accidentally pustular. The tuberculides include a variety of affections, ranging from erysipelas perstans to lichen scrofulosorum, which are toxidermias. The points upon which the right of a disease to admission to this category rests are: absence of tubercle-bacilli, proved by microscopic examination and inoculation; occurrence in scrofulous or frankly tuberculous patients in more than a bare majority of cases; a pathologic anatomy at least comparable to that recognized for tuberculosis, and, finally, if possible, as in the case of lichen scrofulosorum, experimental production of the disease by injections of tuberculin.

Contribution to the Study of Blastomycetic Dermatitis.— Hyde, Hektoen, and Bevan' report a case of this rare manifestation occurring upon the back of the hand, and conclude that a sufficient number of cases have been recorded to prove that blastomycetic dermatitis is a distinct disease, due solely to the invasion of the skin by one of the plantforms of the yeast family; that this affection is one which bears a close resemblance to certain forms of tuberculous infection of the skin, and that while the larger number of cases suggesting in clinical aspect the tuberculous nature of the process will, as heretofore, be demonstrated to be such only, yet in a small proportion of such cases it is probable that blastomycetic invasion may have occurred. The internal use of potassium iodid is worthy of trial in all cases of blastomycetic disease of the skin.

Blastodermic Dermatitis.-Robert Hessler2 states that the yeasts as disease-producers have recently gained prominence. T. C. Gilchrist was the first writer to report cases in this country. A healthy man was slightly cut in the neck by a barber. The wound healed in a few days, followed by the development of a small nodule, which remained in a stationary condition for nearly 3 months, when it suppurated. The pus contained no bacteria, but yeast-cells were found. The yeast was obtained in pure culture from the beginning; it grows readily in all ordinary culture-media and without the formation of carbon dioxid. In the course of time the characteristic fungus-form appears. In the pus the yeast-cells were found chiefly in the interior of the corpuscles in the budding stage. In size they are as large as a nucleus of a polynuclear leukocyte. The abscess, after discharging, healed over in a few days, leaving behind a large amount of scar-tissue. Inflammations caused by pathogenic yeasts seem to be characterized by their slow evolution and their chronicity.

THERAPEUTICS.

Finsen's Phototherapy. Valdemar Bie3 has described this treatment. Three postulates are now proved: 1. The bactericidal property of the chemic rays of light. 2. The power of these rays to produce an inflammation of the skin (erythema solare). 3. The power of the chemic ray to penetrate the skin. The method of this new therapy is based on the above, and consists in treating local superficial (bacterial) skin-diseases by the concentrated chemic rays. It is true that the bactericidal power of light rests in the chemic ray; the red, yellow, and green rays have little, if any, value; in the ultraviolet ray is the most powerful action. The strongest light of summer, unconcentrated, takes more than 2 Jour. Am. Med. Assoc., Apr. 8, 1899. Brit. Med. Jour., Sept. 30, 1899.

1 Brit. Jour. of Derm., July, 1899.
3 Phila. Med. Jour., Oct. 7, 1899;

an hour to destroy plate-cultures; longer yet if the germs are in the living tissue. It is only when the light is so concentrated that it has as much of the blue, violet, and ultraviolet rays as possible that the action is speedy; experiment has shown that bacteria in a stratum of agar (mm. thick) are destroyed in a few seconds. Erythema solare is induced by the chemic ray alone (Widmark; also Finsen). That these rays do penetrate the skin is a fact (Godneff). The anemic skin allows penetration to a greater degree. Remembering the possible erythema, it is necessary in this photochemic therapeusis that the light be cooled. The double object, therefore, of making the light stronger and at the same time cooler is accomplished (when working with sunlight) by an apparatus consisting of "a lens about 20 to 40 cm. in diameter. The lens is composed of a plane glass and a curved one, which are framed in a brass ring, and between them is a bright-blue, weak ammoniacal solution of copper sulphate. As one surface of the liquid is plane, and the other curved, its optical function is that of an ordinary convex glass lens. By making the lens thus a considerable cooling of the light results; the water absorbs the ultrared rays; the color also excludes a considerable amount of the red and yellow rays; the ultraviolet rays are but slightly affected in passing through the blue medium. The lens hangs on a foot, made in such a way that the lens can be raised and lowered as well as turned on a vertical or horizontal axis; therefore it is easy to put the lens perpendicularly to the sun-rays, and at such a distance as to make the light strike the desired area. When using artificial light changes in the apparatus are necessary. [For details reference must be made to the original article.] The method further requires cooling of the skin. For this is used a little apparatus consisting of a plate of quartz and a convex lens of quartz, both framed in a conical brass ring which carries 2 small tubes with 4 arms; to each arm is fastened an elastic band, by means of which the apparatus is pressed against the skin. By having cold water run through these tubes the skin is cooled sufficiently. The pressure of the planoconvex lens causes the skin to become anemic, so that the chemic rays may thus have greater penetration. In this manner an area of skin 1.5 cm. in diameter is treated for 1 hour daily. The skin will redden and swell, but, as yet, necrosis has not been observed. Various diseases have received this treatment; but only in lupus vulgaris, lupus erythematosus, and alopecia areata have a sufficient number of cases been observed to make the results conclusive. Mild cases receive this alone, but the more serious are given pyrogallic-acid ointment in conjunction. Mucous membranes are touched with a solution of iodin and potassium iodid (1 : 2 : 2) or are treated with the galvanocautery. It is claimed that the treatment is nearly painless. [From the photographs given of cases treated (see Plates 7, 8), some of the cures of lupus vulgaris are very striking and remarkable, and the subject is worthy of further study. This article is one of the most interesting and important of the year.]

X-ray Used Therapeutically.-At a meeting of the Hamburg Medical Society, Hahn' presented records of 2 cases of eczema of the foot, one of 4, the other of 2 years' duration, which, although subjected to a great variety of treatment, always tended to recur. Hahn finally subjected them to the action of the x-rays, with the result that they were 1 Boston M. and S. Jour., Apr. 13, 1899.

cured permanently. In one case the fourth application was followed by a slight reaction, as a result of which the healed surface showed a hard and somewhat raised cicatrix; in the other the cicatrix was smooth and soft. Internal Remedies in the Treatment of Skin-diseases. Malcolm Morris, in an address delivered at the annual meeting of the Reading Pathologic Society, endeavors to define the sphere of influence of internal remedies in diseases of the skin, and to determine the conditions in which they are useful and the manner in which they may be used with best effect. As to the sphere of influence of internal remedies, they are the chief means of controlling those affections arising from a constitutional taint, such as syphilis; or from disordered action of the nervous system, as in pemphigus; or from the establishment of a depraved habit in the skin, as in certain forms of eczema, lichen, and psoriasis. First among the alteratives useful in skin-diseases must be placed arsenic. It is a cardinal rule that this remedy should never be given in acute conditions. Another rule is that it should be given in very small doses at first. A better effect is obtained by interrupting the administration for a short period from time to time. It should not be forgotten that arsenical medication, if too long continued, may give rise to evils worse than those for which it is given. It is most useful in pemphigus, in which affection it is almost a specific, in dermatitis herpetiformis, cheiropompholyx, psoriasis, lichen ruber planus, and in some cases of sarcoma. Antimony is likewise useful as an alterative, indicated in acute eruptions, especially when arterial tension is high. This drug has a twofold action, according as it is given in large or small doses. In large doses it lowers blood-pressure and reduces inflammation. In smaller doses it acts as an alterative like arsenic. Phosphorus is of use chiefly in those conditions in which the nervous system needs support, as in the later stages of dermatitis herpetiformis, in certain cases of pemphigus in which arsenic has failed, and in neurotic eczema. Potassium iodid, apart from syphilitic affections, is useful in psoriasis, in erythema keratodes, and in actinomycosis. Salicin and sodium salicylate, which have been recommended by Crocker in psoriasis, have not been found useful by the author; nor has he been able to obtain the remedial effect attributed to thyroid extract in this disease. Another useful class of remedies is internal antiseptics, of which mercury and ichthyol may be taken as examples. Nerve-sedatives, such as opium, are extremely useful in the treatment of skin-diseases. In the opinion of the author, too much has been made of the treatment of diathesis. No amount of "constitutional" treatment will alone cure eczema, psoriasis, or lupus erythematosus, or any other skin-affection.

Proper Preparation of the Yellow Oxid of Mercury Ointment.-T. E. Mitchell writes in regard to the proper way of preparing the yellow oxid of mercury ointment for use in ophthalmologic practice. To the required amount of powder in an impalpable form on a clean glass or porcelain slab add a few drops of any bland, nonirritating fixed oil and mix well with a clean spatula; to this slowly add the necessary petrolatum, and, for reasons well known to chemic law, the powder is so far reduced by the oil that it is evenly incorporated in the vaselin. The following prescription in the hands of a competent pharmacist will 1 Brit. Med. Jour., Oct. 15, 1898. 2 Therap. Gaz., Aug. 15, 1898.