The treatment of this form of Lupus is to be conducted on the same principles as hold in the other varieties. When the lesion is of comparatively small size, as in the first years of its existence, it should be extirpated, if possible, with the knife. If, for any reason, this is impracticable, scraping, followed by the actual or potential cautery, will give the best temporary result, and also the best guarantee for the future.

When, however, the lesion has already attained a large size, as two inches or more in diameter, and extends deeply beneath the corium, the condition may almost, though not absolutely, be regarded as hopeless. The question of the amount of scar or deformity to be left after surgical interference, no longer enters as an element to be considered in deciding the character of the operation, which should be thorough and radical in the extreme. Both the curette and the knife must be brought into play, and every ramification and trace of the disease be removed, so far as it can be mechanically. After the bleeding has ceased, and the wound cleansed, the parts should be thoroughly cauterized, preferably, I think with the pure chloride of zinc, and the cavity packed with absorbent cotton.

In two or three weeks the slough will have separated, and if the patient be possessed of sufficient vitality - and he should not be operated on unless he does - a healthy ulcer, with tendency to heal, will present itself. In a few weeks more, however, there may be at one or more points indications of relapse. These must be immediately attacked, and, by carefully watching for and destroying these fresh outcroppings, the surgeon will be able, in a certain number of oases, to control the disease. In this, as in all the varieties of Lupus, one general statement may be made, and this is that half-way measures do more harm than good. Attack the lesion in the most vigorous manner, or leave it entirely alone.

* I have once, and once only, been obliged to operate a fourth time on the same 15

The following drugs, besides those already mentioned, have been recommended in the treatment of Lupus:

Internally

Arsen. lod., 28; Aurum, 29; Barii Chlorid., 31; Cal-cii Chlorid., 34; Chimaphila, 41; Citrus Limonum, 45; Ferri Arsen., 54; Hydrarg. Chlor. Corros., G4; Hydrarg. Chlor. Mite, 64; Hydroco-tyle Asiat., 68; Ol. Gynocardiae, 78; and Silica, 105.

Externally

Acid. Acetic., 5; Ac. Carbol., 6; Ac. Chromic, 7; Ac.

Citric., 8; Ac Hydrocyan., 8; Ac Pyrogallic, 10; Ac Salicyl., 11; Ammon. Iodid., 15; Bals, Gurgun., 30; Cantharis, 39; Hydrarg. Iod. Virid., 66; Hydrarg. Nitras, 66; Sulph. Iodid., 109; and Zinci Acetas, 116.