Before entering on the consideration of the treatment of cutaneous diseases, it will be wise, I think, to give a thought to the organ with which we propose to deal, and to the relations that it holds to the rest of the economy. We can strip off the skin, and, aided by the microscope, obtain a more or less perfect acquaintance with its structure, and, so far as its anatomy is concerned, we may regard it as an independent tissue, and study it as such; but when we inquire into its physiology we are immediately impressed with its close connection with the entire system. It is no longer an independent tissue, with functions intended solely for its own benefit, but, in reality, is simply a portion of the whole, existing by its dependence on the rest, and without which the rest would perish. Occlusion of the pores by an impermeable covering results in speedy death, and, per contra, removal of the entire integument, or even its outermost stratum, the horny layer of the epidermis, would be followed by a like termination. These two facts point to the necessity of preserving the integrity of the skin, if we would have the rest of the body in a state of perfect health.

The ready disturbance of the cutaneous functions by the influence of internal agencies may be exemplified in many ways; thus, the inhalation of a small quantity of nitrite of amyl is immediately followed by a hyper-emic condition of the facial integument, or, the ingestion of a suitable quantity of jaborandi is followed by an excessive discharge of moisture from the general surface. Numerous other instances of cutaneous disturbance following the ingestion of various substances are noted in the first part of this work, and we need here but allude to arsenic, to belladonna, to cinchona and its derivatives, and to the iodide and bromide of potassium. Not only these, but immaterial influences as well, are capable of impressing the cutaneous system. Fear blanches, and anger reddens the surface, while an immodest word or sight may bring a blush to the cheeks of the virgin. The skin, therefore, in all its physiological and functional relations is connected in the closest manner with the rest of the economy - and so with its pathology. This statement it would hardly be necessary to make, were it not that wo are asked to believe, by the Vienna school, that cutaneous diseases are with few exceptions purely local affairs, and not in any way dependent on pre-existing derangement of the general system or of particular organs. This is essentially the doctrine of Hebra, and is very generally accepted in Vienna by those who have received their inspiration direct from the lips of the great teacher. It is not, however, generally admitted in Germany proper, and hence cannot, with propriety, be called the doctrine of the "German" school. Outside of Austria, upon the continent and in Great Britain, it obtains very little practical recognition. In France there is not a teacher who proclaims it, nor even a writer, so far as I am aware, that advocates it. In neither England, Scotland, nor Ireland is it accepted by a single public teacher. There are a few of the former pupils of Hebra, however, who spare no opportunity of declaring that the views held by their predecessors and elders are erroneous, and that true light in dermatology is to be sought and found only on the banks of the Danube; and these views they urge with great zeal, and, it must be added, with great immoderation. In fact, the devotion shown by the partisans of Hebra to the teachings of their master is equalled only, in modern times, by that of the disciples of Hahnemann to theirs, and there is also a striking parallelism between their methods. Given a condition of irritation of the skin, e.g., an acne or a chronic eczema, and the disciples of Hebra attack it with an irritant, e.g., green soap, or the like. It must be distinctly understood, however, that the doctrines of the present Vienna school are not German, but simply Hebraic, and in their way are as fully exclusive in their tendencies as the Hahnemannic; doctrines that lead to too narrow a conception of disease, and as a consequence to treatment that is less efficient than it might be. It must be added, however, that as a teacher Hebra was pre-eminent; that his writings are marvels of force, perspicuity, and persuasive rhetoric. They are invaluable to every student of cutaneous disease, and the following pages will bear ample testimony to the author's appreciation of them.

The French school, under the leadership of Alibert and his successors, have gone to the opposite extreme. The truth, we believe, lies between the two, namely, in a proper estimate of the internal etiological factors, as well as of the appearances presented by the lesions. The consequence will be a judicious combination of internal with local treatment, which we are satisfied is far better than exclusive devotion to either.

Coming now to the points that more closely concern us, we find that cutaneous, like other diseases, are readily divisible, from a therapeutic stand-point, into three principal classes:

First

Those that are characterized by an acute invasion and a defi-nite course, that is to say, those that are self-limited, as, for instance, Zoster. Here the physician has comparatively little to do, except, perhaps, to shorten their duration and render them less distressing to the patient during their continuance.

Second

Those that are chronic, and for which neither science nor art has yet found efficient remedies. Keloid and Ichthyosis may be taken as examples. Here the physician's labors will be chiefly confined to making a diagnosis, rendering a prognosis, and employing such palliatives as shall from time to time become necessary.

Third

Those that are usually chronic, and without definite limit, and concerning which it is impossible to predict, with any certainty, their probable duration when left to the unaided powers of nature. They are in most instances perfectly, though often with difficulty, curable. Chronic Eczema, Acne, etc., may be taken as examples. This class embraces the vast majority of cases that will apply for treatment, and the physician of to-day, more fortunate than his predecessor of fifty years ago, will be able to achieve results that will enable him to rescue cutaneous therapeu-tics from the position it so long occupied as the opprobrium medicinoe.

We therefore with confidence invite the reader to a more detailed consideration of the subject.

The therapeutics of cutaneous diseases includes not only the use of drugs, but also attention to general hygiene; and in certain affections both electricity and the actual cautery have proved of service. Concerning hygiene little need here be said, as its importance is recognized by all, and details on this point would be out of place in a special treatise like the present. Drugs, electricity, and the cautery merit a few words.