"When the crust has exfoliated from the part first treated, the oil may be applied to a second part, and so on in succession until every portion of the morbid skin has undergone the process; and should the tubercles reappear, the application may be made to the affected skin until the tubercles cease to be formed, and until the integument has regained its natural texture and sensation.

"It has seemed to me that the exudative process set up by the oleum anacardii is not merely local in its operation, but that it performs the office of general derivative or general emunctory to the whole organism; that in fact, it represents the copious and continuous discharges which I have already spoken of as flowing from deep-seated ulcers, and which, while they last exert so favorable an influence on the general comfort and health of the patient."

After this wry thorough exposition of the treatment of Leprosy by those who have had ample opportunities of observing the facts, it is hardly to be expected that the writer can add much of value from his own limited experience with the disease. I have, during the past fifteen years, had a number of cases of Leprosy under my charge, usually, however, for a short time only, as the patients manifested a disposition to change from one physician to another. As the result of personal treatment I can briefly state, that I have found the pains of Lepra controlled by blisters along the course of the affected nerves, that I have seen the tubercles disappear under applications of both Ungt. Potassii Iodidi, and of Chaul-mugra, and that apparent benefit was derived from the internal use of Chloride of Barium in doses of 1/10 of a grain to 1/2 grain daily, and that very decided benefit accrued from the internal use of Chaulmugra.

Although the treatment of Leprosy now presents a far more favorable aspect than formerly, I am by no means satisfied that we have reached the limit in this direction, and with a view to possible further improve-ments I venture to offer a few theoretical considerations looking to a more rational treatment of the disease. Thus far treatment has been purely empirical, but a study of the disease itself, taken in connection with the results of treatment thus far obtained, appears to me to give a clue to a method that may prove still more serviceable.

The disease having been once acquired, a long period, sometimes several years, intervenes before any distinct or pathognomonic symptoms present themselves. When they do come they are usually referable to both the skin and the nervous system. In other words, there is evidence of lesion of both organs. The special point of interest, however, is to determine in which system the lesions first show themselves.

In other words, do the cutaneous lesions appear first, to be followed by lesions of the nerves and spinal cord, or is the cord first affected followed by degeneration of the nerves, and ultimately of the skin? The study of eases and the results of the post-mortem examination of a case that died under my care last year, together with Other circumstances, lead me to the opinion that the disease first attacks the spinal axis, and then involves the nerves, and later implicates the skin. The earlier changes in the nerves would appear to be of a subacute inflammatory, or rather proliferative character succeeded by a sclerotic degeneration and atrophy. If this theory of the disease is correct, it naturally follows that, before commencing treatment, we should carefully consider the stage and condition the disease is in. In the early periods, where we have reason to believe that hyperemia and irritation of the cord exists, our treatment should be specially directed to their relief. To this end counter-irritation, minute doses of strychnia, or full doses of ergot or bromide of potassium, would seem appropriate. Later, I think that mercury, iodide of potassium, and chloride of barium would come in play, and still later, when sclerotic degeneration is commencing, strychnia, phosphorus, phosphoric acid, etc., in full doses, and galvanization. This, together with suitable local treatment would seem to me far more rational than to follow what appears to have been the usual plan, namely, to select one or two drugs and make them the mainstay of treatment, irrespective of the stage or grade of the malady. All of the drugs just mentioned appear to have been useful in some cases of Leprosy, and it only remains to be seen whether they cannot be made still more so, by adapting them to the special indications that they are capable of filling, rather than to attempt to treat all phases of the disease by one routine method. Until we discover a specific for leprosy as we have for syphilis, let us use the same discrimination and care that we would in the management of any other chronic disease.

Since the foregoing was written, the following from the pen of Dr. Labonte of Mauritius has appeared (126, Nov., '80). It will be seen that he speaks far more hopefully of the therapeutics of the disease, than with my own limited experience I had felt justified in doing. He writes as follows:

Is leprosy, tubercular or atrophic, amenable to medical treatment? . . . . I am perfectly satisfied that ere long a cure may yet be found, and that at this present moment we have the means of checking effectually the disease in its progress, and of relieving the sufferings of the patient. Leprosy, tubercular or atrophic, being a dyscrasia, and its poison being specific, I have invariably at the outset of the disease, as well as in its advanced stage, combined alterative medicines with what are commonly called specifics - amongst others, Chaulmugra oil, the fluid extracts of the Hydrocotyle asiatica, the Siegesbeckia orientalis, Cassia occidentalis, C. rosea Linn.

"I am in the habit of putting the patient at once on 10m of the oil daily, increasing the dose to a maximum of 3 j. and 3 ij- in very bad cases, provided the stomach be not upset thereby. It is best given at bedtime in some warm bitter infusion; and in case of nausea, Vichy lozenges answer well. The maximum dose is to be lessened gradually as soon as there is a decided improvement in the patient's condition. At the same time, patient is to drink as much decoction of the Hydrocot. asiat. as he likes, with the addition of 3 j. of the above compound fluid extract to a bottle of decoction. His diet is to be nutritious but non-stimulating; he is to take what exercise he can in the open air, but in the shade, to get a medicated bath daily (alkaline or sulphurous as the case may be), cold or warm, according to his extreme sensibility to cold or heat. If there be large tubercles, they are to be cauterized with the acid nitrate of mercury; if not large, they are to be rubbed briskly twice daily with an ointment containing from 30m to 50m of the acid to an ounce of cold cream. If there be only blotches or insensibility, the affected parts are to be rubbed briskly with a lotion varying from 3 j. to 3 iij. of the acid to a bottle of water. In combination with those medicines, patient is to get 3 m of the liq. arsenicalis after meals. The effects of which treatment are, of course, to be watched narrowly.