large one tightly corked; when this direction is followed only. good results are seen. Sulphite and hyposulphite of soda, in solution, two to four drachms to the ounce, will also serve tolerably efficiently to remove these vegetable parasitic eruptions, but are of less value than the pure sulphurous acid, upon which their virtues depend. We may also use the sulphurous acid very efficiently in the way of the well-known sulphur vapor-bath, which is made by burning sulphur in a closed box in which steam is also confined. This will remove the tinea versicolor, or liver-spots of older writers, on the chest and back, quicker than almost any other measure, a very few baths serving to quite free the skin from it. But this eruption has a very great tendency to relapse, because the destruction of the parasite may not have gone far enough to reach every spore, and a single mass of the vegetable growth remaining in or around a hair follicle may be the means of propagating the disease anew. It is well, therefore, to continue treatment for some time after the apparent removal of the eruption. A word may here be added in regard to the use of sulphur vapor baths in other diseases of the skin, for it is very common for patients to try them, and for physicians to recommend them indiscriminately in all cutaneous diseases. It may at once be stated that they should not be so used, and I have seen far more persons who have tried them either ineffectively or to their harm, than I have seen those who are benefited by them—yes, two to one. It may be almost too trite a remark to make here, that the value of remedies in skin diseases depends wholly on accuracy of diagnosis and applicability of the remedy, but it is a point which is hardly enough borne in mind by the profession at large, and no better exemplification of this can be found than in the reckless way in which sulphur baths are advised when the skin is diseased, unless it be the wholesale administration of arsenic under the same conditions. Sulphur vapor baths are of service in comparatively few diseases of the skin. In the vegetable parasitic diseases as mentioned, they are useful, except, of course, for eruptions on the face and scalp, where they cannot be applied. They are also of value in scabies, though inferior to other means. Psoriasis is benefited by them, but cannot be cured by this means, and not infrequently they will hardly affect the eruption at all. Sulphur vapor baths are, as a rule, inapplicable in eczema, except, perhaps, in some very chronic cases, where the disease is localized to a few patches, and the skin is hard and strong. In the vast majority of cases of eczema the sulphur vapor bath irritates the skin and aggravates the eruption, or causes new disease. It is wholly inapplicable in such eruptions as urticaria, herpes, pemphigus, and the like, together with the large classes of hypertrophies, atrophies, and new formations of skin. In regard to the use of the sulphur vapor bath in syphilis there is some difference of opinion, but there can be no doubt that it cannot cure the disease, though, by increasing the emunctory action of the skin, it may make the mercurial course to be better borne, and more effective in certain cases which have long resisted treatment. Time and space forbid entering more largely into the subject, but sufficient has been said to call attention to the wide field of usefulness which sulphur plays in the treatment of diseases of the skin, and yet to show that it is not a panacea for this class of affections. These remedies are to be employed intelligently, like any others, and when so used, may generally be relied on in the appropriate diseases. Sulphur is of value internally, as it acts upon the liver and intestinal canal in cases of eczema of the anus, and in many cases of other skin diseases which are accompanied with piles. In its compounds it is of value in diseases in which the production of pus is a feature, as in the use of sulphide of calcium, sulphuric acid, and hyposulphite of soda in boils, acne, carbuncles, etc. Locally, sulphur is mainly useful in the treatment of the parasitic diseases, animal and vegetable, and it is also of service in acne. It is a local stimulant, and, if incautiously used, gives rise to irritant action, and is entirely inappropriate in acute inflammatory skin affections, and useless in hypertrophies, atrophies, and new formations. Sulphurous vapor baths and mineral waters containing sulphur should not be used indiscriminately in skin affections, but are of value in parasitic diseases, and also in those in which a rheumatic element is strongly pronounced. DIET-CURE OF RHEUMATISM. By E. N. CHAPMAN. A.M., M.D., THE pathology of rheumatism has, the last thirty-five years, undergone a striking revolution, and its treatment one not less remarkable. To-day, the role of the solids is overshadowed by that of the fluids; the change of structure by the fermentation of the blood. The fever and inflammation are held to be not idiopathic but specific, and, as in the tuberculous and scrofulous dyscrasies, not active, but irritative, and hence amenable, not to depressing, but to sustaining medication. Meanwhile, many other diseases, attended with fever and inflammation, have been traced to the blood, and ranged under the same head. From this standpoint, there cannot be a doubt that the old doctrine, insomuch as it demanded harsh and sanguinary measures, did a deal of harm. Only the more robust were able to withstand the disease and the treatment. These measures— depletion, purgation, salivation, and vesication-being supplanted by anodynes, diuretics, alkalies, and fomentations, there was a great gain. The natural forces were allowed a chance to assert their sovereignty, and right the system; and, what is more, were aided in the work by the agencies invoked to allay the pain, and eliminate the acid element from the blood. And yet, strange to say, the old pathology still survives, and casts its baleful shadow over the new. There is the same penchant for potent remedies and heroic treatment, such as will promptly suppress the more violent symptoms. The activity of the circulation, it is thought, must be reduced, and the irritability of the nerves subdued, at all hazards. A simple, harmless medicine like salicin, that displays such wonderful power in acute attacks of articular rheumatism, is supplanted by dangerous chemicals that produce a more striking and profound impression. Neither the vigor of the assault on the stronghold of the enemy has been slackened, nor any vulnerable point neglected. The old pathologists hoped to subdue the fever and inflammation by reducing the volume of the blood, and the new anticipate the same result by repressing the irritability of the nerves. The field of battle. has been changed, and other tactics adopted; and yet, as hitherto, the invader maintains his foothold on the soil, and ever and anon renews the contest. In transferring the pathological seat of rheumatism from the joints to the blood, there was a great advance in the right direction; only in dismissing the solids from further consideration, the other fluids, as well as the blood, should have been taken into account. The tissues are no more dependent upon the blood than the blood upon the digestion. The gastro-intestinal secretions being depraved, perfect assimilation is impossible. Besides, the quality of the food is an important factor, for all the elements of nutrition must be supplied, and that, too, in the exact proportion needed by the economy. As the blood is being constantly renewed by the food, it is evident that a permanent change in its quality for the better must come through dietetic and hygienic regulations. Drugs, like colchicum, alkalies, salicin, salicylic acid, and iodide of potassium, may eliminate or neutralize the rheumatic element, but cannot prevent its re-formation. The use of gruels, broths, and vegetables, and the disuse of articles taxing the powers of the stomach, may lessen the supply of nutritive materials, but cannot alter the character of the chyle. And hence, while the digestion shall continue defective, the fermentable product will be furnished with each meal. A profound impression upon the bowels, kidneys, and skin, may suppress the symptoms, and afford relief; but should the primary cause remain untouched, the old excitement would continue to return, until the pain and tenderness became chronic and intractable. Inasmuch as the stomach and bowels have, in most cases, been a long time disordered by the quantity and quality of the food, it would be necessary to restore their capacity for active work, before any plan of diet could induce any decided improvement. And, then, as the digestion is due to certain secretions-the solvents of the food-it needs no argument to show that these secretions must become normal before they can prepare normal chyle. |