VOL. III.

Ellustration.

EDWARD ROBERT BICKERSTEITH, F.R.C.S. THE name of Bickersteith is one well inscribed upon the scroll of literary fame. Indeed, so closely is it connected with literature, that to give a mere list of the works the authors of which bear the name of Bickersteith, and the subjects of which embrace fiction, divinity, law, and medicine, would probably occupy all the space which it is our custom to allot to the biographical portion of our journal. It has not been for the sterner sex of the Bickersteiths alone to achieve distinction. In the world of fiction as well as that of religion the female Bickersteiths have not failed to come prominently to the fore. Numerous publications from the pen of Miss Charlotte Bickersteith appeared, and more followed after she had taken to herself a husband and changed her name to Wheeler. Emanations from the fertile imaginations of Miss Alice F. Bickersteith, Miss Emily Bickersteith, and Miss Frances Bickersteith all bear testimony that female Bickersteiths were wont to ply the quill with commendable diligence; whilst connected with theology and matters relating to things divine, writers may be mentioned like Edward Bickersteith, Dean of Lichfield; Edward Bickersteith, Rector of Walton, Herts., who flourished during the latter portion of the last century and lived well into the present one; Edward Bickersteith, English theologian and writer, Archdeacon of Berkshire, born in 1814; Henry Bickersteith, divine and poet, born eleven years later; and again, born between the two dates last mentioned-in 1816-Robert Bickersteith, who in 1857 became Bishop of Ripon. Besides the foregoing there was the Rev. John Bickersteith, who in 1850 wrote a memoir of John Lang Bickersteith from, as he says, "material chiefly supplied by the subject." This memoir was eulogistic of John Lang's great piety. Henry Bickersteith

No. 33.

(Lord Langdale), born in 1783, Master of the Rolls in 1837, Commissioner of the Great Seal in 1850, and who died in 1851, may be taken as the representative name in law, whilst in medicine we have Henry Bickersteith, surgeon, who in the second decade of the present century wrote a book. It was a 12mo, entitled "Medical Hints for the Use of Clergymen." That advice to clergymen might then, as now, be given with great advantage we are not quite prepared to deny, and whether the recommendation to Drink deep or taste not,

at the fount of medical knowledge would not have been sounder counsel than "Medical Hints," we are not called upon to determine, but albeit that

Slight draughts intoxicate the brain,

Whilst drinking deeply sobers us again, the work mentioned reached its third edition in 1829, and doubtless proved a pecuniary success. Parenthetically we cannot but deplore the evident tendency which is developing itself in the ranks of soul-curers to dabble in the shallows of the body-curing art. But recently, the dabbling tendency to which we have alluded displayed itself strongly in a dignitary of the Church of England, who had become imbued with the notion that bodily salvation depended to a great extent upon abstinence from tea drinking, and the columns of a daily contemporary were called into requisition to ventilate his ideas-fads. We have no statistics to inform us how many warriors of the banner blue forsook their ribbon of cerulean hue to swell the number of devotees to the bung and spigot, but we may safely take it that when tea-dealers became aware that the Dean's earthly course had ended there was neither weeping nor wailing nor gnashing of teeth among them. Another instance illustrative of the same tendency, and demonstrating that

A little knowledge is a dangerous thing, occurred not long ago at Malling, near Maidstone. It will be within the recollection of all our readers how a poor

MENT OF DISEASES OF THE SKIN.*

Judging by the portrait which we have pleasure in presenting to our subscribers, and which is a careful copy enlarged of a photograph which the subject very kindly supplied for our artist's use, Edward Robert Bickersteith has many years yet to live ere he arrive at the threescore years and ten span of a man's existence. Similarly judging him by the tone of his reply to our request for permission to insert his biography, etc., we should take him to be a man of very pronounced opinions. Whether our subject be descended from any of the divines to whom allusion has been made, or from the eminent gentleman learned in the law, or from Henry Bickersteith the surgeon, we are not in a position to state; but that he is a distinguished member of the medical profession who has filled important offices in connection therewith, as well as contributed to the medical literature of his day, will be gathered from the following biographical notice of him taken from the "Medical Directory" :-" Bickersteith, Edwd. Robt., F.R.C.S. Edin., 1855. F.R.C.S. Eng. (Elect.) 1879. M. 1851 (Liverpool Royal Infirmary, University Edin. and St. Bartholomew's). Mem. Roy. Med. Soc. Edin.; Paris Med. Soc. and Aberneth. Soc. Lond.; Hon. Surgeon and Lect. on Clin. Surg. Liverpool Roy. Inf.; late Lect. on Systematic Surgery Liverp. Roy. Inf. Sch. of Med., and House Surg. Roy. Inf. Edin.; author On a New Operation for the Treatment of Ununited Fractures,' Med. Chir. Trans. 1864. Contrib. On the Mode of Death by Chloroform,' Edin. Month. Journ., 1853. 'Excision of the Shoulder and Elbow Joint,' Liverp. Med. Chir. Journ., Nos. 1 and 2. 'Contributions to Antiseptic Surgery,' Lancet, 1869 and 1870."

It now only remains for us to express the sincere hope, in which our readers will doubtless join us, that Edward Robert Bickersteith may be spared yet for many years to labour in a sphere of usefulness in which many highminded and earnest men have nobly done their duty, and in which many still (whose doings we hope from time to time to place on record) continue to put forth most praiseworthy exertions.

BY JOHN V. SHOEMAKER, A. M., M.D.,

LECTURER ON DERMATOLOGY AT THE JEFFERSON MEDICAL COLLEGE, AND INSTRUCTOR THEREON IN THE POSTGRADUATE COURSE OF THAT INSTITUTION; PHYSICIAN TO THE PHILADELPHIA HOSPITAL FOR SKIN DISEASES, ETC.

THE old time routine treatment of sulphur and arsenic, zinc ointment and tar, along with the mercurials for specific affections which have so long comprised the mainstays of destined to loosen its hold on dermatologists; and there therapeutics in diseases of the cutaneous covering, seems appears just at this time a tendency not alone to study the lesions, development, and causation of cutaneous disease, but, in keeping with the practical age in which we live, the means and ways by which to affect them curatively are assuming the character of the greatest importance. That these naturally are but the consequence of a thorough understanding of the pathological conditions is not to be denied, but if we were to arrest our efforts at that juncture, we should indeed miss the principal object of our vocation. The last decade, more than any previous period in the development of our special branch of science, has been productive of a system of application of physiological processes to the pathic involvement of skin affections. The dermatologist of this day who would simply depend on the older remedies for support in combating the various cutaneous troubles would indeed be left behind by his more practical colleagues in practical results. The tar of psoriasis treatment has been almost entirely supplanted by naphthol pyrogallic acid and chrysarobin. Scabies, which was thought to be triumphed over by sulphur with its unpleasant odour, is now more clearly and speedily overcome by naphthol and chlorinated oil. The oleates in tional remedies in as many different types of disease of the their various forms and varied names have proven unexcepskin. Favus, once thought almost incurable, is now tractable without epilation to mercuric oleate and copper oleate. Trycophytosis readily yields in its various forms to similar means, while chromophytosis may be said to vanish almost visibly under the use of copper oleate. Ulcerating lupus and chronic ulcers I have shown to yield most readily to short while ago it was only to be met by the cautery, the the irritant action of the jequirity infusion, when but a curette, etc., or the use of caustics. Arsenic is found to answer better when used hypodermically in many cases, while the same method of exhibiting mercury seems fair to take the place of inunction and other specifics for syphilis. To name or number all the successful innovations in the treatment of affections of the skin would be a work beyond the scope and length of this paper, and I will content myself therefore with a description of those that I have been instrumental with in their introduction, and have had an opportunity to watch both in the wards of a hospital for that class of disease, as well as in a private practice devoted largely to the treatment thereof. As I have but recently in a paper to the British Medical Association devoted much time and space to the consideration of the class of remedies known as oleates, I will dwell on them but briefly here, and enumerate simply the more important ones and their therapeutic action. After many laborious experiments with the alkaloidal oleates, I must certainly deny the claim made for them by so many others. They

A paper read before the Section of Dermatology and Syphilis, at the Meeting of the International Medical Congress at Copenhagen, Aug. 12th, 1884.

are neither absorbed in sufficient quantities to be productive of decided action, and as consequence thereof fail to produce constitutional effects. The much-vaunted quinine oleate has never checked a paroxysm of malaria, nor have the narcotic oleates ever relieved, as it was expected and claimed they would do, without other aid, troublesome neuralgias or other pains. The metallic oleates have found a most useful place, however, in the treatment of skin diseases by their power, as solutions in fatty vehicles capable of entering the glands and follicles to exert contact action in the deeper structures of the skin. Thus the ointment of aluminium oleate was found useful in ulcers, pustular eczema, intertrigo, abscesses, sinuses, chilblains and burns; the arsenicum oleate ointment in cancer, lupus, old granulations, warts, horns, and naevi; bismuth oleate in sycosis, acne, rosaceæ, sunburn, and erysipelas; the ointment of cadmium oleate in enlarged glands, ulcers, and chronic eczema; that of copper oleate in ringworm and par excellence in chromophytosis, yellowish brown and black pigmentary deposits as well as in warts, corns and bunions; the ointment of iron oleate in acute eczema, and of the greatest benefit in arsenical sores; the ointment of lead oleate instead of the litharge ointment so hard to preserve in acne, rosaceæ, and the various forms of eczema.

The mercuric oleate ointment is one of the most serviceable remedies in vegetable and animal parasitic affections, the infiltrations of psoriasis, and in enlarged glands. The mercurous oleate much in the same manner, only with more decided effect and with a view of constitutional impression.

Nickel oleate ointment I have found very serviceable in chronic eczema and chronic ulcers. Silver oleate dusted on chronic ulcers, bed-sores, and exuberant granulations produces a most happy effect, while its ointment is beneficial in erysipelas, boils and carbuncles. The tin oleate as ointment applied to diseased nails I have determined to be of value to restore them to their natural state, as well as to impart to them a beautiful lustre. Last, but not least of this group, I would mention the zinc oleate, an impalpable powder of unctuous touch, which is undoubtedly one of the best remedies in seborrhoea oleosa, excessive sweating, erythema, acute eczema and herpes; and in ointment form in eczema and acne.

Chlorinated oil is ordinary olive oil saturated with chlorine, or rather a chlorine substitution in olein. It contains many volumes of chlorine, and as a substitution compound the chlorine therein loses its identity and odour, making an unobjectionable, odourless, and most serviceable remedy in scabies, where it acts without irritation, without inconvenience to the patient, and without interruption of his daily vocation. I had noticed the excellent effects of chlorine in some of my experiments on the acarus scabiei, and when applied as chlorine water mixed with olive oil I was surprised at the absence of the odour of the chlorine, while its good effect was quite as apparent; as deduction thereof, I had olive oil saturated with dry chlorine gas with the same results, forming what I have termed above the chlorinated oil.

Oil of Ergot. This article, which I discovered accidently as a waste product in looking over a chemist's laboratory, has proved with me a most useful and valuable remedy, which has already in our country attained such importance that it forms no longer a waste material. When applied to the skin, it has a protective, soothing, and astringent action, and by its absorption assists in nourishing the diseased part. Few remedies are so efficacious as oil

of ergot in checking the formation of scales in seborrhoea of the scalp and other hairy parts of the body. It is for this purpose much preferable to any of the other fat oils. Its beneficial effect in seborrhoea of the genitals, when lightly brushed over the surface, is not to be omitted here; while, however, its principal use must be as a dressing or hair-oil when suitably flavoured in the idiopathic loss of hair so often met with in consequence of a lack of tone of the hair follicle. In connection with this, I would call attention to a natural soap, the bark of Quillaye saponaria, and its use in the treatment of skin diseases. The soaps, both hard and soft, are such necessary adjuncts to our special branch, and though useful in many cases they prove objectionable in others. It fully meets the requirements of a mild soap, removing by emulsifying the fatty excreta cost upon the dermal surface. I have used it with marked benefit in dandriff of the scalp. It is also useful in removing the scales of simple pityriasis. The foetid excretions are most easily removed by it, and the glands contracting under its effect gradually produce a remedial action over this unpleasant affection. Excessive sweating of the hands and feet can be successfully treated by washing them frequently with an infusion thereof. The tincture of it is a much stronger and efficient preparation, which I prefer in many instances to the tinctura saponis kalius, as it is devoid of the irritant and destructive effect of the latter, and meets all the detergent properties thereof. In the various forms of scrofuladerma I was often at a loss how to insure the assimilation of cod liver oil in the patients, which they either refused to take, or if left to them to do so at home it was by them neglected and omitted, thus often unaccountably retarding curative results. In many such cases I was led to consider the advisability of using this remedy with a view of its retention and assimilation. This I accomplished by injecting it hypodermically in the loose cellular tissue under the skin of the back, and found that with one injection of half-an-ounce (about 15 grammes) daily I attained results far better than if the usual ounce and a half (about 45 grammes) were taken by the mouth. The oil so injected at no time produced unfavourable results, disappearing from observation in from twelve to twenty-four hours. To satisfy myself of the physiological absorption and assimilation, I experimented prior to the more general application of this method by injecting the same amount of castor oil, and was surprised at the prompt and satisfactory laxative action produced by it. The use of cod liver oil hypodermically has aided me to overcome several cases of intense itching in old patients, due to a lack of nutrition of the system. The Beta naphthol is a remedy which has been used and recommended by various investigators and authorities on skin diseases—a most useful remedy, resembling in its action the alterative power of tar. The article I obtained from Dr. J. Wolff, who had manufactured it for me, principally with a view of removing the odorous and more volatile portions; the results of experiments with it had been so satisfactory that I was surprised to learn of the various reports made calling attention to the toxic effects of it often produced when used extensively. That it should at times cause, hæmaturia, ischuria, vomiting, unconsciousness, and eclamptic attacks, was a most serious charge which alarmed me considerably, and caused me to make a series of experiments both on rabbits and on men. The former were both inuncted with it, had it hypodermically injected, and were given it internally, subsequently even to the amount of eight grains, without producing a

serious or lethal effect, or that a post-mortem examination should have proved a renal congestion. Not satisfied with this, both my assistants and students volunteered to try it themselves, which they did, commencing with small doses until they reached ten grains per day, also without bad effect. While I certainly confirm the valuable reports made by other writers on this subject as to its curative action on scabies, prurigo, eczema, and psoriasis, I must further deduct from my experiments that a pure odourless naphthol, such as I have used, is certainly devoid of toxic action in the strength that it can be applied to the skin without causing undue irritation. I must also call attention to its great value as a deodorant and disinfectant and antiseptic, which I had not found mentioned in the literature on the subject. I would lay special stress, however, on the fact that crude naphthol in reddish crystalline masses and lumps should never be used without being recrystallised and deodorised, which is not to be done by means of sublimation, however.

JEQUIRITY. I have established a use for jequirity in diseases of the skin, which bids fair to give it vast importance as a remedial agent in this class of diseases. From the astonishing manner in which it appeared to destroy the exuberant granulations of pannus, I was led to infer that it might be well to employ it in diseases of other parts when exuberant granulation and proliferating cell-growth formed the principal pathological condition. I had used for that purpose, at first, the ordinary infusion that was employed by ophthalmologists, but soon found that it made very little if any impression, and resolved thereupon to have an infusion made which would be strong enough for the purpose I had under consideration. As however, the clear infusion was hardly sufficiently viscid to adhere to the surface, I had it made in the following manner:-200 grains of the bean are decorticated by being slightly bruised and cracked in a mortar; the red hulls are then carefully picked from the cotyledons and placed in a bottle covered with water. They are thus macerated for twentyfour hours, when they are again transferred to a mortar and thoroughly triturated until they are reduced to a smooth paste, when sufficient water is added to make the whole weigh 800 grains. Prepared in this way, it presents all appearances of an emulsion, and is applied with a camels' hair pencil or mop to the surface to be treated. The effect of this preparation to the healthy unbroken skin does not show itself in any way, while although painless when applied to ulcerated and granulated surfaces, it soon develops in the latter, and often within an hour, a great deal irritation and inflammation, rendering the edges red, and infiltrated the surrounding domatous and shining, and causes some febrile exacerbation in the patient depending in degree on the area involved. The usual concomitant symptoms of such febrile process are apt to show themselves at this stage, such as headache, pain in extremities, elevated temperature, high pulse, all of which, however, is only occasionally noticed, and particularly in irritable and easily susceptible patients. In the course of six to twelve hours the products of this specific inflammation are abundant, and soon aggregate on the surface in a desiccated, cuirass like crust which now obscures further observation. This crust, in the course of twenty-four hours further, exhibits a tendency to crack and break, giving vent to the free flow of the products of the breaking-down process. If this is left alone it will continue for five or six days, the discharge lessening by degree; the firmly adhering crusts if not detached of their

own account are now removed by water dressings, and expose to view a surface studded with healthy granulations and islets of healed-up surfaces along with evidence of the progressive regenerative process at the periphery. In cases where one application does not suffice, and where evidence of unhealthy granulation is still observed, a second application is now made and conducted as before, a third and fourth following if found necessary. As cases most suitable for this action of jequirity I had selected specific ulcerations, indolent scrofulous ulcers, ulcerating lupus, epithelial ulcers, all of which I demonstrated before the recent meeting of the Medical Association of the State of Pennsylvania in their various stages, as well as cures affected by this treatment. I have been engaged with the subject of jequirity treatment for about a year, and am so encouraged by the results attained by it, that I lectured upon the subject already in March last, in a clinical lecture, and recommended the use of it to my class. The results with lupus ulceration was particularly striking and gratifying, as in some instances it accomplished complete cures after the patients had been under treatment for years, and under the care of the most skilled dermatologists. Although at times the inflammation produced caused almost alarming symptoms, I have never seen serious consequences follow its employment. The scope of this paper does not permit me to enter upon the modus operandi of its action, and I must refer those interested in the subject to my paper thereon, presented to the Medical Association of the State of Pennyslvania. Suffice it that I can freely state I consider the employment of jequirity in the manner as above described a most powerful remedy in the treatment of diseases of the skin, applicable to almost all cases of unhealthy ulcerating and granulating surfaces, upon which it undoubtedly exercises a destructive action, followed by a constructive change, and favouring under the protective cover of its exudation the rapid development of healthy tissue. Though under proper conditions and careful supervision a remedy of the greatest service, it should be applied with proper caution, as it may give rise sometimes to alarming symptoms, erysipelatous inflammation, and if applied in weak and irritable patients, to grave constitutional disturbances. These, however, can be easily made to subside with proper attention, and will do so of their own account on drying of the crusts.

MECHANICAL REMEDIES.-There are many methods besides the use of drugs which can be resorted to in the treatment of diseases of the skin, and such measures being mechanical in their application may be termed mechanical remedies. These methods are known as massage, compression, blood-letting, incision, excision, enucleation, scooping, scraping, the seton and cauterisation. Although these mechanical applications have been used more or less from time immemorial, principally, however, in the hands of the ignorant, or the sly quack, yet isolated cases have been reported every now and then in this or that country in which some practical physician has availed himself of one or the other means to cure his patients. Mechanical methods of treating diseases of the skin had almost been lost sight of until a few years ago, when I brought the subject before the Medical Society of the State of Pennsylvania in a communication with some illustrations of the value of blood-letting in cutaneous affections. Both before and since that time I have written and spoken much upon the subject, not only of bloodletting, but of all the neglected mechanical remedies, and