52 TILBURY FOX.
shock to the spinal cord, such as exposure to cold and intense solar heat and sudden chill, especially liable to occur in workers in hot places, must be dealt with specially. Mental excitement is a great aggravation not only of hydroa of the face, but of other cases. A ball or party, or other similar excitement, will often be followed by decided exacerbations of the rash in the case of young women. Rest, therefore, freedom from worry, and undue excitement are to be counselled as part of the general treatment. All influences that depress the vitality of the skin, or the bodily powers generally, must be prevented from working on the patient's constitution,
(5) Diet has much influence on the disease, as seen in the use of stimulating food in dyspeptics, the gouty, and rheumatic.
(6) In regard to the alleviation of the "cruel itching" present, internal sedatives do not as a rule seem to do that good which one would naturally anticipate, though they indirectly benefit by promoting or securing sleep. The irritation is greatly mitigated and relieved, however, by local remedies. Yet chloral, belladonna, conium, etc., which we have given freely, and even opiates, must be administered either at night or in the daytime to allay the excessive pruritus that destroys all rest, leads to total loss of appetite, and so brings on profound prostration. We hold that aconite, so favorite a remedy in France, should be carefully avoided in these cases.
(7) The last proposition is, that soothing and antipruritic local remedies are of general service. Erythematous and vesicating surfaces are to be dealt with by such simples as lead or calamine lotion ; and pruritic indolent surfaces by oil inunction, bran, and alkaline baths, and especially by tarry applications.
SECTION VIII.— CONCLUSION.
I am anxious, in conclusion, to point out that this paper is in- tended to be suggestive in regard to future inquiry rather than de- cisive as to the nature and varieties of hydroa. It is a subject much written and talked about at the present time, and I have conse- quently put my later views and experiences together in a definite shape. I hold that there is such a disease, distinct in the bulk of cases in its clinical features, although having close alliance with herpes on the one hand and pemphigus on the other. I only hope that this paper may help in some measure to clear the way and make the further discussion of the matter result in clearer views as to the real nature of these interesting affections. It is a pressing need that we should gather together the records and determine the affinities of the aff'ections described as i>emphigus a petites bulles, pemphigus pruriginosus, pemphigus herpetodes, herpes pemphigodes, herpes generalise febrile, acute general herpes, acute febrile pemphigus, herpes gestationis, impetigo herpetiformis, herpes circinatus bul- losus, etc. It is a duty dermatologists owe to science to set to work, and by careful study and exact observation to relegate these several aff'ections to their proper types, and so simplify this present chaos. This is my contribution to this most desirable end.
