Thus this eruption, externally reduced in cultivated countries to a common itch, could be much more easily removed from the skin through various means, so that with the medicinal external treatment since introduced, especially in the middle and higher classes, through baths, washes and ointments of sulphur and lead, and by preparations of copper, zinc and mercury, the external manifestations of Psosa on the skin were often so quickly suppressed, and are so now, that in most cases, either of children or of grown persons, the history of itch infection may remain undiscovered.

But the state of mankind was not improved thereby; in many respects it grew far worse. For, although in ancient times the eruption of Psora appearing as leprosy was very troublesume to those suffering from it, owing to the lancinating pains in and the violent itching all around the tumors and scabs, the rest of the body enjoyed a fair share of general health. This was owing to the obstinately persistent eruption on the skin, which served as a substitute for the internal Psora. And what is of more importance, the horrible and disgusting appearance of the lepers made such a terrible impression on healthy people that they dreaded even their approach, so that the seclusion of most of these patients, and their separation in leper hospitals, kept them apart from other human society and infection from them was thus limited and comparatively rare.

In consequence of the very much milder form of the Psora during the fourteenth and fifteenth centuries, when it appeared as itch, the few pustules appearing after infection made but little show and could easily be concealed. Nevertheless they were scratched continually because of their unbearable itching, and thus the fluid was diffused around, and the psoric miasma was communicated more certainly and more easily to many other persons the more it was concealed; for the things rendered unclean by the psoric fluid infected the persons who unwittingly touched them, and thus contaminated far more persons than the lepers, who, on account of their horrible appearance, were carefully avoided.

Psora has thus become the most infectious and most-general of all the chronic miasmas. For the miasm has usually been communicated to others before the one from whom it emanates has asked for or received any external repressive remedy against his itching eruption (lead-water, ointment of the white precipitate of mercury), and without confessing that he had an eruption of itch, often even without knowing it himself; yea, without even the physician's or surgeon's knowing the exact nature of the eruption, which has been repressed by the lotion of lead, etc.

It may well be conceived that the poorer and lower classes, who allow the itch to spread on their skin for a long time, until they become an abomination to all around them, and are compelled to use something to remove it, must have in the meanwhile infected many.

Mankind, therefore, is worse off from the change in the external form of the Psora, - from leprosy down to the eruption of itch - not only because this is less visible and more secret and therefore more frequently infectious, but also especially because the Psora, now mitigated externally into a mere itch and on that account more generally spread, nevertheless still retains unchanged its original dreadful nature. Now, after being more easily repressed, the disease grows all the more unperceived within, and so, in the last three centuries, after the destruction* of its chief symptom (the external skin eruption) it plays the sad role of causing innumerable secondary symptoms, i. e., it originates a legion of chronic diseases, the source of which physicians neither surmise nor unravel, and which, therefore, they can no more cure than they could cure the original disease when accompanied by its cutaneous eruption; but these chronic diseases, as daily experience shows, were necessarily aggravated by the multitude of their faulty remedies.

*The external eruption of itch may not only be driven away by the faulty practices of physicians and quacks, but unfortunately it not unfrequently of its own accord withdraws from the skin (see below, e. g., in the observation of the older physicians, Nos. 9, 17, 26, 36, 50, 58, 61, 64, 65). Syphilis and sycosis both have an advantage over the itch disease in this, that the chancre (or bubo) in the one and the fig-wart in the other never leave the external parts until they have been either mischievously destroyed through external repressive remedies or have been in a rational manner removed through the simultaneous internal cure of the whole disease. The venereal disease cannot, therefore, break out so long as the chancre is not artificially destroyed by external applications, nor can the secondary ailments of sycosis break out so long as the fig-wart has not been destroyed by faulty practice; for these local symptoms, which act as substitutes for the internal disease, remain standing even until the eud of man's life, and prevent the breaking out of the internal disease. It is, therefore, just as easy to heal them then, even in their whole extent, i . e., thoroughly, through their specific internal medicines, which need only to be continued until these local symptoms (chancre and fig-wart), which are in their nature unchangeable except through artificial external application, are thoroughly healed. Then we may be quite certain that we have thoroughly cured the internal disease, i. e., syphilis and sycosis.

This good feature Psora has lost in the present more and more mitigated nature of its chief symptom, which has changed from leprosy to itch in the last three centuries. The eruption of itch by no means remains as persistently in its place on the skin as the chancre and fig-wart. Even if the eruption of itch has not (as is nearly always the case) been driven away from the skin through the faulty practices of physicians and quacks by means of desiccating washes, sulphur ointments, drastic purgatives or cupping, it frequently disappears, as we say, of itself, i. e., through causes which are not noticed. It often disappears through some unlucky physical or psychical occurrence, through a violent fright, through continual vexations, deeply-affecting grief, through catching a severe cold, or through a cold temperature (see below, observation 67; through cold, lukewarm and warm river baths or mineral baths, by a fever arising from any cause, or through a different acute disease (e.g., smallpox; see below, observation 39); through persistent diarrhoea, sometimes also perhaps through a peculiar want of activity in the skin, and the results in such a case are just as mischievous as if the eruption had been driven away externally by the irrational practice of a physician. The secondary ailments of the internal Psora and any one of the innumerable chronic diseases flowing from this origin will then break out sooner or later. But let no one think that the Psora, which has been thus mitigated in its local symptom, its cutaneous eruption, differs materially from ancient leprosy. Even leprosy, when not inveterate, could in ancient times not seldom be driven from the skin by cold baths or by repeated dipping in a river and through warm mineral baths (see below, No. 35); but also then the evil effects resulting were as little regarded as the more modern physicians regard the acute diseases and the insidious maladies which do not fail to develop sooner or later from the indwelling Psora when an eruption of the present itch disease has disappeared of itself or has been violently driven away.