Under the name of dermatitis comes a long list of diseases, which are no more inflammatory than eczema, only they do not as uniformly have the exudation so characteristic of eczema. Under the former are classed twenty different forms; under the latter, sixty different varieties are mentioned, all of which are practically unnecessary, for all can be classed under two heads, eczema and dermatitis, or even one head, dermatitis. Under the head of syphilodermata about twenty different forms are described. On account of the protean character of syphilitic eruptions, great care must be exercised in making a diagnosis, especially when a direct history can not be obtained. A few points are absolutely necessary to take into account. They are as follows: prior manifestations of the disease, e. g., the initial lesion, sore throat, general malaise, location of the eruption, color (not considered now as important as formerly); usually, absence of itching, the scaly appearance, etc. The forms the syphilitic eruptions may assume are many, from a mere macule to large tubercles and ulcerations, and should always be borne in mind. The disease called sycosis, an affection usually of the beard, to which is applied several names, need only be considered under two heads (a) coccogenous, due to pus infection and characterized by a diffuse inflammation, accompanied by symptoms attending inflammation generally; (b) hyphogenous variety due to a fungus, usually invading the hair follicles, accompanied by a low grade of inflammation and formation of nodules of varying sizes. The ringworm, tinea tonsurans, is recognized by the tendency to form circular patches upon the head or other hairy portions of the body. The hair has a peculiar, lustreless, stubby appearance. A large class of diseases are created by the different species of this family of fungi, which is unnecessary, practically. The only important thing in the diagnosis of this class of skin affections is to recognize the nature of the infection. Then any name you might apply to express their appearance would be equally as scientific as the names now given. A class of skin affections classed as neurotic are varied, and in naming them no reference is made to their causes, which tends to confuse the student. Disturbance of the sensation of the skin without an eruption, or if any, discrete small papules, is usually neurotic in orgin. A real dermatitis may have a neurotic orgin. Herpes zoster, urticaria and some angioneurotic disturbances are common affections due to nervous derange ment. In making a diagnosis of a skin disease, approach the case with the same idea in mind as when examining any other diseased organ of the body, and look for pathological changes that may have occurred or any deviation from the normal function, and, if possible, determine what particular structure is involved or what particular function may be disturbed, and the problem of naming and classifying will be simplified to a great degree. The treatment of skin disease has, until within the last decade, been still more difficult and unsatisfactory, for the following reasons: first, until within the last half of the nineteenth century there had been no special systematic study made of this class of diseases. Not until Hebra's time was there anything like a scientific investigation carried on when he established a dermatological school, called "Hebra's school," to which there. are many adherents, even today. His study was confined principally to the local pathological changes, which lead to considering cutaneous diseases as idiopathic rather than symptomatic. The consequence of this was that local treatment was the chief dependence, and even had the symptomatic character been more prominently recognized, the materia medica and therapeutics would have been much more inadequate for a successful treatment than at the present time; second, in consequence of the above, great disappointment has been experienced with the methods of treatment, followed by a confirmation of the opinion that this class of diseases was hard to treat successfully. Hebra said that there were a few cases of skin diseases that arsenic would cure and the rest would beat the Devil. Therefore, all kinds of local treatment, the most of it harmful or at least beneficial only in a few cases, and arsenic, were the main dependence in treatment. John Hutchinson, of London, a veteran in this classf diseases, once said, when giving the results of his investigations as to the question whether arsenic caused cancer or not, "Would it not be too bad if we had been causing people to have cancer by our too indiscriminate use of arsenic, especially for skin diseases?" From the physiological action of arsenic, we might conclude that many cases of dry, scaling diseases may have been caused by a long-continued use of the drug. Internal treatment is becoming more important as we better understand the etiology of skin diseases, and with an intelligent, conservative local treatment, greater success is being experienced. There are three points always to be borne in mind when applying local treatment: (a) Remove the debris left by the disease; that is, clean the surface thoroughly of crusts, dirt, pus, etc.; (b) After removal of the accumulation, render the surface aseptic as possible by the use of mild. antiseptic solutions; (c) The permanent dressing or application for constant use should be selected according to the conditions found. If acute inflammation is present, a soothing, mildly astringent, antiseptic lotion, ointment or dusting powder is best. If chronic conditions are present, characterized by poor circulation, ulcerating surfaces, or hyperkeratosis, a stimulating antiseptic dressing is indicated, and if parasitic, antiparasitic remedies are essential. The most important treatment is the general medical, which consists of (a) attention to the digestion and assimilation, and (b) determination of the condition of the katabolic processes and elimination of the waste products; (c) the nervous system comes in for a thorough investigation; (d) the determination as to the presence or absence of organic disease of any organ or organs or systems, and (e) the habits of the patient and his environment should also always be considered. In a paper read by Dr. L. Duncan Bulkley, before the Medical Society of the State of New York, January 29, 1907, entitled "Danger Signals from the Skin," he gave an idea of the broad significance of skin eruptions as related to internal conditions. A few quotations will illustrate the facts: "Eczema is so often regarded and too frequently treated as a wholly local disease of the skin, often without success. In certain cases it gives signals of danger of no uncertain character. General eczema is almost always a sign of nervous or physical breakdown, and a most careful study of the patient in every particular will often reveal gross errors in life or habits, which, if not checked, will lead to direful results. "Localized neurotic eczema of the hands or about the mouth will also indicate a nervous strain to which the patient may succumb, unless properly attended to. Eczema about the eyes is sometimes due to eyestrain or errors of accommodation which call for special attention." "Metabolic errors are indicated by full, plethoric habits, with a hard, bounding pulse; a weak, flabby pulse indicates anemia or a greatly. debilitated system. Therefore, we see that eczema may sometimes be a blessing in disguise, if its danger signals are recognized, properly regarded and correctly interpreted." "Acne is often a danger signal, which it is not wise to ignore. It may be a sign of grave metabolic disturbances, dependent on gross errors of diet and hygiene, anemia, menstrual function, and when on the chin, look for some disorder of the sexual apparatus." Thus we see that acne is not only a local disease, but may indicate grave internal disturbances. In the same way Dr. Bulkley takes up psoriasis, chronic urticaria, erythema multiforme, pruritus, xanthoma diabeticorum, boils and carbuncles, dermatitis maligna, angiomata, lupus vulgaris, etc. In the same way, all skin affections not due to a discoverable local cause must be studied if we expect to treat them successfully. In other words, we must forget the simple appearance, and find the cause, frequently obscure and deep-seated." Much investigation is yet necessary to place the treatment of skin diseases upon a scientific basis, and such is being carried on at the present time more than any time in the history of this branch of medicine. A proper interpretation of skin lesions will lead to the diagnosis of many other diseases in their incipient stages, their location and an indication of the degree of their advancement. 830 Rose Building. MEDICAL NOMENCLATURE. BY HOWELL B. GWIN, M. D., Nashville, Tenn. [Written for the MEDICAL BRIEF.] Some years ago, while pursuing the study of anatomy at the University of Louisville, my attention was arrested by the unscientific, puerile and often absurd namings that exist in our medical vocabulary. There appeared to be about sixty or seventy-five parts of the human body having the names of men; besides these, there are many indefinite and nondescript names, such as acetabulum, for which I would suggest the name of octoform. Some of these names have been displaced and others are doomed. Misnomers occur, also, as regards both diseases and their remedies. It is a mark almost of mental imbecility to continue such names as Addison's, Bright's, Pott's, Graves' disease, etc. Some of the names of this class. are properly supplanted, such as chorea for St. Vitus' dance, erysipelas for St. Anthony's fire. Again, as regards remedies, surgical and medicinal, note Colles' fracture, Cæsarean section or Sanger's operation, Loreta's operation, Wardrop's operation and Warburg's tincture, Blaud's pills, Buckley's uterine tonic, Dover's powder, epsom salts, rochelle salt, etc. As an interesting study, track this false nomenclature through your medical dictionary, catalogues, and literature. Few things are well defined, more are proximately described, but many are whimsically denominated, e. g., electricity from the Greek word elektron, amber, an agent from which it is supposed to have been derived, and in medicine, calomel, derived from the combined stems of two Greek words, meaning beautiful black. While such names are arbitrary, they are now fixed and have the force of a proper name given to a person. I shun the rôle of a merc "purist," a stickler for an impossible accuracy, but as science advances, definitions and names will become clearer and more satisfactory. It is proper to state that besides the sciences embraced in medicine, these lacune of speech characterize all other sciences. Such imperfections inhere in every human mind, which, according to Emerson, has its limitations. Defects through Nature's productions run, We have spots, and spots are on the sun. As examples, in geology many names are geographical, in botany many are personal or fanciful, such as Fuschia, named after a man, and nasturtium, meaning a twisted nose. Finally, I make mention of a proposal of a factitious name made by the friends of the sweet-singing poet of Georgia, who proposed his name, Lanier, for the Southern.songster of the woods called the "mocking bird." Appreciation of Lanier is one thing and the destruction of the name of this charming bird is quite. another-a name, as I discovered last summer, given 300 years ago by Capt. John Smith, the early settler in Virginia, as the "mock bird." Let us, as far as possible, repudiate the false, annul the whimsical and exalt the true in all speech and literature. 482 Church Street. CORRESPONDENCE. Why Not Administer the Best Remedy First? Editor MEDICAL BRIEF: I have read with much interest the excellent article in THE BRIEF from the pen of Dr. Kenner, on "Dysentery," but while reading it I was reminded of the Irishman who once applied to a lawyer for advice. The lawyer told him there were two or three ways by which he could be relieved of his troubles. Quick as a flash the Irishman said, "Begorra, try the best one first, sor, and we'll not need the others." Dr. Kenner mentions quite a number of different remedies, among which are whisky, epsom salts, bismuth and salol, alum, nitrate of silver, dilute sulphuric acid, etc., but adds, "when these remedies fail I resort to that remedy which has won the confidence of able and practical physicians everywhere. I refer to ipecac. This agent is capable of bringing about a cure when all other means have failed, etc." Now, I would like to ask the Doctor, not in a spirit of criticism, but for information, why not administer the best remedy first? Is there any reason why ipecac should be used only as a last resort? Because I have never noticed any untoward effect from its use, and, in fact, so far, nothing but good results have followed its administration in my practice. S. E. GIBS, 8 West 128th St., New York. The Treatment of Acute Dysentery. Editor MEDICAL BRIEF: SIR-In the July issue of your esteemed journal, Dr. Robert C. Kenner, of Louisville, Ky., writes under the above title, giving a list of remedies, but omitting the most reliable, the most rational treatment, na carbonic-acid-gas inflation of the rectum. I beg to refer to my papers on his subject, published during the last twenty-five years, and to the chater, "Carbonic Acid Gas Treatment of Dysentery," in my book, "Carbnic Acid in Medicine.". Carbonic acid gas applied to mucous surfaces stimulates capil ry circulation, and has an anesthetizing influence; this is especially remekable when the gas is applied to painful or irritable ulcers of the mucus membranes; here it is indeed the ideal remedy. Studying the literatre, I learned that Kuester and Perkins, who lived in the eighteenth century, had treated dysentery by inflation of the rectum with carbonic acid. In the year 1883, after having exhausted in vain all kinds of bst |