoms.  Of
still greater value during the first and second stages,
and especially if the exudation is abundant and puru-
lent, is a  drug, or rather a  simple chemical compound,
which thus far has obtained  but  little practical recog-
nition.  I allude to the solution of peroxide of hydro-
gen.  This substance was  formerly difficult to make,
and expensive.  It is now manufactured on a large
scale for  technical purposes,  and  is quite cheap.  Its
only inconvenience is its liability to decompose  when 
                     —  32 —
kept in a warm  place, and thereby lose its  strength.
If the bottle be  placed in a refrigerator it will keep its
strength  indefinitely.  Robbin's  (English)  solution,
contains nine volumes of  peroxide, while Marchand's
(American) is usually sold of the strength of twelve
volumes, and is about  half  the  price of the former.
The twelve volume solution is too strong to apply un-
diluted in many cases of eczema, especially in  chil-
dren, producing an  undesirable degree of  irritation
and reaction.  It  should, therefore, be  diluted  with
from  three  to  five volumes of  water,  increasing in
strength as the patient is found to bear it.  The effect
of the solution of peroxide of hydrogen in many cases
appears  almost  magical, reducing  the  purulent  exu-
dation and permitting the formation of a new epithe-
lium.
    Dilute alkaline lotions, especially a solution of the
carbonate of soda, are useful for cleansing purposes,
and, to a certain extent, for the relief of pruritus.
    Strong alkaline applications of liq. potassae,  pure
or somewhat diluted, green  soap  and  its  solution in
alcohol, have a distinct  function to perform in the re-
duction of  thickened epithelium  in  eczema of the
hands or feet, and in the removal of infiltration.   If a
patch of greatly infiltrated eczema  be  painted  with
liquor  potassae,  in  a  few  moments little droplets  of
serum  will be seen upon the surface;  if these  be
wiped off, fresh serum exudes, and this continues for
some  minutes.   When  the tendency  to  exudation 
                     — 33 —
ceases, the parts should be wiped dry, and a sedative
ointment  applied.   The  application  is repeated on
the second or third  day, according to  the  degree  of
irritation  produced  by the first application, and this
is  continued until  several  applications  have been
made.   The result will be notable diminution of the
infiltration.
     Ointments.—The ointments most in vogue are the
ungt.  zinci  oxidi, ungt.  hydrarg.  ammoniati,  ungt.
hydrarg. nitratis, ungt. diachylon, ungt. picis liquidi,
and ointments containing carbolic and  salicylic acids.
Of these the zinc ointment is probably inert so far  as
any direct medical effect is concerned.   It is simply a
protective, and as such serves  an admirable purpose,
especially in cases of extensive disease, where it would
be  neither safe  nor  prudent to employ the  mercuria
preparations.  If the base of the ointment contained a
little wax  instead of  being  made  with lard only,  it
would  be still better.   The benzoin,  however, which it
contains, tends to preserve it from rancidity, and un-
doubtedly exerts a slight beneficial  influence.  When
a decidedly sedative  effect is desired, I am in the habit
of adding to each ounce of the ointment half a drachm
of the fluid extract of  belladonna, or a drachm of the
fluid  extract  made  from fresh  stramonium  leaves.
Ungt. diachylon resembles zinc ointment in its general
effects, but as it possesses few, if any, advantages over
it, and is rarely well  made, it has not  come into very
general use.
     ** 4 
                     — 34 —
    Ungt.  hydrarg.  ammoniati, either alone or with
the addition of a little stramonium, is more effective
as a curative  agent than zinc  ointment, but must be
used with a certain amount of discretion, and  should
not be applied over extensive surfaces for fear of mer-
curial intoxication.   In some cases it  irritates if used
of the full official  strength,  and should, therefore, be
diluted.  In a few instances  I have known  it to pro-
duce active dermatitis.
    Ungt. hydrarg. nitratis is  more stimulating than
the ungt. hydrarg.  amnion., and  should  usually be
diluted with one or two  parts of  lard.
    Ointments containing from five to  ten  grains of
carbolic acid  are used, and will sometimes control the
itching better than anything else.
    The second stage of eczema with exudation  and
crusting  is the period when the ointments mentioned
are of the most service. After removal of all  crusts
and careful drying of the surface, the ointments may
be  smeared  on the  part, or applied  on muslin  and
bound on.  The salve-muslins of Dr.  Unna, of Ham-
burg, which consist of a loosely-woven fabric like thin
cheese-cloth  or gauze, thickly  impregnated with the
ointment, are exceedingly  convenient when a  fixed
dressing  is desired.
    The frequency of application of  the dressing will
depend in great measure on the amount of discharge.
Sometimes the applications will require removal night
and morning, and  sometimes but once in twenty-four 
                     — 35 —
hours.   As a  rule the  part  should be disturbed as
little as possible, and the dressings removed only when
necessary.
    Ungt.  picis. liquidi, and  ointments containing
oleum  cadinum, oleum rusci, and similar  empyreu-
matic substances, play quite  a different part in the
treatment of  eczema.   They  should never be used
in the first or  second stages  of the  disease, or when
acute conditions are  present.   In  the third  stage,
however, when the skin presents  a dry and  scaly sur-
face, covered with new but imperfectly formed epithe-
lium, and especially if the affection is indolent, these
preparations are of the  utmost service.  Tar  mixed
with four or  five  parts of turpentine, may be used
instead  of the ointment, and  rubbed once or twice a
day into the affected  parts.   Instead of turpentine,
however,  I  usually employ the  oleum pini sylvestris,
and have the mixture perfumed with the oil of  laven-
der or citronella.
    Oleates.—The oleate of zinc  as  a dry powder or
an ointment is used by many  in the place of zinc oint-
ment, but I  have  never been able to  perceive that it
possessed any special advantage  over  the latter  pre-
paration.  The oleate of mercury is a direct stimu-
lant, and occasionally useful.  Its strength should not
be greater than one per cent.
    Collodions.—Contractile collodion  will sometimes,
I believe, abort a threatened  eczema, and prevent ex-
tension  from one already existing, if applied around 
                     - 36 -
the margin of the  lesion.   Flexible collodion  is pro-
tective only, and is sometimes useful when the exuda-
tion is  slight.   Cantharidal collodion  is sometimes
employed as an application to  an old  and obstinate
local patch which it is desired to stir up to  some de-
gree of activity.   Occasionally it hastens a cure; more
frequently it does  more harm than good.   Collodion
medicated with with chrysarobin, a  remedy of such
marvellous efficacy in psoriasis, is of comparative little
value  in  eczema,  although the local conditions are
often quite similar.  Collodion with five  per cent, of
iodine will often prove of service in chronic  thickened
patches.  Collodion with  three or  four  per cent. 01
salicylic acid will dissolve and remove thickened epi-
dermis from the hands and feet more quickly, perhaps,
than any other'drug; mechanical means, however, are
generally preferable.
     Traumaticin is the name in  common use to desig-
nate a ten per cent, solution of gutta-percha in chloro-
form, and it possesses many advantages  over collodion
for some purposes, and I sometimes make use of it as
a protective only, or as  a vehicle for  oxide  of zinc,
sulphur, ammoniated mercury, etc.  It  makes a much
better mixture with them than collodion.
     Powders.—It is sometimes  found that  in  the
 second  stage of  eczema,  ointments and  lotions  of
 every kind  increase the irritation, and add  to the dis-
 comfort of  the  patient.  Fortunately these instances
 are rare, but when they are met with simple or medi- 
                     — 37 —
cated  powders  will  sometimes  prove  of service.
Starch, lycopodium, ordinary  toilet powder, or talc,
may be used alone, or  oxide of zinc, or sub-nitrate of
bismuth may be used  with either of them.  It is in
these cases  that the dry powdered oleate of zinc often
proves useful.
     Soaps.—Of these there are three principal sorts of
use  in  eczema, namely, soft soap, hard soap, and  tar
soap.  Soft potash soap, equivalent to the sapo  viridis
of the Pharmacopoeia, contains an excess of alkali, and
is used for  the reduction of infiltration.  Hard soda
soap, prepared for laundry use, also  contains a large
amount of free alkali,  and may be used for  the same
purpose.  Tar soap is of service in the third and scaly
stage of the disease.
     Certain mechanical means are sometimes employed
in the treatment of eczema.  A few years since wrap-
ping the part in vulcanized rubber was much lauded,
especially in eczema  of the hands, with a view to
keeping the parts moist, and macerating the thickened
epidermis in the secretions of the part.   This method
is sometimes useful.  The application of rubber, how-
ever, in the  form of an elastic bandage, often proves
of the  greatest  service in thickened eczemas of the
lower extremities.   Here the  object sought is steady
pressure, with a view to produce absorption of  the in-
filtration.   The silk  elastic stocking may be used for
the same purpose.
     Sometimes localized patches  of eczema of long 
                     - 3« -
standing fail to yield to any of the ordinary means for
their  relief, and necessitate the most vigorous inter-
ference.  Thorough scraping of the surface with  the
curette, scarifications,  and  even applications of  the
actual cautery may be advisable.
    Antipruritics.—One of  the  most distressing fea-
tures  of many cases of eczema is the intolerable itch-
ing that frequently accompanies the disease.  It is the
symptom of which the patient  complains the most.
An application that will in all cases relieve the itching
has long been  sought, but, unfortunately, has not  yet
been found.  In a minority of cases only is it possible
to materially subdue the pruritus, though in many a
certain measure of relief may be afforded.   Twenty to
thirty grains each of camphor and chloral  rubbed to-
gether and then incorporated with an ounce of simple
ointment, or with the special ointment  it is proposed
to use, may be tried.  If the surface is  much inflamed
and exuding, this application will give  great pain and
increase the trouble.  Three to five grains of carbolic
acid, twenty or thirty of balsam of  Peru, a drachm of
fluid  extract of  stramonium, a few drops of dilute
hydrocyanic acid, half  a grain of corrosive sublimate,
or ten to twenty drops of chloroform, with each ounce
of ointment,  may be tried in  turn, but without  ex-
pectation of affording  much, if any, relief; at least
such has been  the author's experience.   The pruritus
ceases when the eczema gets well, and  not, as a rule,
until then. 
CHAPTER V
TREATMENT  OF  THE  SPECIAL  FORMS  AND
             VARIETIES  OF ECZEMA.
    Bearing in mind the  general  principles that un-
derlie the treatment of all cases  of eczema, we wil
consider the  special  treatment  of the varieties as
influenced  by  age, degree  of  inflammatory action,
locality, etc., commencing with the eczema capitis of
young children.
    In eczema of the scalp, we  frequently, and  per-
haps generally, find the case acute as regards its char-
acter, though it may be chronic  as regards the  dura-
tion of time that it  has existed.   It is  almost always
presented to  us in the second stage, characterized by
exudation  and crusting,  and,  perhaps, complicated
with enlarged  glands at the back of the neck, small
abscesses on  the scalp, and, perhaps, also accompanied
with pediculi.  The vesicular or pustular forms are
the most common, and the crusts entangled and re-
tained by the hair accumulate more thickly than else-
where.  In dispensary practice the scalp often  seems
a mass of animated  filth, fetid  and disgusting  to an
intense  degree.  The first thing  to  do is  to cut the
hair as short as it is possible to do  with scissors.  If
pediculi are present, search through the entire  scalp
for their ova, which will be found  attached to the hair.
These hairs should  then be cut off, or if the trouble is 
                     — 4o —
at all general, it will be better to clip the entire scalp.
This may be done with scissors, or better with clippers
If many crusts adhere to the  scalp after  clipping the
hair, saturate the parts with olive  oil, and after a few
hours give the scalp  a good  washing with  soap  and
warm water, and remove, so far as possible, all crusts.
After drying, apply zinc  or diluted white precipitate
ointment.  The ointment should be renewed daily, or
even twice daily, and crusts and accumulations of old
ointment be  removed  by gentle use of the comb as
often as necessary.   The scalp should  not, however,
be washed again for several days; in fact, the less fre-
quently it is washed the better.  If abscesses are pres-
ent, they must be opened, and perhaps poulticed for a
day or two.   Eczema of the scalp in many cases ap-
pears to be called into being as a consequence of para-
sitic irritation, and when the eczema is limited but the
parasites numerous, cutting the hair may be avoided,
and the first point of attack will  be the insects them-
selves.  I know of nothing more effective than drown-
ing them-out with kerosene. If the scalp be thorough-
ly saturated  with this for two or three days in  succes-
sion, soap and water and a  fine  tooth comb will  do
the rest.  The  parasites destroyed,  the  eczema may
recover spontaneously, or  more quickly if aided  by a
few applications of the ointment.
    In  general  eczema of  the scalp, attended with a
high degree of  inflammatory action,  with a tendency
to suppuration,  sulphide of calcium is probably the 
                    — 41  —
best internal remedy that can be made use of.   It
should be administered  in accordance with the rules
already given.   Later,  viola  tricolor, especially  in
subacute  cases of long standing,  will prove useful.
The enlarged glands at  the nape of the neck require
no  special  attention—when the eczema gets  well,
they will  subside.  Eczema  of  the  scalp  often ex-
tends to the face, and the forehead, cheeks and  ears
become affected.  The   ointment  chosen should be
sedulously applied, and  as little water permitted  to
touch the parts as possible.   If fissures form behind
the ears, I usually add a little finely powdered graph-
ite  (blumbago, black-lead)  to the  ointment, or else
mix it  with lycopodium.   As the  case  progresses
towards  recovery, and  the  exudation and crusting
cease, and the third  stage, characterized  by dryness
and scales,  is ushered  in,  the ireatment requires a
change.
     A little tar  in some one of its forms shonld be
added  to the ointment, and the proportion of tar
increased   as  improvement   occurs.   If  progress
towards  recovery should halt, a tonic of iron, qui-
nine, strychnine,  or physphorus, or of  two or more  of
them combined,  should  not be forgotten.
     Eczema of  the  scalp in adults, whether male  or
female, presents itself more frequently in a subacute
than an acute condition, and very commonly in the
dry and scaly stage, the patient complaining of a cer-
tain amount of irritation, and an excessive  formation 
                      — 42  —
 of dandruff.   In this condition  arsenic is frequently
 of service, but the local treatment  is of the  utmost
 importance.  If the same condition should be present
 on the non-hairy parts,  tar wonld be the remedy first
 thought  of.  This, however, is practically impossible
 on the scalp, except for  those  who are willing to
 abandon  social  and  business pursuits  and   devote
 themselves entirely to their  scalps.   As a substitute
 for tar I have devised a mixture  that appears to me
 to be fully as efficacious; it  is free  from  the objec-
 tionable features of the other.
        1}  Acidi salieylic; gr. x to xx.
           01. lavandul, 3 iiiss.
           01. citronella,  3 ss.
           01. pini sylvestris, § ij.
           01. ricini, ? iss.
        M.

     In this preparation  the salicylic  acid is designed
 to restrict the formation of scales, the oil of the pinus
 sylvestris to act  as  a stimulant, and the castor oil  to
 correct the drying effects of the latter. The lavender
 and  citronella are  simply  perfumes, and  any other
 may be substituted for them.   The best way to apply
 this  preparation  is from a  small  oil can.   The hairs
 having been  separated, a few drops are applied  di^
 rectly to  the  scalp  and gently  rubbed  in with the
finger.  All of the affected  portions  are gone  over in
this manner.   To make the application perfectly and
thoroughly,  assistance will  be required.   If  care be 
                     — 43 —
taken, only so much oil as may be necessary is applied
to the scalp, and the hairs, except near the surface of
the skin,  do  not become  disagreeably  impregnated
with it.  Application of the oil should at first be made
daily, but usually at the end of a week  the  intervals
may  be  lengthened.   If  at  any time the  eruption
should revert to the second stage, with exudation, the
oil must be abandoned and white precipitate  or  zinc
ointment substituted.   If the eczema has  lasted  any
length of time, or if it is  a frequently recurring condi-
tion, careful constitutional  treatment is a necessity.
    Eczema barbae.—In  eczema  affecting  the hairy
portions of the face, the disease  not  infrequently de-
scends into the hair-follicles and infiltration of the in-
terfollicular tissue occurs.  The  most frequent form is
the pustular, in which the follicles are the sites of the
pustules.  It is of the first importance  that a correct
diagnosis be  made, and the  affection  differentiated
from  trichophytosis barbae, which sometimes resembles
it.  This can usually be done  at a glance, but some-
times the aid of the microscope will be necessary.
     If the eczema be purely superficial, that is, if the
inflammation  has not descended into the follicles, it
may be treated in the same manner as eczema  of the
scalp. If, however, it is sycosiform in character,  with
infiltration and pustules, epilation must be employed.
Every hair on the affected portions must  be  plucked
out with  forceps.   As a  rule, they  come  out easily
and without pain, as  the inflammation  has  loosened 
                     — 44 —
the root-sheaths from their  attachments to the folli-
cles.   The necessity for epilation  will be apparent
when we consider the fact  that  the  loosened  hairs,
while in the follicles, are  playing the  part  of foreign
bodies,  and tending to keep up  the inflammation.
After  epilation, white  precipitate  or zinc ointment
should  be  applied   thrice  daily.    Internally calx
sulphurata, gr. fa to gr. \, three times daily  may  be
given to advantage.  In fact, this drug nowhere shows
its power more  strikingly than  in  sycosiform  eczema.
     Eczema of other hairy parts,  as the axillae, breast,
or pubis, does not take on the  sycotic character, and
epilation is unnecessary.
     Eczema  of the  genital region usually  presents
itself to the physician as a chronic  affection  of the
scrotum, and most of the cases I have  met with have
existed for years before consulting  me.   The parts
will usually be found red, dry, and thickened, and the
site of more or  less  intense  pruritus.  At times the
eruption becomes moist with more or  less  serous exu-
dation.   The most noticeable feature in long-standing
cases is the great infiltration.  Of  all forms of eczema,
this is the one which, in  my experience, is the most
difficult to manage.  A well-known  writer disposes of
the question of its treatment in the following words:
     " The treatment of eczema of the genital organs
and anus does not differ from that of  eczema in gen-
eral, except in-so-far as we must bear in mind  the pre-
disposing causes,  and endeavor, to remove  them if
possible." 
                     — 45 —
     This general advice is good so far as it goes, but
perhaps the most important of the predisposing local
causes is the dependent position of the parts and their
constant exposure to friction.  As these causes can-
not be wholly removed, we must confine ourselves to
a partial mitigation of their effects.  This can be ac-
complished in great measure by a properly fitting and
snugly applied suspensory bandage.   The bag may
further be lined with  rubber,  and  should be applied
in such a way as to keep the parts as elevated as pos-
sible, with as  much pressure as can conveniently be
borne, being  careful,  however,  not to constrict the
upper part and impede the venous  circulation.   The
rubber lining favors exudation and reduction of the
infiltration.   This, however, is not all.   Active  meas-
ures must be undertakken to reduce the infiltration.
There are three principal  methods by which we may
seek  to accomplish this end:  First, by a few scarifi-
cations of the scrotum,  permitting  the parts to bleed
freely, care  being taken not to cut into any of the
larger veins.   After sacrification the patient should
sit for some minutes in a tepid antiseptic sitz-bath, to
encourage bleeding and exudation.  After the parts
are dried, a little  tincture of benzoin, or a solution of
iodoform, may be sprayed over them, and the suspen-
sory be applied.  In a week or two the  scarification
may be repeated.  The relief afforded by this is  some-
times surprising.   Many patients, however, have such
a dread of cutting operations about the genitals, that, 
                     - 46 -
as  a  rule, some other procedure must  be advised.
The second means that we have at command  is Gal-
vanization.  The constant current applied daily, or on
alternate days, will sometimes reduce the infiltration
and relieve  the  itching.  The  testicles should be
pushed well up, and the slack of the scrotum held be-
tween two good-sized sponge-covered electrodes.  A
current of from eight to twelve cells may be  passed
for from one to ten minutes.  The strength and dura-
tion of the  application  will  depend  on the  special
susceptibility of the  patient.   The third  method of
reducing the infiltration  is the one most commonly
employed, and consists in the application of liq. potas.
This should be mopped  on with  a small sponge or
wad of absorbent cotton wrapped on the end  of a
probe.  This application should be made by the sur-
geon himself, and not entrusted to the patient.   After
its  immediate effects have passed  off,  a little  zinc
ointment  may be applied and the parts  adjusted in
the suspensory.  From six to a dozen  applications at
intervals of  from three to six days may be necessary.
Despite these  various  measures  the affection  will
not always  yield as  promptly as desired, and  the
patient will  seek advice elsewhere.  Eczema  of  the
penis sometimes accompanies that of the scrotum, but
usually in a milder form and is frequently independent
of it.   When met with alone and in persons in middle
or advanced life, and especially if  the glans and inner
surface of the prepuce  is involved" the  presence or 
                     — 47 —
absence of glycosuria should be ascertained.   If this
condition  is present, the parts should be  carefully
washed after each  emission of urine  in cases where
the urine can come in contact with them, and an anti-
septic lotion of  boracic  acid,  hydro-naphthol, or  the
like applied.  The  general  treatment  should be that
which is required by the diabetic condition.
     Eczema of the vulva is rarely met with  until  the
climacteric and later.  In some cases  it is doubtless
excited by irritating uterine or vaginal discharges, but
in perhaps  the majority it is due to  glycosuria.   In
either case the  preliminary treatment is  clear.  The
best local application in my  experience  is  the per-
oxide of hydrogen.
     Eczema of the palmar and plantar surfaces,  fre-
quently characterized by great thickening  of the  epi-
dermis together with fissures, demands special treat-
ment.
     The epidermic proliferation must first be attacked
with knife, file or sand-paper.  After  all  that is pos-
sible has been removed in this manner liquor potassae
should be thoroughly applied, care being taken that
none of  it gains access to the  fissures, if any be pres-
ent. Several applications of the alkali may be needed.
The fissures themselves  will notably improve if dusted
with graphite and lycopodium,or graphite in ointment.
If there be little infiltration of the derma, tar or its
equivalent is indicated if the surface is dry  with  ten-
dency to scaling, while  some  of  the less  stimulating 
                     _ 48 -
ointments should be applied if the surface be moist
with exudation.
     Chronic eczema of the hands is often exceedingly
obstinate, and is one of the forms of the  disease that
seems to be  benefited  by impermeable  dressings.
India rubber gloves, then,  worn at night should not
be  forgotten.   This  form of eczema is  sometimes
kept up indefinitely in  women  who are obliged to put
their  hands frequently into dish-water,  etc.  When
this is the case the patient should be informed of the
advisability of restricting herself in this respect, or of
making such change iu her avocotion as will enable
her to keep her hands out of water except when abso-
lutely necessary for cleanliness.
    Eczema of the legs is very frequently dependent
on pre-existing varicose  veins, and when such is the
case is  difficult to manage, unless the diseased veins
can  themselves  be  brought under control.   If the
varicose condition be at all  severe, the general nutri-
tion of the skin of the leg seems to suffer greatly, and
a slight wound from scratching may degenerate into
an ulcer.  The cutaneous tissues, which  are  the site
of the lesion, and for a considerable space around  it,
may be  greatly thickened, and the  surface present a
bluish surface from  impeded circulation.  When this
condition exists,  the utmost benefit will be  secured
from the systematic use of the rubber bandage applied
so as to bring firm but  gentle pressure to bear upon
the parts.   The bandage should in the  first instance be 
                     — 49  —
applied by the physician, and the mode of its appli-
cation be taught  the patient.  The bandage should,
when practicable,  be applied morning and night, and
if it become soiled by discharges of any kind should
be replaced by a fresh one, while the first is permitted
to soak in  cold water till  again needed.  After the
leg has been restored to its normal size the bandages
may be discarded, but an ordinary elastic  stocking
should be worn habitually.   The direct remedial ap-
plications to be made will  depend on  the stage  and
condition of the lesion.
     Eczema of the legs, however, is not always of the
varicose variety, but sometimes presents itself as a
chronic subacute circumscribed lesion, with or without
notable infiltration.   In the former case, tar and the
like  is the application usually indicated.   When infil-
tration is present it  may usually be removed by the
persistent application of  potash; many  times,  how-
ever, it  fails to yield to  this, and severer measures
must be employed.  To this  end a blistering applica-
tion of collodion may be made, or croton oil, diluted
perhaps with a little sweet  oil, may be rubbed in. The
object of these  measures is to excite  considerable
substitutive   inflammation,  which, when  it subsides,
leaves the parts in a condition  disposed to heal.  As
an  alternative, scarification  may be  employed, and
liquor potassae may be applied to the scarified surface.
This, it must be born in mind, is exceedingly painful.
The  scarification, with or without the potash solution,
     ** s 
                     — 5°  —
must  be repeated at the end of a week or ten days if
necessary.   When the infiltration and thickening have
been dissipated, and there remains only a raw  exud-
ing surface, the  zinc or other ointments should  be
applied, to be followed by the  tarry preparations as
the progress of the lesion warrants.
    Acute eczema of the leg  demands quite  different
treatment.   If the greater part of the  leg, or both
legs, are involved, rest in bed, or on the  lounge, with
the feet slightly elevated, is a  sine qua non.  The
parts are red, hot, swollen, with more or less of the
stratum corneum gone, and exuding.  In this condi-
tion absolute rest must be  enforced; it  may  be for a
week; it may be  for two.   Unless the patient consent
to  this, make  him  no promises.  After he is fairly
anchored, apply lotions—black wash, lead and opium,
or  peroxide of hydrogen.   This latter,  of   properly
graded strength, should be  applied three  or four
times  a  day  with  an  atomizer.    The   tube   of
the atomizer should be of  glass.*   If the exudation
be profuse and fhe weather  warm, the odor may be
offensive.   The  peroxide produces complete deodor-
ization, instead of substituting one bad smell for  an-
other  as would be the case with carbolic acid, iodo-

    * If the ordinary atomiser with silver-plated brass tube be
used, the fluid will become of a pale bluish color, and the por-
tion of the tube that dips into it will be deprived of the silver
and show a  bright brass surface when the adhering oxide is
rubbed off. 
                     —  5i —
form, etc   Immediately  on  the  application  of the
peroxide, a fine white froth will appear whenever the
surface is denuded of epithelium.   After two Or three
days, as a rule, the extent of denuded surface  will  be
found greatly lessened,  and over  a great part of the
lesion a condition of  extreme dryness with large semi-
detached  scales.   These  partially   adhering scales
should  not be removed  by  traction, but  their loose
edges carefully  trimmed with scissors.  When this
condition is reached the period for ointments has  ar-
rived, but I do not like the officinal zinc or white pre-
cipitate as well as cerate made as follows:
        5  Ceratum cetacei, ^ *v-
           Tinct. benzoin,  § ss.
           Hydronaphihol, gr. *>
           Zinci oxidi, 3 iij.
     M.
     This should be evenly spread  on  old linen, and
retained by bandages or adhesive plaster.   Unna's
salve muslins make admirable dressings for  this con-
dition, and may be readily  extemporized  by  thickly
impregnating gauze (the kind used for antiseptic pur-
posee) with the  above or  any other desired cerate.  If
the case proceed favorably, the dry and scaly  condi-
tion noted will give way to  a surface  still  dry  but in
which the scales are much finer.   The patient  by this
time will probably desire to leave his bed  and  attend
to his daily business.   This  he may be permitted  to
do, provided the dressings are applied, and the whole 
                     — 52  —
covered with a snugly and  evenly applied bandage, or
still better with a silk elastic stocking.   As the color
fades .from  the  affected skin, the  use of tar or its
equivalent may be commenced.   During all this time
washing the parts should be abstained from as  much
as possible.   Any old or adhering  cerate  should  be
removed  mechanically  rather than  with  the  aid  of
soap and water, as the tincture  of  benzoin  and  the
hydronaphthol will prevent the cerate from  becoming
rancid.  As  the case  approaches completion, the cerate
is entirely dispensed  with, and slight friction at  night
with the mixture  of  ol. ricini  and ol. pini  sylvestris,
will be all that is necessary.  The  elastic  stocking
should be worn for some weeks after the  skin  seems
entirely sound and well.
    Eczema of the inner surface of the thigh from the
groin to the  knee,  frequently assumes the papular
form accompanied with considerable  irritation.   In
this condition a salve-muslin  impregnated with  zinc
cerate, or with diachylon ointment, and  kept in  con-
stant contact, will usually afford great relief.   As the
papules and the color subside, a little  tar should  be
added.
    Eczema of the anus is  an insidious  affection, and
is  frequently of long standing before it  is brought to
the attention of the physician.  Thickening and  fis-
sures often  co-exist, and  the  latter should first  be
healed,  by   cauterization,  peroxide  of  hydrogen,
graphite  ointment or powder, etc., before  attempt is 
                     — 53 —
made to reduce the infiltration by strong alkaline ap-
plications.   The irritation  produced by applications
of liq. potassae is greatly mitigated by diachylon oint-
ment or zinc cerate.  One of the most effective appli-
cations to  the  fissures, and by no means the  most
painful, is the fine point of a Paquelin  cautery, at a
white heat.
     Eczema of the mammae and nipples is a very fre-
quent accompaniment  of scabies in the female,  and
when met with, the latter disease should be suspected
and carefully sought for.   As the eczema is  due to
the irritation of  the parasite, the insects must first be
destroyed.   I know of nothing more effective for the
purpose than the alkaline sulphur ointment, to which
iodide of potassium has been added in the proportion
of a drachm to  the ounce; afterwards zinc cerate,
     The so-called " Paget's disease of the nipple" so
closely resembles an eczema of the part, that an accu-
rate diagnosis is extremely essential.   Ezcema sur-
rounding the nipple is readily curable,  while Paget's
disease is rebellious to all simple measures of  relief.
It is removed only by vigorous cauterization or excis-
ion.  When left to run  its course,  it  terminates in
mammary cancer.  Hence,  the importance of its early
recognition.
     In obese persons, an eczema may arise from the
irritation produced by confinement of the cutaneous
secretions  by  over-lapping folds  of  skin, as  under
pendulous breasts, and in the groin between the thigh 
                     — 54 —
and scrotum, or thigh and vulva.   In these situations
simple dusting  powders, with separation of  the parts
by folds of linen, will often accomplish all that is de-
sired.  If there be much secretion,  a small  quantity
of tannin may be incorporated with the powder,  and
if fissures are present, graphite should be added.  If
the surface be decidedly deprived  of epidermis, the
zinc oxide cerate should be used. 
Empty   and    Filled  Gelatin   Capsules.
    THE development of aesthetic tastes has been a most marked accom-
      paniment of the material progress of the people of America.  The
      desire to unite beauty with utility is so universally manifested that
      it was to have been  anticipated  that it would modify forms  of
medicine, and this has been the case.   To-day the physician who fails to
recognize and satisfy this demand, however  sterling his qualities, will
not attain practical success.
      We have a special laboratory for the manufacture of Gelatin  Pro-
ducts, and it is, we believe,  due to our efforts that this variety of medica-
tion has become popular among physicians.   The application of Gelatin
Capsules in the administration of bitter or nauseous drugs has, we might
almost  say,  revolutionized  the  exhibition  of  medicines,  and to day
Gelatin Capsules are a favorite method of medication  with both physi-
cians and patients.
      The step from empty to filled Gelatin Capsules was a most natural
one, and at the present time it may be said that physicians  might  con-
fine internal medication exclusively to this class of products and be able
to meet almost every conceivable indication for treatment.
      Pharmacy has given to medicine no more elegant method of ad-
ministering drugs, especially those of a bitter and  nauseous character,
than the soluble elastic  filled capsules properly made.  We say properly
made advisedly, for owing to the  great  demand  for  them, so many in-
ferior capsules have been put upon the market by  those having imper-
fect facilities for their manufacture, the resultant product being inelastic,
insoluble, and  inelegant  in appearance, that many physicians do  not
properly appreciate the advantages offered by a highly-elastic,  per-
fectly- soluble capsule  with medicinal contents  of the  very  purest
QUALITY OBTAINABLE.
      Of the elastic filled capsules we  make 87  formulae.   Especially
convenient and  in  greatest demand are elastic capsules of quinine,
cascara  sagrada,  pichi, castor oil, cod-liver oil, copaiba,  and cubebs.
We trust those of  our medical friends  not already familiar with this class
of our products,  will send for our formula  book of capsules,  wherein
many points are presented which we cannot adequately cover here.
PARKE,   DAVIS  &  CO.,

                      DETROIT AND NEW YORK, 
IN   EXPLANATION
OF
Library.
     We have made a new departure in the publication of medical books.  As you
no doubt know, many of the large treatises published, which sell for four or five or
more dollars, contain much irrelevant matter of no practical value to the physi-
cian, and their high price makes it often impossible for the average practitioner to
purchase anything like a complete library.
     Believing that short practical treatises, prepared by well known authors, con-
taining the gist of what they had to say  regarding  the treatment of diseases com-
monly met with, and of which they had  made a special study, sold at a small price,
would be welcomed by the majority of the profession, we have arranged for  the
publication of such a series, calling it The Physicians' leisure library.
     This series has met with the approval and appreciation of the medical profes-
sion, and we shall continue to issue in it books by eminent authors  of this country
and Europe, covering the best modern treatment of prevalent diseases
     The series will certainly afford practitioners and students an  opportunity
never before presented for obtaining a working library of books by the best authors
at a price which places them within the  reach of all.   The  books are amply illus-
trated, and issued in attractive form.
     They may be had bound, either in durable paper covers at 25  Cts. per copy,
or in cloth at 50 Cts. per copy.  Complete series of 12 books in sets as announced,
at $2.50, in paper, or cloth at $5.00, postage prepaid.  See complete list.


PHYSICIANS'  LEISURE  LIBRARY
PRICE: PAPER, 25 CTS. PER COPY, $2.50  PER SET) CLOTH, 50 CTS. PER COPY,
                         $5,00 PER SET.
SERIES  I.
Inhalers, Inhalations and Inhalants,
   By Beverley Robinson, M. D.
The Use of Electricity in the Removal of
 Superfluous Hair and the Treatment of
 Various Facial Blemishes.
   By Geo. Henry Fox, M. D.
New Medications, in 2 Vols.
   By Dujardin-Beaumetz, M. D.
The Modern Treatment of Ear Diseases.
   By Samuel  Sexton, M. D.
The Modern Treatment of Eczema.
   By Henry G. Piffard, M. D.
Antiseptic Midwifery.
   By Henry J. Garrigues, M. D.
On the Determination of the Necessity for
 Wearing Glasses.
   By D. B. St. John Roosa, M. D.
The Physiological,Pathological and Ther-
 apeutic Effects of Compressed  Air.
   By Andrew H. Smith, M. D.
GranularLids and ContagiousOphthalmia.
   By W. F. Mittendorf, M. D.
Practical Bacteriology.
   By Thomas E. Satterthwaite, M. D.
Pregnancy, Parturition,  the  Puerperal
 State and their Complication*.
   By Paul F. Munde, M. D.
07 
SERIES  II.
The Diagnosis and Treatment of Haemor-
 rhoids.
   By Chas. B. Kelsey, M. D.
Diseases of the Heart, in 2 Vols.
   By Dujardin-Beaumetz, M. D.
   Translated by E. P. Hurd, M. D.
The Modern Treatment of Diarrhoea and
 Dysentery.
   By  A.  B  Palmer, M.  D.
Intestinal Diseases of Children, in 2  Vols.
   By A. Jacobi, M. D.
The Modern Treatment of Headaches.
   By Allan McLane Hamilton, M. D.
The Modern Treatment  of Pleurisy and
 Pneumonia.
   By G. M. Garland, M. D.
Diseases of the Male Urethra.
   By Fessenden N. Otis, M. D.
The Disorders of Menstruation.
   By Edward W. Jenks, M. D.
The Infectious Diseases.      In 2 vols.
   By Karl  Liebermeister.
   Translattd by E. P. Hurd, M. D.
SERIES III.
Abdominal Surgery
   By Hal C. Wyman, M. D.

Diseases of the Liver.
   By Dujardin-Beaumetz, M.D.

Hysteria and Epilepsy.
   By J. Leonard Corning, M. D.

Diseases of the Kidney.
   By Dujardin-Beaumetz, M. D.

The Theory and Practice of the Ophthal-
 moscope.
   By J. Herbert Claiborne, Jr., M. D.

Modern Treatment of Bright's Disease,
   By Alfred L. Loomis,  M. D.
D.,
Clinical Lectures on Certain Diseases of
 Nervous System.
   By Prof. J M. Charcot, M. D.
The Radical Cure of Hernia.
   By Henry O.  Marcy,  A. M., M.
     L. L D.
Spinal Irritation.
   By William A. Hammond, M. D.
Dyspepsia.
   By Frank Woodbury, M. D.
The Treatment of the Morphia Habit.
   By Erlenmeyer.
The Etiologly, Diagnosis and Therapy of
 Tuberculosis.
   By Prof. H. von Ziemssen.
   Translated by D J. Doherty, M. D.
series nr.
Nervous Syphilis.
   By  H. C. Wood, M. D.
Education and  Culture as  correlated to
 the Health and Diseases of Women.
   By  A. J. C. Skene, M. U.
Diabetes.
   By  \. H  Smith, M. D.
A Treatise on Fractures.
   By  Armand Despres, M. D.
Some  Major and  Minor Fallacies con-
 cerning Syphilis.
   By  E. L. Keyes, M. D.
Hypodermic Medication.
   By  Bourneville and Bricon.
Practical Points in the Management ol
 Diseases of Children
   By I.N. Love, M. D.

Neuralgia.
   By  E. P. Hurd, M. D.
Rheumatism and Gout.
   By F. Le Roy  Satterlee, M. D.
Electricity,  its application in Medicine.
   By Wellington Adams, M. D.

Taking Cold.
   By F. H. Bosworth, M. D.

Auscultation and Percussion.
   By Frederick C. Shattuck, M. D.
8eries IV will be issued one a month, beginning with November, 1889.
           GEORGE  S.  DAVIS,  Publisher,
E\ O.  Box  4T70.                       JDetroit,  Ifcv£icii.- 
 
 
 
 
 
 

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