DISEASES OF THE SKIN. 



further and similar deposits in the substance of the cutis. With regard 

 to the first point, all surgeons and dermatologists entirely agree that 

 the lupus nodules must be removed or destroyed ; but opinions differ 

 greatly as to the surest and most advantageous means and method of 

 effecting this object. It is not for me to go into the merits of purely 

 surgical questions, nor to express a preference for the use of the knife, 

 the actual or the potential cautery, nor to declare in favor of nitrate 

 of silver, or caustic potash, rather than for nitric acid, arsenic, iodide 

 of mercury, or chloride of zinc. In my opinion it matters much less 

 what particular caustic is employed, than that the operator should be 

 well versed in the management of the caustic, and should be familiar 

 with its action. Very obscure and ill-educated surgeons often acquire 

 a reputation from their wonderful success in the treatment of cancer, 

 and of " eating-sores," by means of a secret remedy. It would be 

 wrong to assume that all such reputations are without foundation. 

 Individuals of this class, the so-called " cancer-doctors," by dint of 

 operating daily, and in numerous cases, with one particular kind of 

 caustic, finally become more skilled in its use, and know better how 

 to adapt it to especial instances, than the most distinguished surgeons. 

 Patients, in whom the application of caustic is indicated, may be in- 

 trusted to their hands with perfect reliance. But if the state were to 

 buy the secret, science would be but little benefited by the purchase, 

 even though the seller were to act with perfect honesty ; for other 

 surgeons operating with the same caustic will not be nearly so suc- 

 cessful as the original possessor of the nostrum. 



The second indication in the treatment of lupus is far more difficult 

 of fulfilment than the first. Unfortunately, we know of no sure means 

 of preventing the recurrence of lupus nodules in the vicinity of the old 

 site of the disease, nor in the scar of an old lupus, whether healed 

 spontaneously or by artificial means. We are not agreed even as to 

 the necessity of an internal medication for lupus, in addition to the 

 local treatment ; or whether we should rely upon external application 

 to produce an alterative effect upon the nutrition of the endangered 

 region. The internal medicines most in vogue are the iodide of potas- 

 sium, with or without an addition of iodine, and cod-liver oil, which 

 has been given in the enormous dose of twenty-five tablespoonfuls a 

 day. In badly-nourished subjects, and even in those who are not 

 scrofulous, experience warrants the trial of these articles, especially 

 the oil, in very large doses, although not such excessive ones as the 

 above say six tablespoonfuls a day. In recent cases, and in robust 

 and plethoric subjects, in whom the lupus was making rapid progress, 

 I have seen remarkable benefit obtained from Zittmanri's decoction. 

 If the disease should come to a stand-still during this treatment, and 



