become wet, or reapplying those that have become saturated with the urine without washing. In all cases of strophulus in which, from bad management or accidental causes, any degree of febrile excitement is produced, the eruption is increased in extent and severity, and constitutes the S. Volaticus.

The eruption in strophulus is generally described as papular. Plumbe, however, refers it to an over-distension of the cutaneous vessels, giving rise to the escape of minute portions of lymph beneath the cuticle.

The predisposition to this affection consists in the greater degree of vascularity and irritability of the skin, and the extreme delicacy of the cuticle during infancy. The exciting causes are, over-feeding, a too stimulating diet, too rough and warm clothing, the irritation of teething, or any circumstance calculated to quicken the circulation, and promote undue determination to the skin.

In the treatment of strophulus, the extent and intensity of the eruption must be taken into consideration.

In the milder cases, and where the eruption is of little extent, nothing is required beyond a proper regulation of the patient's diet and clothing, gentle aperients, and the occasional use of the warm bath. During dentition, the gums should be attended to, and if inflamed or swollen, they should be freely scarified. When the disease is connected with derangement of the digestive organs, the same treatment will be required as would be proper were no eruption present. In aggravated cases, accompanied by much febrile excitement, an emetic, followed by mild aperients and minute doses of a combination of calomel, ipecacuanha and nitre, with the tepid bath, and a mild, unirritating diet, will generally succeed in relieving the violence of the symptoms. If the eruption frequently occurs during suckling, it will be judicious to change the nurse. When it is attended with itching, pain and excoriation, much relief will be obtained by bathing the parts frequently with any simple mucilaginous wash, as bran tea, infusion of slippery elm bark, or of the pith of sassafras.

In cases in which the eruption continues for a long time, or frequently recurs at short intervals, the health of the patient is liable to become much deranged; clusters of pimples of a dark color, to arise on different parts of the body, terminating in brown exfoliations, and accompanied by febrile symptoms; while a brown, scabrous condition of the skin, often of long duration, succeeds. This condition is generally connected with more or less disease of the digestive organs, and demands for its removal minute doses of calomel, combined with magnesia and ipecacuanha, and some light tonic, the daily use of the warm bath, and a well regulated diet. Occasionally, change of air is attended with the best effects.

2.- Prurigo.

Prurigo is an eruption of pimples, differing but little from those of strophulus, but usually less distinct, and flatter, and mostly confined to the outer surface of the limbs and trunk.

Prurigo is attended by a sense of itching, which is aggravated by

whatever induces an undue determination to the surface; as when the patient becomes heated or excited, or is warmly covered in bed. By scratching to relieve this intolerable pruritus, considerable heat and redness of the surrounding skin is produced, and the pimples becoming abraded, there issues from them a transparent or bloody fluid, which, concreting on the surface, forms thin crusts, of a brown or black color. When the crusts separate, a dull, crimson mark often remains for some time. In children of a full, gross habit, the irritation of scratching or friction, gives rise, occasionally, to a superficial ulceration, or pustule, terminating in the crust of impetigo.

In the more aggravated form of this eruption (P. Formicans), the itching is intense and constant, resembling the crawling or stinging of insects: this is increased by heat, and by warm stimulating food. Occasionally white wheals and dark-brown crusts appear over different parts of the body, attended often with some degree of tumefaction about the arms and legs, by which the freedom of their movements is impeded.

It

Prurigo is most troublesome in the spring, and at the commencement of summer. It is apt to recur for months, and even years. is usually accompanied by symptoms indicative of more or less derangement of the digestive organs. Its most common cause is excess of food, or the use of such as is indigestible, or has undergone some change by which its wholesomeness is impaired. Fish or oysters, when out of season, will often produce it; it has even occurred in some cases after a draught of cold water, or of some acid drink. In certain constitutions, it will result from a very slight irritation of the stomach or bowels, and in others it can be traced to no evident cause, except it be a sudden change in the temperature of the season, from cold to warm. In the greater number of the cases which occur in children, the disease would readily give way to an emetic, followed by a mild cathartic, and a properly regulated diet, could the patient be prevented from constantly irritating the pimples by scratching and rubbing with his hands. This might generally be accomplished by muffling or securing the hands, and frequently bathing the eruption with tepid water, or some mucilaginous wash. A watery solution of opium has occasionally suc ceeded, in our hands, in allaying the irritation on the skin.

In robust, plethoric habits, purgatives and a plain vegetable diet. will, occasionally, be proper. In violent cases, even the loss of a few ounces of blood may be demanded. In cases attended with derange. ment of the digestive functions, such remedies should be resorted to as are calculated to restore the latter to a healthy condition.

For the cure of inveterate cases, the decoction of dulcamara, the hydrochloric acid, and the arsenite of potassa internally; touching the more prominent pimples with aromatic vinegar, or a solution of hydrochloride of ammonia; lotions of the sulphate of potassa, the chlorate of lime, or of a solution, in water, of the extract of belladonna, or ointments of sulphur, have been recommended. We have, however, seen no case occurring in children in which we have found it necessary to resort to either of these remedies.

A moderate, wholesome diet, a cooling regimen, attention to the

state of the bowels and digestive organs, the daily use of the warm bath, and, as local applications to allay itching, and subdue irritation, frequent lotions with tepid water, or some simple mucilaginous wash, and occasionally the application of a watery solution of opium; and in cases in which there was nothing present to forbid its use, an anodyne at night, are the remedies, which, in our hands, have never failed to subdue prurigo as it appears in children.

3. Crusta Lactea.

Impetigo Larvalis Vel Mucosa-Porrigo Lactea Vel Larvalis-Tinea Muciflua-Eczema Lactea.

Crusta lactea generally occurs upon some portion of the face, especially upon the cheeks, and is more frequent during dentition than at any other period. It usually commences in one or more distinct red blotches which become studded with numerous, small, yellowish pustules, nearly confluent, and attended with considerable itching; these being preceded and accompanied, in severe cases, by some degree of erysipelatous inflammation. At the end of three or four days, and sometimes earlier, the pustules burst, and discharge their contents, which dries upon the skin, forming concretions of a whitish yellow or greenish tinge, semi-transparent, and very friable. The crusts lie in laminæ, some overlapping others, or they are intersected by narrow pink or olive-colored fissures. The discharge continues to ooze from under the scab, which grows constantly thicker.

The incrustations may be confined to a small space, or occur on several parts of the face at the same time; or they may extend over nearly the whole face, covering it as with a mask. When the crusts are detached, the surface of the skin beneath them is found to be red and inflamed, and studded with numerous minute pores from which the discharge proceeds.

The crusts usually remain attached from two to four weeks, when the secretion of matter diminishes, and the crusts separate, and fall off gradually, leaving a red, shining, and very tender surface, which, upon the slightest irritation, is liable again to form pustules, and reproduce the disease. In this manner, by fresh crops of pustules occurring after the separation of the scabs, the disease may be prolonged for an indefinite period. In such cases, deep chaps, and even ulcerations of the skin are liable to ensue.

In prolonged cases, occurring in children of a lymphatic temperament with fair hair, pale, delicate skin, and languid circulation, some degree of intumescence of the parotid, submaxillary, or cervical glands, will often occur.

The matter discharged from beneath the scabs would appear to possess some degree of acrimony, for the part of the child's breast which is brought frequently in contact with the diseased chin, when the latter is the seat of the eruption, soon becomes red, and exhibits an eruption of pustules, which terminate, as on the face, in a superficial ulceration. A similar effect is produced, occasionally, on the arms of whoever nurses a child affected with crusta lactea.

Even after the severest forms of the disease, no permanent marks are left upon the skin.

The treatment will depend very much upon the period at which the disease is first seen by the physician. In ordinary cases, and in the earlier stages of the eruption, it will generally yield, very readily, to a proper regulation of the diet, in conjunction with mild aperients, minute doses of calomel, magnesia, and ipecacuanha, the daily use of the warm bath, and exposure to a fresh, pure atmosphere. The diet of children affected with crusta lactea should consist, either of the breast-milk of a healthy nurse, or, after weaning, chiefly of the farinacea, with or without milk, according as this is found to agree or not with the stomach of the patient. The best local applications are emollient washes, and the watery solution of opium. When, however, from the long continuance of the eruption, the general health of the patient has begun to suffer, it may be found necessary, in conjunction with a cautious course of alteratives, to administer some of the lighter mineral and vegetable tonics-as the tartrate of iron, the cold infusion of bark, or the infusion of gentian, cascarilla, or calomba.

When the inflammation has entirely subsided in the neighborhood of the eruption, we have found one of the best local applications to be the unguentum nitratis hydrargyri, diluted by the addition of onethird portion of simple cerate.

4.- Impetigo.

Crusted Tetter-Humid Tetter-Scall.

Impetigo consists in an incrustation of an umber, sienna brown, or olive color, appearing either in defined patches (figurata), or scattered over the surface (sparsa).

This eruption appears in the form of minute pustules, collected together in clusters, or dispersed irregularly over the surface. It generally occurs upon the extremities; the clusters of pustules being usually smaller and more circular on the upper, and larger, oval, and more irregular upon the lower.

The pustules appear either upon an inflamed surface, of from two to four days' duration, or in clusters, with a defined inflamed margin: They are accompanied with heat and smarting, in proportion to the extent and intensity of the inflammation. The pustules are slightly elevated, and, in two or three days after their formation, burst and discharge their contents, leaving a red and shining surface; the matter being evacuated through numerous minute orifices. When the pustules appear in clusters, a crust is soon formed by the inspissation of the matter; from beneath which there is a constant oozing of a thin fluid, while around its edges fresh pustules often appear.

When, from neglect or mismanagement, the disease is allowed to proceed, it may extend over the whole limb, which becomes encased in an almost continuous rugose covering (I. Scabida). The crust at the same time assumes grayish brown color, surrounded by a lake. colored margin. There is considerable heat and itching in the limb, and its motions are impeded or completely obstructed. After a time,

the incrustation presents deep cracks or fissures, through which the matter exudes, and drying, increases the thickness of the scabrous coating of the limb. When the disease extends to the hands or feet, an ulceration of a purplish hue takes place around the roots of the nails, which often drop off, and are succeeded by others of an irregu lar form.

The erythematous inflammation surrounding the eruption increasing in intensity, will occasionally give rise to slight vesications (I. erysipelatoides). In these cases, the subcutaneous cellular membrane becoming involved in disease, the affection is one of considerable severity and danger.

The crusts may separate as early as at the end of two weeks, or not until the termination of four or five. The healing process generally commences at the centre of the patches, and extends towards the circumference. On the dull crimson surface left by the separation of the crusts, small, elevated spots occasionally occur, apparently vesicular, but in reality formed by indurated follicles.

Impetigo is often combined with other forms of eruptive disease: thus, eczematous vesicles are often interspersed (Eczema impetiginodes); these are attended with little redness, but by great irritation, heat, and itching.

The incrustations of impetigo differ from those of porrigo, by being slower of inspissation, more circular, thinner, browner, and less adherent, and by their occurring, most generally, upon the extremities. The matter discharged is also purulent and glutinous—that of impetigo more thin and ichorous. The interspersion of vesicles causes some resemblance between impetigo and lymphatic scabies. The vesicles of the former are, however, slower in their progress, attended rather with heat and smarting, than with itching; while the cuticle is redder and more fissured, and the ichorous exudation more copious than in scabies.

In mild cases, a simple, unirritating diet, a mercurial. purgative, followed by a dose of sulphate of magnesia, or of magnesia and precipitated sulphur, with the local application of lotions of tepid water, or some mild, mucilaginous fluid, or a thin bread-and-milk poultice, with the occasional use of a watery solution of opium, comprises the whole treatment that is necessary. If any derangement of the digestive organs exists, this should be removed by an appropriate treatment. When the local inflammation in the neighborhood of the eruption is severe and extensive, especially in plethoric habits, bleeding by leeches, or from the arm, will be demanded, with saline purgatives, and a very restricted diet; the inflamed part being covered with a soft linen rag, wet with the liq. plumb. acet. dilut. In cases attended with considerable irritation, a few drops of the tincture of hyoscyamus may be given two or three times a day; or a pill, composed of from one half of a grain to a grain or two of the extract of hyoscyamus, with the third of a grain of ipecacuanha, and one or two of carbonate of soda may be given at bed-time.

In the more severe forms of the disease, one of the best local applications is the hydrocyanic acid, combined with alcohol; the affected