panies this affection often necessitates the addition of some anti-pruritic agent. In other chronic forms of lichen, this acid may often be used with great benefit. I have now under treatment a case of lupus erythematosus, which I am sanguine of curing by an ointment of twenty grains of the acid.

In a number of cases of papular and scaling syphilides, I have had excellent results from the use of a mild ointment. Particularly valuable is this agent, combined with diachylon ointment in the scaling of syphilides of the palms and soles. Its application must here be continuous, and a previous removal of the scales may be necessary; and in severe cases the hands should be enveloped in India-rubber gloves.

It is to its success in the cure (perhaps I may more properly say the removal) of psoriasis that this acid owes its great and well-deserved reputation. And here I may add that my experience in its use convinces nie that the high praise that has been accorded to it by others, is well deserved. Indeed, it is rare to see any agent act as promptly and uniformly as this one does. One feels assured, in prescribing it, that a good result will follow its use. In psoriasis, it is generally necessary to use mild ointments, from ten to sixty grains; rarely any stronger. Care and caution should be exercised in treating children, particularly if very young, since severe inflammatory reaction may follow the use of a strong ointment. For such patients, I have rarely had to exceed fifteen grains, and I usually employ only ten. Of course the scales must be removed by scraping, or by baths, and the ointment should be well rubbed into the patches. If inflammation follows, the parts must be treated by the water dressing. In some very chronic cases, I have used the twodrachm ointment, and in order to avoid inflammatory reaction, I have ordered the parts to be enveloped in linen, and kept continually wet with cold water. In this way I hurried the cure, and avoided bad results. In general, however, a mild ointment is sufficient, and the strong one should not be used, unless the patient is fully under control.

Though chrysophanic acid has been recommended in the treatment of tinea versicolor, I am able to say, from considerable experience, that it is less efficacious than the remedies usually employed.

THE TREATMENT OF SCROFULOUS DISEASE OF THE

SKIN.

BY JOHN V. SHOEMAKER, A.M., M.D.,

PHILADELPHIA, PA.

IN referring to this important and vexatious disease upon this occasion, I have omitted the description of its course, which has already been so ably discussed by many modern writers, and have simply confined my remarks to a brief but practical account of its treatment. It was the indefinite and uncertain action of many of our standard preparations upon scrofulous disease of the skin that induced me to carefully study the action of other remedies upon this disease After several years of practical work with the various remedies, I have concluded to bring the result of my labor before this Section in order to lead, if possible, into further investigation of the subject.

The literature of scrofuloderma presents a large number of remedies which are regarded by their advocates as specifics for this disease. Leeches, issues, blisters, the iodides, the mercurials, cod-liver oil, iron, quinine, and barium have each had their respective supporters. Having repeatedly failed to cure many of those who applied to me for relief by using the remedies just named, I was finally led to try the chiorate of potassium internally with the most happy results. I claim, after watching the action of this remedy in a large number of cases of scrofulous disease of the skin, some of which will be included in this paper, that the chlorate of potassium overcomes the morbid condition in the system that leads to the development of various lesions on the skin. The following cases are a few of many that have come under my notice, and will illustrate the value of the abovenamed remedy.

CASE I. A lad aged 13, rather stout, and of sallow complexion, came under my observation at the Pennsylvania Free Dispensary

for Skin Diseases in February, 1878. At this time his skin was harsh and his expression was haggard and worn. The most prominent part of the disease involved the nose, which was somewhat enlarged, and the tip was covered with exuberant granulations that extended down on both sides of the ale and likewise passed up into the mucous surface of both anterior nasal outlets. These flabby granulations were covered with a thin pus, and bled freely on being touched. In addition, the upper lip and the buccal regions were the seat of several dull red, tubercular formations, and the glands around the inferior maxillary were slightly enlarged. These morbid conditions, together with the old scars that were scattered over both the face and neck, were a sufficient tell-tale of the disease. Upon inquiry I learned from the patient that he lived with his parents and two sisters in a small court in the lower part of the city. Not being able to obtain much of the family history from the boy, who was very dull in intellect, I called at his home to make further inquiry into his case. I found the family, consisting of the father, mother, the lad, and two sisters, living in two small and very cleanly rooms. The mother had every appearance of good health, and stated that her husband was sound in every respect and had only one fault, which was that of occasionally getting drunk. I examined the two sisters of the boy and found them free from all signs of scrofulous disease.

After some effort the mother informed me that during the period of her pregnancy with this boy she frequently suffered from hunger, by reason of the father being drunk and not supplying the necessaries of life. At the time of the boy's birth he was unhealthy, and had occasionally, during his first and second years, been deprived of the proper food. I succeeded, after repeated attempts, in meeting the father of the lad, who was healthy in every way, and frankly acknowledged his little weakness for getting drunk, but strongly protested that he had never been afflicted with any venereal trouble. I therefore concluded that the boy's condition was due to a disordered state of the blood, beginning very probably in intra-uterine life from improper nutrition.

I began the treatment by using internally, small doses of the accepted remedy, cod-liver oil, but was compelled to discontinue its use in a short time, owing to the oil disagreeing with the stomach. The iodide of potassium had the same effect, and the

corrosive chloride of mercury ran off by the bowels. I finally concluded to discontinue for a time all constitutional treatment, and to try the use alone of local remedies. I began the local treatment by puncturing and scarifying the surface; used, also, in turn pressure, blisters, the mercurials, the iodides, the sulphate of copper, and various other astringents, and as soon as the disease would disappear at one point, it would go on even more violently at another.

Six months were consumed in this way in trying the various internal and local remedies, and all to no purpose, as the patient's condition remained unchanged. After these repeated trials and failures with many of the old remedies for this disease, I made up my mind to try the chlorate of potassium, a remedy which had already proved very efficacious in some lighter cases of scrofulous disease of the skin under my care.

I began the new treatment by giving the patient two grains of the chlorate of potassium three times daily; the dose was gradually increased until he could take five grains four times daily. In the course of two weeks the spots became lighter in color, the skin clearer, and this state of improvement continued until my patient was entirely cured in the month of November, 1878. In this case I began the treatment with a mild aperient, ordered a substantial diet, and applied the sulphate of copper to the granulations once a week.

CASE II. Mary W., aged 19, came under my care at the same Dispensary in September, 1878. She was brought to me by her mother for enlarged maxillary glands, loss of appetite, and great weakness. Her complexion was sallow, and she was very thin. Her medical history was as follows: she had been ailing ever since she was three years of age; about that time the mother noticed small lumps around the neck, and an eruption on the scalp as the child was recovering from scarlatina. Her mother further stated that after this attack her child would improve for a time, and afterwards, upon the slightest change in the weather, would be seized with rheumatism, which was always followed by great prostration, loss of appetite, and either diarrhoea or constipation. The patient had continued from time. to time to suffer from rheumatism, until about one year ago, when she was seized with even a more severe attack than at any previous period. The mother, who was very intelligent, added