APPENDIX TO DISEASES OF THE SKIN. 521 



have already mentioned the beneficial effect of the preparations of 

 sulphur, when treating of acne. For the treatment of milium, 

 Hebra recommends removal of the epidermic covering by bathing 

 it with a moderately strong solution of caustic potash (one drachm 

 to a pint of water), or by the application of soft soap upon a flan- 

 nel rag. Treatment of atheroma consists in division and extirpation 

 of the degenerated follicle. 



[APPENDIX TO DISEASES OF THE SKIK 



SCLEEODEEMA. 



SCLEBODEBMA occurs at any age, but especially in middle-aged 

 women from unknown causes, and is due to a gradual increase and 

 atrophy of the cutaneous connective tissue especially of the face, 

 arms, etc., which becomes hardened, pale, red, or pigmented, and 

 adherent to the parts beneath, so that the lineaments of the face may 

 be stiffened, the lips and nostrils shortened, the fingers stiff, etc. The 

 disease goes on for years, and when arrived at the stage of atrophy 

 is incurable ; but earlier it may subside. This favorable result does 

 not appear due to rubbing, bathing, mercurial salve, or the internal 

 use of iodide of potash ; but tonic treatment and good nourishment 

 may do good. The nature of this disease is not fully understood ; 

 while some attribute the changes in the skin to stasis of lymph, either 

 from thickening or from disease of the lymphatics (and regard it as 

 related to elephantiasis), other observers, who have seen the joints 

 and some bones implicated, refer the disease to trophic neurosis 

 originating in the ganglionary system. A different form of the dis- 

 ease is sclerema neonatorum, or cellular-tissue hardening, which 

 attacks feeble, premature children under fourteen days old. There 

 is decided disturbance of circulation in the outer portions of the 

 body and great depression of the temperature ; the skin begins to 

 harden on the legs, and this hardening extends to the trunk, arms, 

 and even face. The portions of skin affected are sometimes rede- 

 matous, and subsequently hard as boards, cold and cyanotic ; the 

 stiffness greatly hinders all motion, the face is wrinkled, sucking and 

 drinking are impaired, the bodily temperature falls markedly, and 

 death usually occurs within a week. On autopsy, besides oedema of 

 the skin and perhaps of the deeper parts, the fatty tissues are found 

 unusually firm ; some regard this as due to the sinking of the bodily 



