496 DISEASES OF THE SKIN. 



was in the beard, the other half without it, presented the features of 

 herpes circinatus in the latter situation and that of mentagra in the 

 former. 



SYMPTOMS AND COURSE. The disease commences with a sense of 

 heat and tension, accompanied by the development of red infiltrated 

 nodules, of the size of a pea or lentil, between the hairs of the beard 

 upon the lips, chin, cheeks, and, in rare instances, between the hairs 

 of the eyebrows and armpits. After a while, pustules, which are al- 

 ways perforated by a hair, appear upon the tips of the nodules. The 

 pustules burst in a day or two, and pour out their contents, which im- 

 mediately dry into brownish crusts. The nodules still continue beneath 

 the crusts, and, even after the latter have fallen, they diminish very 

 slowly or not at all. Although at first the eruption is scanty and 

 scattered, yet, under the influence of successive attacks, the tubercles 

 multiply gradually, until, from the close crowding of the nodules, 

 together with the infiltration of the intervening skin, the appearance 

 of the surface becomes suggestive of a fig whence its name, " syco- 

 sis" Sometimes sycosis is confined to single spots of no great mag- 

 nitude ; in other cases, every part of the face where the hah* grows is 

 covered with dusky-red nodules, pustules, and scabs. The disease is 

 of indefinite duration, and often lasts for years and even tens of years 

 without subsiding, but also without leading to other lesions. When 

 it heals, the hair-follicles having been destroyed, the hair does not 

 grow again upon the affected spot, which presents the appearance of 

 a scar. 



TREATMENT. I used formerly to regard sycosis as one of the most 

 intractable of diseases, as it generally resisted all treatment, notwith- 

 standing the numerous remedies which have been proposed for its cure. 

 In the last few years, however, during which I have adhered strictly 

 to the treatment proposed by Hebra, in Virchoufs hand-book, I have 

 altered my opinion, and recommend the following procedure. In the 

 first place, all the scabs are to be softened and removed by rubbing 

 them with oil, or by the application to them of a rag saturated with 

 oil. We must then insist upon the patient's shaving daily, in spite 

 both of his opposition and his barber's. The pustules which appear 

 after the shaving are all to be opened with a delicate scalpel ; and 

 where they are confluent, long incisions must be made through the 

 clusters. Like the shaving, this scarification is far less painful than 

 might be supposed, and it likewise must be repeated daily. In ex- 

 traordinarily obstinate cases the opened pustules must be touched with 

 concentrated acetic acid, or with a solution of corrosive sublimate, 

 consisting of one part of the sublimate to two of alcohol. During the 

 night it is generally sufficient to cover the affected part with a rag, 



