nules, the difference in the tissue being in the relative quantity of earthy matter with which the granules are impregnated. Till lately but little was known upon the structure of the teeth, and that little was overlooked. Luenooke made out the dental structure to be tubular, but his observations were disregarded until the subject was taken up by Purkinje. Professor Retzius. of Stockholm, about the same time, pursued the minute anatomy of the teeth, and with similar results to Purkinje, which were published in Stockholm in 1836. Late in the year 1837, prior to the appearance of the works either of Purkinje or Retzius in this country, I commenced the investigation of the structure of the teeth, under the im pression that lit le or nothing was known upon the subject. The whole of my time which was not occupied on lectures, or necessary professional study (I was then a pupil at King's College), was devoted to the pursuit of dental anatomy, and in a short time I found many points, as I then thought. quite unknown. After I had exhausted the subject, so far as human teeth were cocerned, and examined the teeth of all the common animals, I became acquainted with Professor Owen, who, after examining many of my preparations, and accepting a few, mentioned, in his lecture at the College of Surgeons in 1838, my researches in terms of great commendation, as having confirmed those of the continental anatomists, and in some points extended further than they. I drew up an account of my researches in a paper, entitled, "On the structure of the teeth, the vascularity of those organs, and their relation to bone, which was read before the Royal Society, June 21st, 1838, having been presented by Thomas Bell, Esq.† This was the first account written upon the structure of the teeth in this country; and, in addition to the confirmation of Purkinje's and Retzius' views, it contained several new points. The most important of these was the vascularity of the tubular structure. At a later date, in the same year, Professor Owen read a paper on the structure of the teeth before the British Association. Shortly afterwards Mr. Nasmyth published a work on the same subject, which contained a full account of Retzius' views, together with a detail of the results of his own researches. * De Penitiori dentium humanorum structura observationes. Breslau, 1835. Metetamata circa dentium evolutionem. BresIau, 1835. † Proceedings of the Royal Society, June 21st, 1838. LONDON MEDICAL GAZETTE, Feb. 16th, 1839; and July 10th, and July 31st, 1840. Lancet, July 25th, 1840. Dublin Medical Press, Aug. 19th, 1840. DISEASES OF THE SKIN.* BY JOHN ERICHSEN, F.R.C.S. On some Local Forms of Chronic THE frequency of the occurrence of eczema, the variety of forms that it assumes, and the very intractable character that it frequently puts on, render its study one of peculiar interest and importance to the practitioner. And I purpose, in the following observations, to direct attention to the different forms assumed by this disease as affecting the face, the ears, the tongue, the scrotum and anus, the scalp, and the hands. Chronic Eczema of the Face. Eczema of the face of children usually assumes an impetiginous character, and is, as every one knows, a disease of daily occurrence; it is, however, comparatively seldom met with in the aduit: and when it does make its appearance, is usually the consequence of the extension of the disease from the scalp or ears. The following case is therefore interesting as an instance of the strictly local form of this disease. CASE IV.-Susan Murray, æt. 21, a ladies' m id, came under my care on the 27th January, 1843. She is tall and slender, has fair hair, grey eyes, and a thin delicate skin; has always enjoyed very good health, and has never suffered from any cutaneous affection until this attack: there is no derangement either of the digestive or uterine organs. Shestates, that about three months ago, whilst travelling outside a carriage on a very cold and windy day, she felt her face become stiff and inflamed; a number of pimples with watery heads then made their appearance about the forehead and cheeks, and since then the disease has continued without interruption, although she has been subjected to much treatment. * Continued from page 1240 of the last Volume. The skin of the greater part of the forehead, and of the upper part of one cheek, now presents a dry and glazed appearance, and is of a vivid red colour; it is covered by a number of thin curling furfuraceous scales, of a whitish or greyish colour, is slightly chapped in the direction of the natural wrinkles of the skin, and is occasionally bedewed with a watery exhalation. Vesicles no longer form, as in the first instance, on the parts on which the disease is most active, but they occasionally make their appearance about the circumference of the patch, where they present the true eczematous character. The affected parts feel very tense, smart and tingle much, more especially after exertion, during cold weather, or if exposed to sudden changes of temperature. As it was of considerable importance to the patient to be cured as speedily as possible, as she had already been subjected to much treatment without deriving any benefit, and as there was no circumstance to contraindicate it, it was determined to have recourse to arsenic. I accordingly commenced by ordering three drops of the Liquor Arsenicalis three times a day, and directed that the affected part should be preserved day and night from the action of the atmosphere by covering them up with lint spread well with zinc ointment. Feb. 13th.-Much better. The skin is softer, not so glazed, and the feeling of tension is less. The Liquor Arsenicalis was now increased to four minims for a dose, and the Unguent. Hydrarg. Precipitat. Albi was substituted for the zinc ointment, it being thought that a slight stimulant might be of service. March 8th.-The forehead is very much better, the diseased patch being much smaller in extent, less red, does not scale, and feels much more comfortable. As the patient complains of having been thirsty, of having lost her appetite during the last few days, and of dreaming vividly at night, she was ordered to omit the arsenic, and to take some saline medicine, but to continue the ointment. On the 14th, she resumed the Liquor Arsenicalis in three-minim doses, and continued it until the 25th, when, the disease appearing to be perfectly cured, it was discontinued. The disease having, a few months after, returned in the same place in consequence of exposure to atmospheric changes, the patient was put on the same plan of treatment as before, and speedily recovered. This case is interesting on account of the somewhat unusual situation of the eczematous eruption in the adult, its strictly local character, being apparently unconnected with any morbid condition of the general health, and the readiness with which it yielded to the careful administration of arsenic. The following case forms a striking contrast with the preceding one in almost every respect except the seat of the disease. CASE V.-A gentleman, 34 years of age, from the neigbourhood of Clitheroe, consulted me, on the 20th May, 1844, for an eczematous eruption of the face, to which he had been subject from childhood. He is a good example of the sanguine temperament; has light hair, verging on red, grey eyes,an exceedingly thin delicate skin, a florid complexion, and a quick excitable pulse. Although residing in the country, leading a temperate life, and much addicted to field sports, he suffers from almost constant irritative dyspepsia, with occasional attacks of pyrosis, the mucous membranes appearing to be as irritable as the skin; the tongue is red at the tip and edges, though somewhat coated in the centre, and the bowels are frequently relaxed. The skin of the face, especially that covering the cheeks, lips, and skin, isred, irritable, and hot. There is a feeling of tension, dryness, and stiffness about it, and it readily flushes after exertion or meals, and on exposure to the wind. The cheeks, lips, and skin, were, when I saw him, covered with thin, peeling, furfuraceous scales, of a whitish-grey colour; but occasionally, under the influence of any cause of irritation, they become the seat of a watery exudation, which, on drying, formed thicker and more laminated incrustations, adding greatly to the distress and discomfort. He likewise suffers occasionally from an attack of eczema about the extremities, especially on the fore-arms. The patient was ordered to apply the Unguent. Hydrarg. Precipitat. Albi to the affected parts every night, to take five grains of Plummer's pill every second night, effervescing saline draughts twice a day, in order to allay the irritability of the stomach, and as soon as this was accomplished, was put on a course of the Harrowgate waters. He was, at the same time, directed to observe a very strict diet, avoiding all stimuli, whether solid or liquid: to this he adhered most rigidly. He continued the waters without intermission until the early part of last summermore than twelve months from the time he commenced taking them, when he omitted them, having had no return of the disease for several months. He still continues perfectly free from it, and states that he is in better general health than he ever recollects to have enjoyed. In this case the disease appeared to be dependent on irritation of the tegumentary and mucous surfaces, and has been checked, and in all probability cured, by attention to this condition, by carefully regulating the diet, and by the use of one of the most efficient remedies that we possess in affections of this class the Harrowgate waters. In a case of this description occurring in an individual of an irritable temperament, arsenic, cantharides, or other remedies of this class, would infallibly have aggravated the disease: and most benefit will result from carefully regulating the general health; from strict attention to dietetic means, and the avoidance of all stimulating or heating articles of food, and perseverance in the use of the natural or artificial sulphureous waters. Chronic Eczema of the Ears. This disease, which is a very frequent complication of eczema of the scalp, is a most obstinate, troublesome, and painful affection, and one that is very apt, when occurring in the adult, to fall into a chronic and intractable condition. The ears, when attacked by eczema, become exceedingly red, tense, hot, and shining; a number of small vesicles then appear, which contain a clear transparent serum, of a reddish or pale yellow colour; when these give way, the fluid that is effused forms thin scabs or scales, which are usually cracked in all directions, and which are frequently curled up or project from the surface of the skin. If the disease continue, the pinna attains a very large size, becoming hypertrophied, and often fissured; sometimes, indeed, the swelling goes on to such an extent as to block up the external meatus, giving rise to temporary deafness. In this form the disease may either pass into a chronic condition, continuing for an indefinite period, or else, if proper means be adopted, it may be cut short, and speedily get well. When the disease is on the decline, all fresh eruption of vesicles ceases, the discharge gradually lessens, the scabs which are formed fall off, and are either replaced by some that are thinner, more scaly and lamellated, or else are not reproduced at all, leaving the cutis exposed, red, and glistening, on which thin scales of epidermis are gradually deposited, and which, in time, acquires a natural appearance. Eczema of the ears occurring in children as a consequence of the same affection of the scalp, is usually very readily cured by simple treatment. It is when attacking persons after the age of puberty, and especially young females from 15 to 25 years of age, or women at the critical period of life, that it is so obstinate and rebellious a complaint. When occurring at these periods, it is usually unconnected with any eczematous affection on the scalp or on any other part of the body, except about the temporal or mastoidean regions, as an extension of the disease from its primary seat, the ears; and it almost always, if not invariably, occurs in a symmetrical manner, affecting both ears at the same time, though not always to the same extent or degree. Eczema of the ears, when occurring in the adult, is most commonly met with in the female, and is, in many instances, connected wtih irregular menstruation. On looking over the notes of seven cases of eczema confined to this situation, and occurring in adults, I find that in two cases the menstrual function had ceased entirely, the ages of the patients being 52 and 69 years. In four cases there was more or less irregularity in the performance of this function, the patients' ages being 21, 22, 24, and 27 years; and in one case only, that of a woman 38 years of age, did the uterus act properly and regularly.. That the menstrual function exercises some influence on eczema of the ears is evident from the fact of the disease being worse at the periods at which the uterus ought to act. This fact, which was well marked in the following case, I have had occasion to observe in other patients who have been under my care for the same affection. M. S., t. 21, came under my care on the 13th February 1844. She is of moderate conformation, with grey eyes and auburn hair. Has enjoyed good health until the last year, during the whole of which she has menstruated very irregularly, occasionally passing two months or more without menstruating. Has been affected with eczema of the ears for six months, but can asssign no cause for it. Both ears were found, on examination, to be affected nearly to an equal degree. They are red, glazed, much swollen and chapped, are covered with thin, flimsy, scaly incrustations, from under which a serous fluid occasionally oozes, and are very hot and tense. The integuments of the mastoid, temporal, and parotidean regions are likewise involved, being inflamed and covered with thin furfuraceous laminæ. The patient states that the disease is invariably worse at the periods at which she ought to menstruate, whether she does so or not, and becomes better after that evacuation has taken place, which has not now been the case for seven weeks. She was ordered to apply bread and water poultices to the ears every night, to cover them up in rags spread with zinc ointment during the day; to take ten grains of the Pil. Aloes c. Myrrha every second night at bed-time, to abstain from all stimulants, and to adhere as strictly as possible to a milk diet. The ordinary means, such as mustard and water to the feet, &c., have been likewise directed to be adopted for re-establishing the menstrual function, and were attended with success in the course of a week. At the end of a fortnight she was much better, the ears were less tense, and not so red or swollen. She was now ordered to apply an ointment composed of equal parts of the Ceratum Plumbi Comp. and zinc ointment, and to take five minims of Tincture of Cantharides, and thirty of Liquor Potassæ twice a-day. This plan of treatment was continued until the end of April when she was perfectly cured, the ears presenting their normal ap pearance, and having lost entirely their hypertrophied condition. The treatment of chronic eczema of the ears occurring in the adult is to be conducted on the same principles that guide us in the treatment of this disease occurring in other parts of the body. Any irritation that may exist must be subdued by means of poultices and fomentations; if necessary, a few leeches might be applied. The zinc ointment, or the Unguent, or Ceratum Plumbi Comp. or the Ceratum Cretæ Comp. diluted with elder-flower ointment, will be found the most eligible applications when a very mild astringent is required. The general treatment must be conducted in reference to the condition of the system. If there be any disorder of the digestive organs, or uterus, that must first of all be remedied. If none exist, or after its removal, it will be necessary to have recourse to those means that are generally iound to succeed in cases of chronic eczema, such as the dilute nitric, or nitro-muriatic acids, the Tincture of Cantharides (especially when there is amenorrhea), either alone or in combination with the Liquor Potassæ, or the arsenical solution. Owing to the very rebellious nature of the form of eczema now under consideration, it will often be necessary to have recourse to the last-named remedy. which will, if properly administered, and with those precautions that I formerly pointed out*, most generally succeed. I have at present under my care a case of chronic eczema of the ears of the kind just described, which, after resisting all other remedies, is rapidly yielding to the administrat on of Fowler's Solution. Many writers recommend the employment of lint to keep the meatus auditorius externus open; this I do not think is ever necessary, any obstruction that may have been occasioned by the swelling of these parts subsiding as the disease is cured, and no chance of permanent occlusion ever existing. Eczema of the Tongue and inside of the Mouth. Eczema of the tongue, and of the mucous membrane lining the interior of the mouth, is a very rare variety of the disease. The following case will * Vide MED. GAZ. 1843-44. illustrate its general symptoms and progress more clearly than any mere formal description of it could. Eliza Elsely, æt. 27, came under my care on the 25th March, 1844. Is short, rather stout, pale, with brown hair and grey eyes. She states, that she has for several years been subject to attacks of eczema, most generally affecting the arms, the hands, the elbows, and the axillæ. These attacks of the disease are usually cured by the employment of saline aperients, and the application of simple ointment. She is now free from the disease about the body, and is in a tolerably good state of health, her digestive and uterine functions being properly performed. About three months ago, shortly after the disappearance of one of the attacks of eczema of the body to which she is liable, she noticed a number of vesicles on the tongue and the inside of the lips, which parts soon became excoriated, swollen, andexcessively tender, so much so as to prevent her taking any but the mildest food. On examination, the tongue appears to be much swollen, and presents a tuberculated or soft warty appearance, the surface being of a greyish or purplish colour, uneven, and glazed; vesicles occasionally form upon it, which soon give way, leaving small excoriations. The mucous membrane lining the inside of the lips is also thickened, soft, and of a bluish leaden tint, with small excoriations and fissures towards the angles of the mouth. There is a considerable serous or watery discharge from the inside of the mouth. which is very annoying to the patient, and resembles a mild salivation; she has, however, never taken any mer cury. She was ordered occasional saline aperients, with the dilute nitric acid in 3ss. doses twice a day, a blister behind the angles of the jaw, and a liniment of one part of Balsam of Peru to two parts of yolk of egg, to apply night and morning to the affected parts. This plan of treatment was continued until the 10th of April, when, as she was not much better, the Nitric Acid was omitted, and she was ordered three minims of the Liquor Arsenicalis twice a-day. After a week, this was increased to three minims three times a day, the blisters were kept open, and the Balsam of Peru was continued as before. Under this plan of treatment she gradually improved, the swelling of the tongue, and the watery discharge, diminishing considerably. As I lost sight of her, however, before she was perfectly cured, I cannot speak with confidence of the ultimate result, which, however, was most probably a favourable one. In this case the disease of the tongue and mucous membrane of the mouth appeared clearly to follow the suppression or the cure of the same affection on the arms and trunk; and the treatment would, in all probability, have been more speedily successful if the blisters had been applied to the former seat of the disease instead of below the jaw. Under any circumstances, however, the case is an interesting one, as affording a good instance of a rare local form of eczema. [To be continued.] ON THE DETECTION OF BLOOD-STAINS. THE number of the Annales d'Hygiène for July contains a memoir by M. Orfila on the subject of a new process, recommended by M. Perscz, of Strasburg, for detecting bloodstains. It consists in the employment of hypochlorous acid. As a solvent, this acid, according to M. Persoz, at once destroys all stains, except those formed by rust or by blood, which are rendered of a brownish black colour on contact with the acid. He observes, that it is especially important to make use of hypochlorous acid as a test, because it frequently happens that blood-stains found on tissues have lost the property of dissolving in water, and cannot therefore be communication by M. Persoz, two chemists detected by this means. Shortly after this of Bordeaux, engaged in a medico-legal inquiry, tried this new process by Orfila's advice; but they observed that the bloodstains behaved differently according as they were formed directly by a jet of blood thrown on to the cloth, or were produced only by contact with an object smeared with blood and still moist; for whilst in the first case the stains speedily became brown on the addition of hypochlorous acid, then turned a little pale, and remained undestroyed even after several hours' maceration, the stains The mediately or secondarily produced, soon disappeared, though only partially so. threads of the weft were more prominent than those of the warp, and thus having by their contact with the blooded substance imbibed more of the sanguineous fluid, assumed and preserved a brownish tint, whilst the threads of the warp alone were quite |