"Water. - I will begin by speaking of water as a local remedy for psoriasis. Under this category must be mentioned water-dressing, baths, vapor-baths, the 'hydropathic' method practised by Priessnitz and others for the cure of various complaints, hot springs, and, lastly, the 'continual bath,' invented by myself.

"And, first of all, I may state that simple water-dressing, if continued long enough, may remove a psoriasis. For this purpose, clean strips of bandage are used. These are dipped in lukewarm or warm water, and are wound round the affected parts, and covered with thin gutta-percha or oil-silk, so as to retard evaporation of the water and to increase the effect of its application. Patients who are being treated in this way need not be kept in bed, or even within-doors, but may be allowed to go out in the open air. In the less severe forms of psoriasis, and especially when the affection is confined to the limbs, this method is very often sufficient to remove it entirely; but in all oases it may be employed as an adjuvant while internal medicines are being given, or as a substitute for the warm bath when. this cannot be obtained. Instead of the water-dressing, if anything should prevent its application as above described, it may be sufficient to wrap the affected parts simply in thin gutta-percha or oil-silk.

The products of the cutaneous perspiration will then accumulate between the skin and its impermeable covering, so as to form a layer of fluid which, remaining always in contact with the skin, keeps it constantly moist.

"It is generally supposed that warm bat/is, at an agreeable temperature (90° - 100° Fahr.), are essential to a patient suffering from cutaneous disease, and that, in psoriasis especially, they are of great service. Now this I altogether deny so far as the baths in ordinary use are concerned, in which a person remains for only half an hour or an hour; for I have never seen them diminish, and certainly never cure, this affection. It is true that when baths are continued for several hours, or when my 'continual bath' is employed, more marked effects are observed; but even then they appear much more slowly in this disease than in many others; consequently, I cannot recommend the use of warm baths in cases of psoriasis, excepting, indeed, in so far as they are an essential part of other methods of treatment.

"Now, if I make the employment of warm baths, and even of the continual bath, a very subordinate part of the treatment of psoriasis, I attach still less value to vapor-baths. And yet, according to some, these have special curative powers in the disease in question. The only cases in which it seems to me desirable to order vapor-baths are those in which water-dressing cannot be applied, and warm baths cannot be used, either because the patient's circumstances do not permit it, or because the disease is situated on some part of the body (as, for instance, the face or head) which is not accessible to the ordinary warm bath. I do not, however, mean to say that the existence of psoriasis upon the other regions of the body contraindicates the employment of the vapor-bath, but only that it must not be supposed to be more efficacious than an ordinary warm bath.

"The effects of peat- and mud-baths are about on a par with those of water-dressing.

"Hydropathy, however, according to the original method of Priess-nitz, is a much more effectual mode of treating psoriasis. A most essential part of this procedure is that in making up the patient's bed, the directions which are given should be strictly obeyed. The proper plan is the following: Over an ordinary bed, having a straw mattress as well as a common mattress, a sheet of thin gutta-percha or oil-silk is laid, to prevent the mattresses getting wet. Across this there are then placed two strong binders, or folded towels; upon these, a thick, fleecy blanket, doubled and folded in such a way as to project a little beyond each end of the mattresses; and upon this, again, a linen sheet which has been dipped in cold water and well wrung out. The patient, who must be quite naked, is now made to lie down on the sheet, with a bottle between his thighs to receive his urine. He is next completely wrapped up in the wet sheet, so that the head and forehead are covered as low as the eyebrows, and the ears and cheeks round to the chin, the sides of the sheet being, of course, wound about the trunk and limbs. The blanket is then wrapped round him in exactly the same way; the nose, mouth, and eyes being thus the only parts left exposed. Finally, the binders or towels are tied so as to keep the blanket and sheet in close contact with the patient's body.

"It is only at first that uncomfortable sensations arise from this procedure, which is known as 'packing' ('Die Priessnitzsche Einwickelung'); these are at once followed by a glow, which, however, does not exceed the natural temperature of the body, and which, besides being very bene-ficial, is not disagreeable, provided that respiration is established. To favor sweating, and also to cool the patient, water is frequently given him to drink, and the 'packing' is left undisturbed for three or four hours; at the end of this time, when he has thus been bathed in his own perspiration, the second part of the treatment begins, that of cooling him down. For this purpose, a bath (either in the same room, or in one close to that in which the patient lies packed) is filled with cold river or spring-water; and, when possible, a douche apparatus also is provided. The lower of the two binders, which surrounds the patient's knees, is now unfastened, and the blanket and wet sheet are drawn away from his feet and raised, so that he can get up from his bed and walk to the bath. When he has reached its side the second binder also is undone, the blanket and sheet are quickly removed, and he is told to plunge instantly into the cold water. While in the bath he is rubbed with cloths, and is also made to rub himself, and to move about in the water. By these means the disagreeable sensation at first caused by the cold water is relieved, and is soon followed by a feeling of warmth, which every one describes as being very pleasant and comfortable. Next, if there is a douche apparatus connected with the bath, it is made to play on every part of the patient's body; but when this cannot be done, sponges dipped in cold water are used instead, or water is poured over him from a can. Lastly, having been made to leave the bath, he is wrapped in dry cloths, and frictions are again employed. He is then quickly dressed and made to take a walk in the open air.

"The whole of this process, including the cold bath and the douche, as well as the ' packing,' is gone through twice in the twenty-four hours; early in the morning (generally at 4 or 5 a.m.), and again some hours after dinner (at 4 or 5 p.m.). At the same time the patient is kept on a nutritious, but simple, diet; is forbidden to partake of alcoholic liquors, and is made to drink cold water frequently.

"Having myself had recourse to this method of treatment with marked success on many occasions, both in hospital and in private practice, I can with a good conscience recommend its adoption in all those cases of psoriasis in which the disease is extensive, and in which it is possible to carry out a practice requiring so much time and patience. As I have already said, however, it is essential that the 'packing' should be done carefully, and that (if employed at all) it should be persevered in; nor must it be expected to do more good than other kinds of systematic local treatment.

The method recommended by Prirssnitz at a later period - that of frictions - is very much leas effectual than the process of ' packing' above described. It consists in wrapping up the patient successively in several cloths soaked in cold water, and then employing friction at once, without having made use of blankets. He is afterward simply made to take a cold bath, and to have the douche applied.

"Psoriasis is so obstinate and difficult of cure that every spa and watering-place in the world has probably been visited by patients affected with this disease, belonging to the more wealthy classes. Yet there is not one such locality which has been able to earn a permanent reputation for its treatment. Neither sulphur springs, nor those containing iodine, 17 nor those which have brine as their principal constituent, nor, lastly, those in which there is no special ingredient (indifferente Thermen), have shown themselves to be possessed of specific powers against psoriasis; and although one or two watering-places have gained somewhat more renown than others, this has been due merely to the way in which the baths are used, and not at all to the chemical composition of the water. The remark just made applies mainly to the baths of Loueche (Leuk) in Switzerland, which are frequently recommended by German as well as by French physicians to patients suffering from cutaneous diseases (especially psoriasis), and have, in certain cases, been resorted to with success. At this spa a peculiar custom prevails which does not exist elsewhere. The patient does not merely spend half an hour or an hour in the bath, but remains in it for six or eight hours at a time - from early in the morning until dinner time. Thus, for equal periods of treatment, the time devoted to the bath is about six times as great as at other watering-places. I am firmly convinced that Loueche owes to this circumstance most of its fame for the cure of cutaneous diseases. For certain other spas (such as Baden near Vienna, Gastein, and Krapina-Toplitz in Croatia), which are made use of in the same thorough way by visitors, particularly by persons who belong to the country, do, in fact, enjoy a similar reputation both abroad and at home.

"As I stated in the first volume of this work, when speaking of the treatment of smallpox and of burns, I have had an apparatus constructed by means of which the warm bath may be continued for a long time, the patient in fact remaining uninterruptedly day and night in warm water. I have made trial of this apparatus in psoriasis, as well as in the diseases above mentioned. The effect, however, has merely been such as I could have arrived at by using lotions or any other topical applications by which the cuticle would be kept in a state of maceration. The complaint has not been cured.

"In concluding the subject of the treatment of psoriasis by means of water, I must also mention bathing in the sea, or in ponds, lakes, or rivers, but only to state that it is useless.