Osler1 quotes cases of scleroderma in which the thyroid is fibrous and reduced in size.

Depigmentation.-J. Fryding-Lund reports an interesting series of experiments. He says that the successful process must be unaccompanied by tissue-destruction. The agents, naturally, are those substances having a bleaching or oxidizing action; these he found useful in weak solution. Sodium peroxid (4%) requires 1 hour; calcium chlorate (5%), 3 hours; liquor sod. hypochlorat. (undilut.), 5-6 hours; hydrogen peroxid, more than 24 hours. The work is given in detail.

NEOPLASMS (NEW FORMATIONS).

3

Multiple Cutaneous Lupus Following Measles.—Adamson 3 reports a case of verrucose lupus, with multiple lesions, occurring in a boy 3 years of age, in which the eruption was said to have appeared first during an attack of measles when the patient was 2 years of age. The lesions appeared simultaneously; and since the first eruption there had been no new lesions, although the old ones had grown larger. The eruption consisted of raised, purplish-brown patches, from to in. in diameter. Many were scaly, and those upon the hands were warty. They were most abundant upon the right elbow, the right wrist and hand, on both knees, and on the right ankle and foot. Later the patient was treated for postpharyngeal abscess and hip-joint disease. There was no family history of tuberculosis.

Local Treatment of Lupus with Creasote.-Protopopow reports 3 cases of lupus greatly improved by the use of creasote. Before making the applications the diseased patches are thoroughly scarified. The disagreeable odor and the somnolence caused by the creasote are the chief disadvantages of this method.

5

Unna makes use of the following ointment in small superficial patches of lupus: Acid. salicylic., antimon. chlorid., āā 2 gm.; creasoti, ext. cannabis ind., āā 4 gm.; lanolini, 8 gm.-M. This is spread upon the patches and covered with zinc-oxid adhesive plaster. The ointment. is renewed every 24 or 48 hours. The nodules subside very rapidly under this treatment, healthy granulations taking their place.

Treatment of Tuberculous Processes with Pyrogallol.— Veiel regards the use of pyrogallol in tuberculous affections of the skin as superior to any surgical treatment, the only disadvantage attending this method of treatment being its long duration. The diseased parts are first destroyed by 10% pyrogallol vaselin, spread upon lint, and applied for 3 to 5 days. The wound thus made is treated by applications of 1% to 2% vaselin, this ointment being strong enough to destroy lupous tissue without preventing the formation of sound granulations.

Injection of Calomel in the Treatment of Lupus.-Du Castel treated 2 patients with lupus vulgaris by means of calomel injections. A process resembling somewhat that seen after injections of tuberculin was noticed in the diseased areas after injection of the calomel. In

1 Pacific Med. Jour., Sept., 1898.

3 Brit. Jour. of Derm., Jan., 1899. 5 Sem. méd., Dec. 21, 1898.

2 Monatsh. f. prakt. Dermat., May 1, 1899. * Dermat. Centralbl., Feb., 1899. Arch. f. Derm. u. Syph., Band 44. 'Ann. de Derm. et de Syph., No. 7, 1898.

the first patient so treated a slight improvement was noticed, but no appreciable effect followed in the second. After 6 months' study of this method Du Castel concludes that injections of calomel are only an adjuvant to the treatment of lupus, and should be associated with surgical measures. Berntheim' reports a case of lupus, which had been unsuccessfully treated by caustics, scarifications, curetting, and tuberculin, cured by injections of calomel. A 10% emulsion in olive oil was used at intervals of 8 days, 12 minims being given at each injection. After 8 injections there was a decided diminution of the hyperemia; and a few weeks later all ulcerations were healed, and a cure was obtained in 31 months.

Potassium Permanganate in Lupus.-Kaczanowski has had successful results in 34 cases of lupus from dusting the surface with potassium permanganate, the crusts having first been removed with vaselin, warm water, and soap. A single application is sufficient; the crust formed falls off in a fortnight and the patch heals. The applications are painful, but not more so than other caustic remedies, and are not intolerable.

Radical Excision and Transplantation in Lupus.-Schultze3 asserts that this method gives most favorable results. During 8 years, out of 57 cases so treated, in but 2 has there been a serious return: 8 recurred at the margin, and 2 in the center; but in these excision and suture led to ultimate recovery. The prognosis rests largely on the situation of the lesion and the measure of involvement of tissue.

4

Dilute Caustic Potash in Lupus.-This dressing has been found so effective by Unna that he recommends it as superior to all others used to date. It never smarts, and the beneficial action is notable in

many cases.

5

Tuberculosis Verrucosa Cutis.-Comby reports cases of this disease, which was first recognized by Riehl and Paltauf. The warts are situated on a red base surrounded by a zone of erythema. On squeezing, a little sanious pus exudes from the center, which is deeply fissured. The lesions are most frequent on the hands. The actual cautery, preceded by scraping, if the individual lesions are large, is the treatment recommended.

6

Keloid and Intractable Patches of Chronic Inflammation of the Skin Treated by Scarification.-H. Lawrence reports the success of this treatment when excision of a keloid (Alibert) had twice failed. The blades of the scarifier should be at least in. apart; otherwise pieces of the skin will be torn away by the cross-incisions. After thorough "mince-meating" the tissues, involving the blood vessels, use hot fomentations of boric acid, dust with iodoform, and dress with zincglycogelatin. Follow by continuous pressure. Patches of chronic eczema, lupus erythematosus (edematous variety), patches of chronic traumatic dermatitis, and intractable chronic lichen planus have been cured by this method.

Liomyoma Cutis.-C. J. White' records a case of this rare disease

1 Münch. med. Woch., No. 46, 1898. 3 Wien. med. Woch., Nov. 5, 1898.

5 Arch. de Méd. des Enfants, Dec., 1898.

2 Med. Sentinel, Sept., 1898.
Jour. Am. Med. Assoc., Sept. 17, 1898.
6 Brit. Med. Jour., Jan. 14, 1899.

7 Jour. Cutan. and Gen.-Urin. Dis., June, 1899.

(see Fig. 2) occurring on the face (particularly the region of the lower jaw and neck) of a man, an American by birth, aged 45. The disease consists of pinhead- and pea-sized, pinkish, glistening, translucent, firm, discrete, painful tumors, the pain being always marked when the lesions were exposed to pressure and also to a cold atmosphere. The tumor, under the microscope, showed a growth of muscular tissue which had replaced almost entirely the usual constituents of the normal corium. There was also hyperplasia of the blood vessels; and, moreover, a secondary process in the form of degeneration was observed in the substance of

FIG. 2.-Liomyoma of the side of the face (Jour. Cutan. and Gen.-Urin. Dis., June, 1899).

the tumor. [While this form of neoplasm usually persists, occasionally it undergoes spontaneous involution, as in some of Jadassohn's cases.] The Treatment of Lupus Erythematosus.-Hans Hebra' has obtained very good results from the external application of alcohol to the affected areas by means of cotton. The alcohol should be applied repeatedly without rubbing, and allowed to evaporate. These applications should be made several times a day, the more frequently the better. The cold produced by the evaporation of the alcohol, and the abstraction of water, contract the blood vessels, causing the patches to become less visible and the elevation and edema to disappear. The use of soap

should be avoided during the treatment. Hutchinson reports a case of lupus erythematosus apparently cured by the application of pure carbolic acid. The acid was painted over the patches once or twice a week, while an ointment of boric acid-20 grains to the ounce—was applied daily. In addition to this local treatment the patient was given minim doses of Pearson's solution of arsenic.

Spontaneous Cure of Lupus after Operation for Salpingitis. Seeligman reports this case in a woman, aged 40. Her father had died of tuberculosis, and the patient had an extensive lupus of the face and scalp. Shortly after the operation the ulcers were replaced by smooth cicatricial tissue without local treatment.

Tuberculosis Cutis Propria.-E. Bloch3 makes a sharp distinction between primary tubercular ulcerations of the skin and other forms of tubercular disease, as lupus vulgaris and scrofuloderma. The first are rare; the latter common. The reporter records a case of tubercular ulceration of the vulva accompanied with advanced tuberculosis of the lungs and intestines. The ulcers on the skin were extensive, irregular, superficial, pale, and studded with grayish nodules.

Case of Acute Disseminated Miliary Tuberculosis of the Skin. Pelagatti records a case occurring in a child 2 years old, the cutaneous disease appearing after measles, along with acute tuberculosis of the lungs and intestines. The eruption consisted of hemispherical papules the size of hemp-seeds, or rather larger, of a yellowish-red color, without surrounding hyperemia, sharply defined from the earthy-white skin on which they were seated. The center of each papule was rough and scaly. There was no grouping; no itching. Some papules disappeared, leaving no trace; others increased in size, forming nodules with scales adherent to their summits. On removing the scale a concavity remained; a few scars were left, like those of variola. The skin-lesions consisted of typical tuberculous formations with giant cells and large numbers of tubercle-bacilli.

Primary Tuberculosis of the Skin.-E. Schwimmer," in a very conservative paper, considers the subject in several of its phases. The development of the modern standpoint is given, since he holds that forms the key to the medical science of today. The effects of the tuberculous and the syphilitic virus are contrasted. "We denote as tuberculous disease of the skin those processes in which the following 2 conditions are met: 1. The presence of tubercle-bacilli. 2. Positive results following inoculation in previously healthy tissue. Four such diseases exist: (1) Skin-tubercle and tuberculous ulcer, (2) lupus vulgaris, (3) scrofuloderma, and (4) tuberculosis verrucosa cutis." Each of these 4 is subjected to a careful discussion as to nature and interrelation from a clinical and a pathologic point of view. Under the first are noted the development and subsequent breaking down with ulceration. "The duration of the nodules, the appearance of similar ones, their persistence, and the softening which follows, producing destruction of the tissue, make the picture pathognomonic." The miliary nodules at the base of the ulcer, and the elevations covered

Arch. of Surg., Jan., 1898.

3 Dermat. Centralbl., Jan., 1899.

2 Med. Bull., Apr., 1899.

Gior. Ital. delle Mal. Ven. e della Pelle, 1898; Brit. Jour. of Derm., July, 1899.
Wien. med. Woch., Nos. 36-38, 1898.

with epidermis in the neighborhood of the lesion, he claims typical of this disease in his experience. True tuberculous ulcer is of rarest occurrence. Skin-tubercle appears in many forms, the diagnosis of which, previously very difficult, now is reasonably certain. Experimental inoculation gives the most sure test, since the bacilli are absent more often than would be expected. It seems probable that all these processes are due more to the toxin than to the germs themselves; in doubtful cases the conjunction of general tuberculosis with a local manifestation is significant. Lupus, whose nature was once doubtful, since the work of Leloir must be considered tubercular. Those parts of the body which are unclothed appear most often affected-the face particularly; the openings of the sebaceous and sweat-glands afford lodgement for the infection. Unna recently asserted that the lesions find their origin in the vessels of the locality, in the connective tissue; this is yet to be proved. Lupus is essentially a local disease, infectious beyond doubt, but it is questionable if this is through the bacilli. Further research is to be desired in this direction. Scrofuloderma belongs usually to the secondary forms of tuberculosis. It does occur synchronously with other skin-affections, and in so far is germane to this article. This form differs from the 2 preceding in that, while they are cutaneous, this is distinctly subcutaneous. The skin, at first intact, allows us, more by palpation than by inspection, to observe the nodules, which gradually increase in size, become bluish, soften, and suppurate. It appears often as a diffuse infiltration of the skin, in numerous places having small, lupus-like (yet not true lupus) formations. The scrofulous ulcer is characterized by its sharp, dark-red, punched-out edges; by the watery pus, and the slightly protruding base. Tuberculosis verrucosa cutis, but recently known as such to pathologists, is the "lupus sclereux" of the French. This disease ranks between lupus and true skin-tuberculosis. It is held to have the following characteristics: 1. The appearance of nodules with wart-like layers and having a tendency to spread in the periphery. 2. Autoinoculation. 3. Presence of tuberclebacilli. Out of 8899 cases of all skin-diseases seen in 3 years he finds but 10 of this affection; one ending fatally in tuberculosis of the lung. Histologically the disease is characteristic. The corium shows tuberculous nodules of the usual type, and there occurs also a small-cell infiltration of greater extension; bacilli are not always found. This variety is held less infectious than the preceding, since from its locality, usually the extremity, it is more easily treated and more successfully. Finally, several other diseases are mentioned whose possible tuberculous nature is admitted: these are lichen, acne scrofulosorum, and erythema tuberculatum. The relation of local and general tuberculosis is discussed, and their connection with the synchronous or subsequent occurrence of pityriasis rubra, impetigo herpetiformis, and pemphigus.

The Cutaneous Paratuberculoses.-J. C. Johnston1 concludes from his studies that there is a class of cutaneous diseases analogous to the parasyphilides which may be designated paratuberculoses. They are not in themselves tuberculous, but develop and flourish in a tuberculous soil. They may be divided into 3 groups: scrofuloderms, tuberculides, and dyschromia. The scrofuloderms are pure pyodermias, by which characteristic they are separated from the tuberculides, which are only 1 Jour. Cutan. and Gen.-Urin. Dis., July, 1899.