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Madeira Porto Santo directions 2nd ed Edition Hancock
Digital Instant Download
Author(s): Hancock, Matthew; Tomlin, Amanda; Gordon, Jane
ISBN(s): 9781858280547, 1858280540
Edition: 2nd ed
File Details: PDF, 18.33 MB
Year: 2008
Language: english
ROUGHGUIDES

Rough Guide DIRECTIONS

Madeira & Porto Santo

 US $11.99/ CAN $13.99
I S B N 978-1-85828-054-7
51199
9 781858 280547
 Madeira
& Porto Santo
DIR E C T IO N S

WRITTEN AND RESEARCHED BY

Matthew Hancock
wi th addi ti o n al acco u n ts by

Amanda Tomlin and Jane Gordon

NEW YORK • LONDON • DELHI

www.roughguides.com

00 Mad DIR Intro 1-8.indd 1 1/21/08 5:56:20 PM

00 Mad DIR Intro 1-8.indd 2 1/21/08 5:56:26 PM
 Contents
Introduction 4 The southeast and Machico............ 113

CONTENTS
The east and Porto da Cruz ............ 125
The west .......................................135
Porto Moniz and northwestern
Ideas 9 Madeira.......................................149
Northern Madeira ..........................160
The big six........................................10
Porto Santo.....................................176
Walks ...............................................12
Transport ..........................................14
Sports and activities .........................16
Viewpoints........................................18 Essentials 189
Swimming .......................................20 Arrival ............................................191
Parks and gardens............................22 Transport ........................................191
Museums.......................................... 24 Accommodation..............................194
Azulejos............................................26 Information .....................................194
Festivals ...........................................28 Money ............................................195
Children’s Madeira............................30 Food ..............................................195
Weird and wonderful......................... 32 Sport and outdoor activities ............ 196
Historic Madeira ...............................34 Children’s Madeira..........................199
Unspoilt villages................................ 36 Holidays and festivals .....................199
Shopping ..........................................38 Directory.........................................201
Hotels ...............................................40
Cool Madeira ....................................42
Cafés and bars .................................44 Chronology 203
Restaurants ......................................46

Language 207
Places 49
Central Funchal ................................51
Western Funchal and Travel store 213
the Hotel Zone............................... 68
Eastern Funchal and the Old Town.... 81
Monte and northeast of Funchal ....... 93
Northwest of Funchal......................104 Index 215

00 Mad DIR Intro 1-8.indd 3 1/21/08 5:56:27 PM

 4
Introduction to

Madeira
INTRODUCTION

& Porto Santo


Surrounded by the warm seas of

Ajuzelos, Chamber of Commerce

the Atlantic some 600km off the
west coast of Morocco, Madeira
is an island of wild mountains,
precipitous valleys and sheer
cliffs – including some of the
highest sea cliffs in the world
at Cabo Girão. The island’s
dramatic scenery makes for some
fantastic walking, and it also
boasts a diverse array of colourful
sub-tropical vegetation, gently
cultivated terraces and rocky beaches. Its
lesser-known sister island, Porto Santo, has a less
dramatic landscape, but compensates with a superb
nine-kilometre-long beach.
The island’s year-round mild climate, excellent hotel facilities and
extremely low levels of crime have long attracted older visitors,
though these days a much younger crowd is being lured by the

 Fortaleza do Pico, Funchal

00 Mad DIR Intro 1-8.indd 4 1/21/08 5:56:31 PM

 5

When to go
Near-permanent sunshine makes Madeira an all-year destination. Northern
Europeans visit mostly in winter, when average maximum daily tempera-
tures are around 20°C. Portuguese visitors predominate in summer
(around 24°C), when – despite the modest increase in temperature – the

INTRODUCTION
whole island has a more outdoor feel, with cafés moving their tables out
onto the streets and every accessible part of coast thronging with bathers.
Peak time, however, is over New Year, when hotels hike up their prices
by some thirty percent. Other busy times coincide with school holidays,
especially Easter and August. Low season is roughly late October to early
December and late January to pre-Easter, which also coincides with the
wettest months. Outside high summer, rain is possible at any time, though
it rarely sets in for long.
Porto Santo has its own climate. Rainfall is very low and most days are
dry and sunny, though it can be breezy. On both Madeira and Porto Santo,
low cloud, known as capacete, sometimes descends from the mountains
at around lunchtime, though this usually clears by mid-afternoon and acts
as a handy shield against the strongest sun of the day.

island’s “green” and healthy credentials. These include excellent

levada walks along the island’s network of irrigation canals, various
spa facilities and a growing number of sports, such as golf, deep-sea
fishing, diving and surfing.
Madeira and Porto Santo were uninhabited until they were
discovered and colonized by Portuguese explorers in the fifteenth
century. Thanks to its strategic position on a major shipping route,
Madeira soon established itself as an important trading post, linking
Portugal with its colonies in Africa and America. In the seventeenth
century, the British – Portugal’s traditional commercial ally – largely
took control of a burgeoning wine trade, leading to a strong British
influence on the island’s elite. Influential Anglo–Madeiran familes

 The Lido, Funchal

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 6


The mountainous interior, Rabacal
INTRODUCTION

can be found to this day, but, although English is widely spoken,

the population is nearly all of mainland Portuguese descent – the
signs, culture and architecture are Portuguese, and so are the superb
pastries, powerful coffees and top table wines.
Once one of the poorest parts of Portugal and consequently of
Europe, Madeira gained semi-autonomous status within the Portu-
guese Republic in 1976 and the island has since flourished. Its
president has successfully lobbied for EU funds to subsidize new
roads, tunnels and building projects that have propelled most of
the island firmly into


the twenty-first century.

Nossa Senhora de Monte

These days Madeirans

are not only proudly
Portuguese, but proudly
Madeiran too.
Madeira’s building
boom continues, but
equal efforts have been
made to preserve its
natural heritage: the
island boasts the greatest
concentration of virgin
lauraceous forests in the
world, and an astonishing
66 percent of the island
enjoys protected national-
park status. Despite its
compact size, there are
parts of the island where
you feel as though you’re
in the middle of a magical
wilderness.

00 Mad DIR Intro 1-8.indd 6 1/21/08 5:56:39 PM

 Madeira & Porto Santo
AT A GLANCE

INTRODUCTION
FUNCHAL
Funchal is the island’s historic
capital. Very Portuguese in
character and architecture, the
town has enough museums,
sights, restaurants, bars and shops
to keep you occupied for at least
a week. It’s also close to many of
the island’s top tourist attractions,
including Monte, a pretty hilltop
town famed for its gardens and
dry toboggan run, and Câmara
de Lobos, an atmospheric fishing  Cable car to Monte
village that Winston Churchill took
to his heart. EASTERN MADEIRA
 Jardim Botânico, Funchal
Relatively built up, eastern
Madeira’s highlights include
Machico, the island’s first capital;
the rocky peninsula of Ponta de
São Lourenço, with Madeira’s only
natural sand beach; and Santo da
Serra, home to the island’s top golf
course. The main resort is Caniço
de Baixo, with superb swimming
and diving possibilities.

WESTERN MADEIRA
Set among verdant banana
plantations, Ribeira Brava and
Calheta are the main resorts on
the unspoilt western coastline.
Calheta boasts an artificial sandy
beach and the island’s top art
centre. The smaller Jardim do Mar
and Paúl do Mar have a growing
surfing scene, while inland there
are superb walks around the
wooded valleys of Rabaçal.

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 8


Summit, Pico Ruivo
INTRODUCTION

NORTHEASTERN MADEIRA NORTHWESTERN MADEIRA

Highlights in the northeast include The northwest of the island is wild
Santana, famed for its triangular and dramatic, with precipitous
houses, and the picturesque hillsides gouged by waterfalls.
village of Porto da Cruz. Also in The main centres here are Porto
this area, the dramatic peaks of Moniz, which has invigorating
Pico Arieiro and Pico Ruivo, more natural sea pools, and São
than 1800m high, offer great walks Vicente, one of the island’s
and fantastic alpine views over the prettiest villages, close to some
island’s coasts. weird volcanic grottoes.

PORTO SANTO
Easily accessible by ferry or plane, Porto Santo, Madeira’s neighbouring
island, is fringed by a sumptuous sandy beach accessible from the
pretty town of Vila Baleira.

Porto Santo

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 Ideas

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 10
Madeira’s main
The big six
sights are readily
accessible from
any point of the
island and can
easily be visited
during a week’s
stay. The following
give an idea of
the diverse attractions
available, from historic
towns and churches to
natural wonders such as
towering mountains and
sheer cliff faces, not to
mention the superb sandy
beach on Porto Santo.  Funchal
The only town of any size on Madeira, the
attractive capital makes the perfect base for
exploring the island.
P.51  CENTRAL FUNCHAL

 Cabo Girão
Whether viewed from the sea or from
the top, these vertiginous sea cliffs are a
spectacular sight.
P.108  NORTHWEST OF
FUNCHAL

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 11
 Monte
A hilltop town boasting great views, lush
gardens and the island’s most sacred
church, guarding a venerated statue of the
Virgin.
P.93  MONTE AND NORTHEAST
OF FUNCHAL

 Machico
With its own little beach and surrounded by
banana plantations, historic Machico makes
a great alternative base to Funchal.
P.118  THE SOUTHEAST AND
MACHICO

 Pico Ruivo
At 1862m high, this
mountain peak offers
stupendous views across
the whole island, often
from high above the
cloudline.
P.168  NORTHERN
MADEIRA

 Porto Santo
Perhaps Europe’s best-
kept secret, Madeira’s
sister island has 9km
of pristine sands and a
famous golf course.
P.176  PORTO
SANTO

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 12
Madeira is rightly
Walks
famous for its
walks. Many of
these are along
the well-marked
veredas (paths) which
were used by locals to
travel from village to village
before the road network
was constructed. Even
more popular are the
island’s levada walks,
along the sides of irrigation
canals that wend through  Prazeres to Paúl do Mar
Zigzag down one of the west coast’s
some of the island’s steepest cliffs, with great views en route.
wildest scenery. P.142  THE WEST

 Levada do Caldeirão Verde

One of the island’s most spectacular levada
walks, winding through ancient lauraceous
forests.
P.167  NORTHERN MADEIRA

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 13

 Levada da Central da
Ribeira da Janela, Porto
Moniz
An attractive, gentle levada hike that takes
you deep into the rural north.
P.154  PORTO MONIZ AND THE
NORTHWEST

 Pico do Arieiro to Pico

Ruivo
Madeira’s most famous and memorable
walk, between two of its highest peaks.
P.170  NORTHERN MADEIRA

 Lorano to Machico
An exhilarating clifftop path high above the
north coast.
P.132  THE EAST AND PORTO
DA CRUZ

 Rabaçal to 25 Fontes
A beautiful levada walk into Madeira’s lush
woodland heart.
P.143  THE WEST

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 14
Getting around
Transport
Madeira
– surrounded by
the Atlantic, fringed
by cliffs and rising
inland to 1862m
above sea level
– has long posed
problems to travellers and
engineers alike. Over time,
many of the island’s most
challenging features have
been ingeniously exploited
to provide easy access
and highly enjoyable ways
of getting from A to B.
From dry toboggans to
high-tech lifts and cable
cars, many of the rides are
worth going on for the thrill
alone.

 Lift to Fajã das Padres

The beachside settlement of Fajã das Padres
is reached by a thrilling descent down the
cliff face in a glass-fronted lift.
P.108  NORTHWEST OF
FUNCHAL

02 Mad DIR Idea 9-48.indd 14 1/21/08 5:51:21 PM

 15
 Monte toboggan
Traditional basket toboggans are a bizarre,
novel and exhilarating way to get down a
mountain.
P.97  MONTE AND NORTHEAST
OF FUNCHAL

 Cable car to Monte

The best views over Funchal are from the
slowly ascending cable car from the Zona
Velha.
P.85  EASTERN FUNCHAL AND
THE OLD TOWN
 Santa Maria de Columbo
Get a different perspective on the island on a
boat trip from Funchal harbour.
P.198  ESSENTIALS

 Cable car at Achada da

Cruz
Not for the faint-hearted, this dizzy descent
is an adrenalin-pumping way to see the wild
northwest coast.
P.151  PORTO MONIZ AND
NORTHWESTERN
MADEIRA

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 16
Madeira and Porto
Sports and activities
Santo boast three
top golf courses
between them,
while Madeira’s
climate and terrain
are also ideal
for several other
sports. Game
fishing is big
business, surfing
has a dedicated
following and an
increasing number
of companies offer
adventure sports,
from canyoning to diving.
Madeira’s pre-eminent
sport, however, is football,
and the island that
produced the silky skills of
Cristiano Ronaldo also has
teams in Portugal’s top
division.

 Mountain bikes
Get off the beaten track on a mountain-bike
trip along the spectacular levada paths.
P.197  ESSENTIALS

02 Mad DIR Idea 9-48.indd 16 1/21/08 5:51:35 PM

 17

 Diving  Football
Explore sea caverns, wrecks and the clear, Catch one of Portugal’s top teams, Marítimo
deep water, swimming with moray eels, or Nacional, who entertain the likes of Porto
Atlantic rays and mantas. and Benfica.
P.197  ESSENTIALS P.198  ESSENTIALS

 Porto Santo Golf

Porto Santo Golf, on Porto Santo, is rated the
best course in this corner of the Atlantic.
P.181  PORTO SANTO

 Surfing
Madeira has a burgeoning reputation as a
surfing centre. Jardim do Mar is one of the
top places to take to the waves.
P.197  ESSENTIALS

02 Mad DIR Idea 9-48.indd 17 1/21/08 5:51:44 PM

 18
The legacy of
Viewpoints
Madeira’s volcanic
past is a landscape
of peaks and cliffs
rising sheer from
the ocean floor.
Wherever you go
you’ll find dazzling
vistas and dramatic
miradouro viewpoints.
Madeirans love nothing
better than taking off for a
summer picnic, and there
are little wooden benches
dotted round some of
the island’s most scenic
spots. At others, you’ll be
alone to enjoy the view in
spectacular solitude.

 Pico do Arieiro
One of the highest points on the island
– conveniently accessible by road for
jaw-dropping views.
P.170  NORTHERN MADEIRA

02 Mad DIR Idea 9-48.indd 18 1/21/08 5:51:47 PM

Other documents randomly have
different content
the patient. Acne resulting from the ingestion of the bromides and
iodides is almost always of an acute and markedly inflammatory
type, the lesions being scattered over the general surface, and are
usually larger and more virulent in character than those of acne
vulgaris. From acne rosacea it may be known by the characters
referred to in speaking of that disease.

TREATMENT.—Cases of acne vary considerably as to their course and

curability. There is in almost every case a natural inclination toward
disappearance of the eruption at the age of twenty or thirty.
Although the lesions are at any age of the patient generally easily
removable by treatment, relapses are the rule; but the older the
patient the less probability is there of a recurrence. Even in young
subjects, however, the cure may be permanent, depending upon the
ability to discover and remove the cause. The disease requires both
constitutional and local treatment. For the removal of the existing
eruption local applications alone are usually sufficient, but the
disposition to the development of new lesions in most cases yields
only to appropriate internal treatment.

Each case of acne for its successful management demands careful

investigation with a view of discovering the etiological factors. If
these can be ascertained and removed, a successful result is
assured. As already intimated, disorders of digestion play a most
important part in the etiology of this disease, and in a large
proportion of cases remedies appropriate to such conditions are
required. The diet is to be strictly regulated: all indigestible articles
of food, such as pork, salt meats, pastry, cheese, pickles, etc.,
should be interdicted. If constipation exists, laxatives are to be
prescribed. As a rule, salines are more serviceable than vegetable
preparations for plethoric individuals, while for others the latter,
especially for long-continued administration, are to be preferred. A
change from one to the other is often advisable. The dose should be
sufficient to produce a free evacuation daily. An excellent tonic
aperient mixture is the following:
 Rx. Magnesii sulphatis, ounce iss;
Ferri sulphatis, gr. viij;
Acidi sulphurici diluti, fluidrachm ij;
Aquæ menthæ piperitæ,fluidounce iij drachm vi.

M.—S. A tablespoonful in a tumblerful of water a half hour before

breakfast. The tonic effect of such a mixture is best obtained by
prescribing one or two teaspoonfuls in a large wineglassful of water
before each meal: as a rule, however, when thus given its laxative
property is not so well marked. The mint-water may be replaced by
a bitter infusion, such as quassia, but the mixture, unpalatable at the
best, is not improved by such a substitution. In some cases the acid
in the above mixture is contraindicated, and the following, also a
valuable formula, may be prescribed:

Rx. Magnesii sulphatis, ounce iss;

Potassii bitart., drachm iv;
Sulphuris præcip., drachm ij;
Glycerinæ, fluidrachm ij;
Aquæ menthæ pip., fluidounce iv.

M.—S. Tablespoonful in a tumblerful of water a half hour before

breakfast. Hunyadi Janos water, in the dose of a large wineglassful
thirty or forty minutes before the morning meal, is a useful saline,
and is not especially disagreeable. Friedrichshall water is an efficient
laxative and cathartic, but has a nauseous taste and odor. The
ordinary mixture of rhubarb and soda is of value, not only for its
laxative effect, but also for its antacid property where such is
indicated. The following formula, containing cascara sagrada, is of
service:

Rx. Ext. cascaræ sagradæ fl., fluidrachm iv;

Acidi muriatici diluti, fluidrachm ij;
Tincturæ gentianæ comp., fluidounce iij drachm ij.
M.—S. Teaspoonful in a large wineglassful of water before meals. At
times this proportion of cascara sagrada is too large, and, on the
other hand, in some cases it must be increased. A laxative pill, as
the following, containing aloin, belladonna, and strychnia, may be
given:

Rx. Aloin, gr. iij;

Ext. belladonnæ, gr. ij;
Strychniæ sulphatis, gr. ¼.

M. Ft. pilul. No. xv.—S. One or two at night. If there is torpor of the
liver, an occasional dose of blue mass or calomel may be prescribed.
When there is flatulence or other symptoms of fermentative
indigestion, a mixture such as the following will be found useful:

Rx. Sodii hyposulphitis, drachm ijss-ounce j;

Ext. nucis vomicæ fl. fluidrachm ij;
Aquæ menthæ piperitæ, fluidounce iv.

M.—S. Teaspoonful in a large wineglassful of water a half hour

before meals. The hyposulphite of sodium contained in the mixture
may have a laxative effect in addition to its antifermentative action.

If there is anæmia or chlorosis, a preparation of iron, combined with

aloes if there is tendency to constipation, is to be prescribed, the
wine of iron being one of the most eligible ferruginous preparations.
Ergot in the dose of a half drachm of the fluid extract has been
recommended in the acne of females, especially where it seems
probable that uterine disturbance is the exciting cause. Possibly its
effect is, as has been suggested, due to its action on the unstriped
muscular fibres of the skin. After one or two weeks' administration it
is apt to cause gastric disturbance and, directly or indirectly,
vertiginous symptoms. Calx sulphurata in the dose of one-tenth to
one-half grain every three or four hours is of value in some cases,
usually proving of most service in the pustular type. In strumous
individuals, and in those whose nutrition is below the average, cod-
liver oil is a valuable remedy. In like cases glycerin in similar doses
may be prescribed, although its action is not so certain.

Arsenic is of decided value in some cases, but proves powerless in

others. The sluggish papular forms are often influenced favorably by
its continued administration. The alterative effect of mercury is
sometimes beneficial, corrosive sublimate in small doses being the
most available preparation. Where the inflammation is of a high
grade, potassium acetate and other alkalies may be prescribed, as in
the following formula:

Rx. Potassii acetatis, drachm v gr. xx;

Liq. potassæ, fluidrachm ijss;
Liq. ammonii acetatis, fluidounce iij drachm v.

M.—Sig. Teaspoonful in a large wineglassful of water one hour

before meals.

Local Treatment.—This is of great importance and is demanded in

every case. In acute acne, rarely encountered, mildly astringent
applications are to be advised. The disease, as generally met with,
however, is of a subacute or chronic character, requiring stimulating
measures. External treatment in these cases has for its object the
production of hyperæmia and the removal of the superficial layers of
the epidermis, thus stimulating the glands and circulation and
assisting in the excretion of the sebaceous matter. For this purpose
washing the parts energetically with sapo viridis and hot water every
night, using a sponge or preferably a piece of flannel, may be
advised. After the soap-washing the parts are to be sponged with
hot water for several minutes, or the face held over a basin
containing steaming hot water. Subsequently, the comedones are to
be pressed out by means of pressure with the fingers, or, better, by
a watch-key with rounded edges so as not to injure the skin. An
application of a simple emollient, such as cold cream or vaseline,
may then be made and allowed to remain on over night. This plan of
treatment is to be repeated nightly or every other night.
In many simple cases of acne the above method of external
treatment, combined with appropriate constitutional medication, will
bring about marked improvement and sometimes permanent relief.
In the majority of cases, however, a more stimulating plan of
treatment is called for. In almost all cases the soap-washing, either
with the sapo viridis or a milder soap, and the sponging with hot
water, are to precede the nightly remedial applications. Among the
external remedies for acne sulphur preparations stand first. Properly
managed, they rarely fail to benefit, and often prove curative.
Precipitated sulphur is the preparation generally employed, and in
many cases the most suitable. It may be prescribed as a powder, in
ointment, or in lotion. As a powder it may be applied pure or mixed
with starch, and as an ointment the following formula can be
recommended:

Rx. Sulphuris præcipitati, drachm iss;

Adipis benzoati, drachm iv;
Ugt. petrolei, drachm ijss;
Olei rosæ, gtt. iij.

M. Ft. ugt.—Sig. To be rubbed thoroughly into the skin at night. Or,

instead of the precipitated sulphur in the above ointment, the
sulphur hypochloride may be substituted. As a mild stimulant sulphur
soap may often be ordered with advantage in connection with other
remedies.

In sluggish, non-inflammatory cases the following may be used:

Rx. Sulphuris præcipitati,

Potassii carbonatis,
drachm ij.
Glycerinæ,
Ugt. petrolei, aa.

M. Ft. ugt.—Sig. Apply at night, rubbing it into the skin. In the above
formula the petroleum ointment may be replaced with the same
quantity of alcohol. In the form of a lotion precipitated sulphur at
times acts more decidedly than as an ointment. There are several
useful formulæ which, as a rule, answer equally well, although in
some cases differing in their beneficial effects. In the average case
the following seems most certain in its results:

Rx. Sulphuris præcipitati, drachm ij;

Pulv. camphoræ, gr. xx;
Pulv. tragacanthæ, gr. xxx;
Aquæ aurantii flor.,
fluidounce ij.
Liq. calcis, aa.

M.—S. Dab on with a mop or rag; shake before using.

A similar mixture in the form of a paste may be made with equal

parts of mucilage of acacia, glycerin, and sulphur, and is to be
applied with a brush, being allowed to remain on the skin over night.

Another sulphur lotion is the following:

Rx. Sulphuris præcipitati, drachm ij;

Glycerinæ, fluidrachm j;
Alcoholis, fluidounce j;
Liq. calcis, fluidounce ij;
Aquæ aurantii flor., fluidounce j.

M.—Sig. Apply with a sponge or rag, shaking well before using.

The annexed is also a good stimulating lotion:

Rx. Sulphuris præcipitati, drachm ij;

Ætheris, fluidrachm iv;
Aquæ cologniensis, fluidrachm iv;
Alcoholis, fluidounce iij.

M.—Sig. Shake well and dab on with a rag.

Potassium sulphide is a preparation of sulphur which often acts
admirably in this disease. It may be employed as an ointment, or,
preferably, as a lotion. An excellent formula, containing the sulphide,
which can be prescribed with advantage in many cases, is the
following:

Rx. Potassii sulphidi,

drachm j;
Zinci sulphatis, aa.
Aquæ rosæ, fluidounce iv.

M.—S. Apply with a sponge or rag. The resulting lotion from this
mixture is a complex one, a double reaction taking place. The salts
should be separately dissolved, and then mixed. If properly made,
the lotion when shaken is of a milky color and free from odor; upon
standing the particles sink and form a white sediment, the liquid
above being clear. If improperly prepared, as is often the case, it is
of a yellowish tinge with a decided odor of the potassium sulphide,
and has an entirely different effect. Vleminckx's solution,4 perfumed
with an essential oil, is often of service; it is to be diluted with three
to six parts of water and dabbed on every night, the strength
gradually increased if necessary.
4 See treatment of Psoriasis for formula.

Another class of external remedies found of service in the treatment

of this disease are the mercurials. They are not so valuable as the
sulphur preparations. Corrosive sublimate, white precipitate, and
calomel are the mercurials commonly used. If sulphur has been
previously employed, several days should intervene and the parts be
repeatedly cleansed before using a mercurial, otherwise the skin is
darkened temporarily by the formation of the black sulphuret of
mercury. Corrosive sublimate is prescribed in the form of a lotion,
from one-half to two grains to the ounce of alcohol and water, or as
in the following formula:

Rx. Hydrargyri chloridi corros., gr. ij;

 Zinci sulphatis, gr. xv;
Alcoholis, fluidounce ij;
Aquæ rosæ, fluidounce ij.

M.—S. Apply with a rag. The zinc sulphate renders the lotion
astringent, and is often a valuable addition. Ammoniated mercury,
thirty to sixty grains to the ounce of benzoated lard or cold cream,
will frequently prove serviceable. If the lesions are numerous and
are seated close together, the application is to be made to the entire
surface of the part; on the other hand, if they are sparse, it may be
made to the spots only. The same may be said also in regard to the
sulphur preparations. A 5 or 10 per cent. ointment of oleate of
mercury, rubbed thoroughly into sluggish and indurated lesions, will
often shorten their course by promoting suppuration. In many cases
puncturing the lesions with a sharp knife or scraping with a curette
before applying the hot water will be of assistance in the treatment.
In obstinate indurated lesions, in addition to puncturing the lesions,
the apices may be treated with carbolic acid. The protiodide of
mercury, in the strength of five to fifteen grains to the ounce of
ointment, is well spoken of by some authorities; it is to be used with
care, as it is actively stimulant. In some cases rubbing energetically
over the parts a mixture of sapo viridis and sulphur, adding enough
hot water to make a lather, and allowing it to remain on over night,
will, if repeated nightly until the skin becomes slightly inflamed and
then followed subsequently by a mild ointment, produce a decided
effect.

Acne Rosacea.

Acne rosacea, or rosacea, is a chronic, hyperæmic or inflammatory

disease of the face, invading especially the nose and cheeks,
characterized by redness, dilatation and enlargement of the blood-
vessels, more or less acne, and hypertrophy. The course of the
disease divides itself naturally into three stages. There is at first
simply a hyperæmia, due to passive congestion. In young subjects
the affection is seen in this stage, and rarely passes beyond it. In
other cases, however, sooner or later, dilatation and enlargement of
the vessels (telangiectasis) take place, and acne papules and
pustules are scattered over the parts, constituting the second stage
of the disease. This stage is frequently met with, and illustrates the
acne rosacea usually seen. Exceptionally, however, the disease
progresses, the vessels increase in calibre, the glands are enlarged,
and there is more less hypertrophy of the connective tissue and the
third stage is developed. The nose may become much enlarged,
even lobulated, and in some portions pendulous (rhinophyma). The
nose and its immediate neighborhood are the favorite localities for
the development of acne rosacea, but it is not infrequently confined
to the cheeks, and sometimes is localized upon the forehead, while
all these parts are not infrequently affected simultaneously. As a
rule, there are no marked subjective symptoms, although in some
instances burning or a sense of fulness is complained of.

It is seen in both sexes, but is more frequent in males; in women it

rarely, if ever, reaches the same degree of development as in men. It
is most common about middle life. The causes are varied. Chronic
stomachic and intestinal derangements, anæmia, and chlorosis are
common causes. The habitual use of spirituous liquors is not
infrequently a source of the disease. Long-continued exposure to
excessive cold or heat is in some cases a causative agent. In
women, menstrual and uterine difficulties are often the responsible
factors; hence in this sex it is much more common at the climacteric
period. When occurring in the young about the period of
adolescence, it is frequently associated with seborrhoea, and rarely
advances beyond a condition of hyperæmia. Pathologically, in the
first stage of the disease there is simply a hyperæmia—a stasis; in
the second, hypertrophy and dilatation of the vessels are
superadded, together with acne and slight hypertrophy of the
sebaceous glands; in the third stage there is, in addition,
hypertrophy of the connective tissue of the corium.
Acne rosacea is to be distinguished from the tubercular syphiloderm,
lupus vulgaris, and acne vulgaris, to which affections it at times
bears resemblance. The tubercular syphiloderm is comparatively
more rapid in its course; does not necessarily involve the sebaceous
glands; has frequently as a consequence ulceration and crusting; is
usually confined to a part of the nose; and is unaccompanied with
dilatation and enlargement of the blood-vessels. Its history, the
firmer consistence, and the more dusky color of the tubercles, and
frequently the presence of other evidences of syphilis, are also
points of difference. In lupus vulgaris the characteristic soft,
yellowish-red papules, the absence of the hypertrophied blood-
vessels, the degeneration, ulceration, and cicatricial-tissue formation,
the more or less limited character of the eruption, and the history of
the case, will serve to distinguish it. A simple case of acne vulgaris
can scarcely be confounded with acne rosacea: in many cases,
however, the dividing-line is far from being marked; in fact, the
disease under consideration is often acne with hyperæmia and
dilated blood-vessels superadded.

TREATMENT.—The affection may in all cases be more or less favorably

influenced by treatment. The milder cases, although at times
obstinate, are curable; but when the disease has advanced to
marked dilatation and hypertrophy of the blood-vessels and
connective tissue, the prognosis is not so favorable. In all stages of
the affection, however, as stated, a great deal can be accomplished
by appropriate remedies. External and internal treatment are
required in the majority of cases. The former usually proves the
more valuable.

Concerning internal remedies, there is no drug that exerts a specific

influence. The guide to constitutional treatment should be a study of
the etiological causes of the disease. Constipation is frequently
present, and hence laxatives, especially the salines, are indicated.
Chlorosis in the female is often the predisposing cause, and such
remedies as iron, quinine, and strychnia will be found useful.
Dyspepsia is one of the most frequent causes, and treatment
directed toward a removal of that condition will often be of
considerable aid in curing the disease. Menstrual irregularities should
be inquired into and the appropriate remedies employed.

There are mainly two classes of external remedies which are used in
the treatment—namely, the mercurials and the sulphur preparations.
The latter are by far the more valuable, precipitated and sublimed
sulphur, the hypochloride of sulphur, and the sulphuret of potassium
being the most serviceable. They are prescribed either in the form of
lotions or ointments. The officinal sulphur ointment, an ointment of
the precipitated sulphur and of the hypochloride of sulphur, of the
strength of one or two drachms to the ounce, may be referred to as
valuable applications. Sulphur may also be used as a dusting-powder
or in the form of a paste, as in the following formula:

Rx. Mucilag. acaciæ, fluidrachm ij;

Glycerinæ, fluidrachm ij;
Sulphur, præcip., drachm iij.

M.—Sig. Use with a brush as a paint.

A lotion containing one to four drachms of precipitated sulphur,

twenty or thirty grains of camphor, thirty to sixty grains of
tragacanth, in two ounces each of lime-water and orange-flower
water, or one of the same quantity of sulphur, two or three drachms
of ether, and three and a half ounces of alcohol, will in many cases
prove serviceable. A lotion of one or two drachms each of sulphide
of potassium and sulphate of zinc, in four ounces of water, is one of
great value.

Concerning the mercurials, corrosive sublimate, calomel, and white

precipitate are in some cases of service. Corrosive sublimate is
prescribed as a lotion of the strength of one-half to four grains to
the ounce of water or water and alcohol. Calomel and white
precipitate are prescribed in ointment, twenty grains to two drachms
of either to the ounce, or they may be used in the form of a powder,
full strength or weakened with starch powder, dusted over the
surface.

To a great extent, the treatment of acne rosacea is the same as

simple acne, and for other formulæ and for the method of applying
the various remedies the reader is referred to that disease. When
dilated blood-vessels are present, however, other measures, in
addition to those advised above, are to be adopted. There are two
methods of destroying the blood-vessels. One plan is by the knife,
cutting across the vessels at several points or slitting their whole
length, permitting them to bleed; subsequently cold water may be
applied. The other method is by means of electrolysis, according to
the procedure fully described in the treatment of hypertrichosis. If
the vessel is long, inserting the needle at several points along its
length will be necessary; if short, insertion at one or two points will
suffice. While either of these methods will, if properly managed,
destroy the vessels, neither will prevent the growth of new vessels.
In those cases, however, in which the cause has long ceased to
operate destruction of the existing vessels may not be followed by
new growth. Excessive connective-tissue hypertrophy may require
ablation by the knife.

Sycosis.

Sycosis (syn., sycosis non-parasitica, folliculitis barbæ) is a chronic

inflammatory, non-contagious affection, involving the hair-follicles,
appearing generally upon the bearded region, and characterized by
papules, tubercles and pustules perforated by hairs. The disease is
seen, as a rule, only on the bearded part of the face, either about
the cheeks, chin, or upper lip, involving a small portion or the whole
of these parts. The hairy portion of the neck may also be invaded.
The disease may begin by the formation of papules and pustules
about the hair-follicles on previously healthy skin, or chronic
hyperæmia, or even eczema, may have preceded. The lesions
generally occur in numbers, in close proximity, and, together with
the accompanying inflammation, make up a patch of disease
involving a greater or less area. The pustules are discrete, flat or
acuminated, small in size, yellowish in color, perforated by hairs,
show no disposition to rupture, and are, as a rule, apt to appear in
crops. They dry to thin yellowish-brown crusts. There is more or less
swelling and infiltration. Papules and tubercles may usually be seen
intermingled with the pustules, or the former may constitute the
greater part of the eruption. At first the hairs are firmly seated, but
later, when suppuration has involved the follicles, they may be easily
extracted. Not infrequently the hair-follicles are completely
destroyed, in which case scarring and alopecia result. The process is
chronic, it being of a subacute or chronic character, with, usually,
acute exacerbations. Burning sensations, and at times pain or
itching, accompany the disease.

According to Robinson, the affection is primarily a perifolliculitis, the

first changes, which are those usually observed in vascular
connective-tissue inflammations, taking place around the follicle.
Later, the follicle and its sheath become involved, the pus and
transuded serum finding their way into these structures. At times
pus does not enter within the follicle, the changes observed therein
being due to the transuded serum. The pus reaches the surface by
forcing its way through the epidermis close to the hair. The causes of
the disease are not understood. It is usually seen in those between
the ages of twenty-five and fifty, in all classes of society, and in
those in good or bad health. Persons with eczematous skin and
those having thick and stiff hair are especially predisposed to the
disease. Local irritation may serve as the exciting cause. The
affection is not common. It is not contagious.

The disease is to be distinguished from tinea sycosis and eczema.

Tinea sycosis usually begins as a circular scaly patch—in fact, as
simple ringworm—later invading the hairs and follicles and giving
rise to papules and tubercles. These lesions are larger than in simple
sycosis, and appear and feel like lumps and nodules. Moreover, the
changes in the hairs in the parasitic disease are characteristic: they
become opaque, brittle, loose, and can be readily extracted. If
necessary, a microscopical examination of the hairs may be resorted
to. In eczema there is either an oozing, red, crusted surface, or it is
dry and scaly; the lesions, as a rule, do not remain discrete, are not
perforated by hairs, and the eruption is apt to involve other parts of
the face. It is scarcely possible to confound the disease with syphilis.

The disease is essentially a chronic one, and under the best

management is often rebellious. Relapses are not uncommon. The
treatment consists mainly of external measures. Suitable internal
remedies are, however, in some cases, as in plethoric or in broken-
down subjects, of value. The digestive apparatus is to be looked
after. The extremes of heat and cold are to be, as far as possible,
avoided. Clipping the hair, or shaving if not too painful, will permit a
more thorough application of remedies. If the disease be of an acute
type, soothing applications are at first to be advised. If there is
crusting, it should be removed by poultices or oily applications. The
use of lotio nigra, and subsequently a cloth spread with oxide-of-zinc
ointment, as in acute vesicular eczema, may be advised to allay
inflammation. Cold cream, vaseline, or applications of lead-water
and like remedies, will also be found useful in the acute stage. As a
rule, however, astringent and stimulating ointments may be
prescribed when the case first comes under observation. As an
astringent ointment there is in the average case nothing superior to
a good unguentum diachyli. It should be spread thickly on muslin
and bound down to the parts, renewing every six or twelve hours. If
stimulation is permissible, twenty grains to a drachm of ammoniated
mercury or calomel to the ounce of ointment may be prescribed.

If the process be chronic in character, the parts may be washed with

sapo viridis and water, and then diachylon ointment applied,
repeating the washing every day and the application of the ointment
twice or thrice daily. Sulphur, one to three drachms to the ounce of
ointment, is a valuable stimulating remedy, and should be applied
thoroughly twice daily; citrine ointment, two or three drachms to the
ounce of lard or cold cream, will sometimes have a good effect.
Shaving will be found useful in many cases. In some instances
epilation proves a valuable adjunct to the treatment. In acute stages
the hairs should be extracted from the pustules only—in the chronic
stage both from papules and pustules. The operation will be
rendered less painful by previously steaming or applying hot water
to the parts. After the operation the surface should be dressed with
a mild ointment. Epilation at the proper time will often save follicles
from irreparable destruction; if for any reason it is not advisable, the
pustules should be incised, so that free egress may be given to the
pus.

Impetigo.

Impetigo is an acute inflammatory disease, characterized by the

formation of one or more pea- or finger-nail-sized, rounded and
elevated, usually firm, discrete pustules, seated upon an
inflammatory base. The affection is at times preceded by slight
malaise. The lesion is pustular from the beginning, and when well
advanced may be of the size of a pea or finger-nail, is rounded, or
semiglobular, markedly elevated, yellowish or whitish in color, with at
first a more or less pronounced areola, which as the lesion matures
becomes less and less marked, and finally almost entirely subsides.
The pustule is usually distended, shows no disposition to rupture nor
to umbilication, and is characterized by but little surrounding
infiltration, and even where several exist close together they show
no tendency to coalesce. Ten, twenty, or more lesions are usually
present, and are most common about the face, hands, feet, and
lower extremities. They dry to crusts of a yellowish or brownish
color, which are usually thin and drop off, no pigmentation or scar
remaining. The process is of brief duration, is benign in character,
and is rarely attended with subjective symptoms. It is commonly
seen in children under the age of ten.

The disease, apparently, is not related to eczema; occurs, as a rule,

in well-nourished subjects, and is not contagious. The lesion is a
typical pustule, the process being distinctly circumscribed. The walls
are somewhat thick, and are probably made up of both the horny
and mucous layers. There is no inflammatory base. Microscopically,
the contents are found to be composed of pus-corpuscles, a few red
blood-corpuscles, epithelial cells, and cellular débris. The disease is
to be distinguished from pustular eczema, impetigo contagiosa, and
erythema. The pustules of eczema are numerous, closely crowded
together, small in size, tend to coalesce, with a decided disposition
to rupture, and are accompanied by itching. The lesions of impetigo
contagiosa are vesicular or vesico-pustular, flattened, superficial,
thin-walled, often umbilicated; if close together they tend to
coalesce, and dry to lamellar crusts of a yellowish color, and the
affection is distinctly contagious. The pustules of ecthyma are flat,
with an inflammatory base and areola; the crusts are brownish or
blackish, and seated upon a deep excoriation; and the affection is,
moreover, usually seen in adults and in those whose general health
is markedly below the standard.

The affection rarely calls for treatment, as it tends to spontaneous

recovery. Incision and evacuation of the matured lesions and a
simple protective dressing of a mild ointment, such as oxide-of-zinc
ointment, may be advised. If slight stimulation is desirable, ten or
twenty grains of ammoniated mercury may be added to the ounce of
the ointment.

Impetigo Contagiosa.

Impetigo contagiosa is an acute, inflammatory, contagious disease,

characterized by the formation of discrete, superficial, flat, rounded
or ovalish vesicles or blebs, which soon become vesico-pustular and
pass into crusts. Precursory febrile symptoms, especially in young
children, frequently usher in the eruption. The lesions begin as
discrete vesicles, small in size, becoming vesico-pustular and
increasing by extension peripherally, reaching the size of a pea or
developing into blebs as large as a dime or silver quarter dollar. They
are flat, slightly or markedly umbilicated, the umbilication being
more marked in the older lesions. Several or a few dozen such
vesicles or blebs may be present, and if situated close together may
coalesce and form patches. There is very little areola, and the
covering of the lesion is thin and withered-looking. The superficial
character of the process is a striking feature. In a few days the
lesions dry to crusts, thin, granular, wafer-like in character, light-
yellowish or straw-colored, and but slightly adherent. If the vesicular
or bleb wall or the crust is removed, a slightly excoriated surface is
disclosed, resembling a superficial burn, secreting a thin fluid. The
lesions are seen most commonly about the face and hands, although
they frequently occur on other parts. In some cases one or two
dozen lesions are scattered over the general surface. In these
instances the resemblance of the whole process to an acute
contagious systemic disease with cutaneous manifestations is
striking. The lesions of the affection as ordinarily encountered
appear simultaneously or in crops. As a rule, there is very little
itching, and when it exists is usually present only in the beginning of
the disease or at night. The affection is contagious and auto-
inoculable, and at times apparently epidemic; is seen most
frequently in the warm months, and is confined almost exclusively to
children. When occurring in adults it is usually of an abortive type. In
addition to the cutaneous covering, the mucous membranes of the
mouth and conjunctiva are sometimes affected. As a rule, it runs an
acute course, lasting ten days or two weeks. In exceptional
instances the disease is anomalous, as regards not only its course,
but the character and type of the individual lesions.

The causes of the disease are not understood. Some authorities

consider it due to the presence of a parasite,—a view in which we
are not prepared to coincide. A fungus—in fact, several varieties—
may be found in microscopic examinations of the crusts, but the
same may be found in crusts of other diseases, and their presence
may be considered as accidental. There seem to be two varieties of
the disease, in one of which the lesions are for the most part
confined to the face and hands, and in the other the lesions are
scattered over the general surface. The affection is encountered
most frequently among the poor and ill-cared-for. A relationship to
vaccination has at times been noted.

In the diagnosis eczema and simple impetigo are to be excluded.

The history, course, and characters of the lesions of contagious
impetigo are entirely different from those of these two diseases. The
size, growth, isolated character, the non-inclination to rupture, and
the comparative absence of itching will serve to distinguish it from
eczema. The pustule of simple impetigo is prominently raised; that
of contagious impetigo is flat and usually umbilicated; the contents
of the former are distinctly pustular, and the crusts thicker, smaller,
and usually yellowish-brown; of the latter the contents are rarely
more than vesico-pustular, the crust thin, light-yellowish or straw-
colored, and has the appearance of being stuck on. Those cases
which resemble an exanthem may in the early stages be confounded
with varicella, but later the lesions are much larger than seen in that
disease. In exceptional instances the resemblance to the blebs of
pemphigus is more or less pronounced.

As a rule, but little treatment is necessary, as the affection tends to

spontaneous disappearance. In some cases, however, in which there
is more or less itching, auto-inoculation at the excoriated points
takes place, and in this manner the affection may persist. An
ointment of ammoniated mercury, ten or fifteen grains to the ounce,
rubbed in the lesions, will have a curative effect; likewise an
ointment or lotion of carbolic acid, ten grains to the ounce.

Ecthyma.

Ecthyma is characterized by the formation of one or more discrete

finger-nail-sized, flat, inflammatory pustules. The pustules are
usually few in number, vary in size from that of a pea to a large
finger-nail, roundish or ovalish in shape, and are situated on an
inflammatory base, with a marked areola of a bright-red color. In the
beginning they are yellowish, but later, from an admixture of more
or less blood, they become reddish, subsequently drying to brownish
but slightly adherent crusts. If the crust is removed, a superficial
excoriation, secreting a yellowish fluid, is disclosed. The lesions
pursue an acute course, but new pustules are apt to form from time
to time. The lower extremities, shoulders and back are favorite
localities. The subjective symptoms are usually slight, but burning
and pain may be complained of. More or less pigmentation is left to
mark the site of the lesions, which sooner or later disappears. The
affection is seen in both sexes and at all ages, but is more frequently
met with in men.

It is a disease of the poorly-nourished and debilitated; hence it is

chiefly seen in the lower walks of life. All causes that tend to reduce
the tone of the general health are indirectly responsible for the
disease. In such persons external irritants, such as pediculi, bed-
bugs, and similar parasites, may provoke the formation of
ecthymatous lesions. The affection is not contagious. The process is
of a markedly inflammatory type, and tends rapidly to pus-
formation. The lesion is a typical pustule, and the excoriation does
not extend deeper than the papillary layer. Permanent scarring never
results. In the negro, instead of increased pigmentation, loss of
pigment results.

The disease is to be distinguished from simple impetigo, contagious

impetigo, and the flat pustular syphiloderm. It differs from impetigo
in the flat form of the lesion and the character of its crust, and in the
more inflammatory nature of the process. The non-contagiousness
of the affection, the character and color of the crust, the regions
involved, and the course will serve to differentiate it from impetigo
contagiosa. In exceptional cases of this latter disease some of the
lesions bear considerable resemblance to ecthyma. A striking
similarity to the large flat pustule of syphilis is often noticed in
ecthyma, and it is here that difficulty in the diagnosis is most likely
to be experienced. The local disturbance, such as pain and heat, is
generally more marked in ecthyma. The syphiloderm is usually of
slower development and runs a more chronic course; moreover,
positive ulceration beneath the crusts does not occur in ecthyma.
The crusts of syphilis are darker in color, and usually have a greenish
hue. Concomitant symptoms of syphilis are almost always present,
and are valuable in the diagnosis. Ecthyma can scarcely be
confounded with pustular eczema, as the size and discrete character
of the pustules and the absence of marked itching are sufficiently
distinctive.

Where it is possible for the patient to follow out treatment the result
is always favorable. The importance of good food and proper
hygiene cannot be overestimated. Tonics may be prescribed as
efficient adjuvants. Iron, quinine, nux vomica, and the mineral acids
are valuable. As a rule, simple measures are sufficient in the external
treatment. If the lesions are numerous and are markedly
inflammatory, alkaline baths, six ounces of sodium bicarbonate or of
a similar alkaline salt to the bath, will be of service. The crusts are to
be removed by poultices or hot-water applications, and the
excoriations dressed with an ointment of ten to twenty grains of
ammoniated mercury in an ounce of oxide-of-zinc ointment. In some
cases a more stimulating ointment is required. Where active
stimulation is demanded, touching the parts with nitrate of silver,
diluted carbolic acid or a similar agent will prove serviceable.

Miliaria.

Miliaria—popularly known as prickly heat or heat-rash—is an acute

inflammatory disorder of the sweat-glands, characterized by pinpoint
to milletseed-sized papules or vesicles, attended usually by
sensations of pricking, tingling, or burning. In some cases the
eruption is almost entirely made up of papular lesions, and
constitutes the form of the affection known as miliaria papulosa. In
other cases the lesions are vesicular in nature, and miliaria
vesiculosa is typified. It is chiefly the papular form to which the
name of prickly heat has been applied. This variety begins with the
formation of minute elevated, acuminated, bright-red papules,
occurring usually in great numbers, more or less crowded together;
the individual lesions, however, remain discrete. The affection may
be localized, or, as is usually the case, may involve considerable
surface. In miliaria vesiculosa the lesions are in the form of vesicles
the same in size as the papules, and appear as whitish or yellowish
points surrounded with inflammatory areolæ. They are usually
crowded so closely together as to give the skin a bright-red look
(miliaria rubra). At first the vesicles are transparent and contain a
clear fluid, but as they become older they appear opaque and
yellowish-white (miliaria alba), and instead of the bright-red
appearance the eruption has then a yellowish cast. As in the papular
form of the eruption, small areas may be involved or the greater part
of the entire surface. The trunk is a favorite locality. The vesicles dry
up in a few days, showing no tendency to rupture, and terminate in
slight desquamation. In the majority of cases the eruption consists
of papular, vesico-papular, and vesicular lesions interspersed. They
make their appearance suddenly, usually accompanied with
considerable sweating, and if the cause has ceased to act terminate
in the course of a few days. As a rule, the subjective symptoms are
mild in character, nothing more than slight tingling, burning, being
noted; in others, however, these may be so marked as to give rise to
considerable annoyance. Individuals who are debilitated seem most
prone to an outbreak. Hot weather predisposes to it; in fact,
excessive heat from whatever cause is apt to provoke an attack. It is
especially common in children. The affection as usually met with is
essentially an inflammatory disorder of the sweat-glands, congestion
and exudation taking place about the ducts, giving rise to papules or
vesicles, according to the intensity of the process.

It is to be distinguished from eczema and sudamen. The papules of

eczema are larger, more elevated, firmer, make their appearance
more slowly, and are of much longer duration; moreover, the itching
of papular eczema is usually marked. Vesicular eczema differs from
miliaria vesiculosa by the larger size of the lesions, their disposition
to rupture, their tendency to become confluent, and their greater
itchiness, and by the general features of the eruption both as
regards its appearance and duration. It is to be noted that miliaria
occurring in children from the conjoint effects of warm weather and
superfluous clothing may, if the exciting causes are continued, result
in eczema. Sudamen may be differentiated by the absence of
inflammatory symptoms.

The affection under favorable circumstances runs a rapid course,

disappearing in a few days or weeks. A removal of the exciting cause
will in all cases have a favorable effect. Too active treatment is to be
avoided, not only as being useless but prejudicial. Undue
perspiration should be guarded against. The patient is for the time to
avoid exercise and to be properly clad. Refrigerating diuretics, as
citrate or the acetate of potassium or simple lemon-juice diluted,
may be prescribed. When the eruption is kept up or frequently
recurs as a result of impaired health, tonics, as quinine, iron, and the
mineral acids, will be useful. In the majority of cases local treatment
alone is necessary. Dusting-powders and cooling or astringent lotions
are of most value. Starch and lycopodium powder, equal quantities
or with 20 to 30 per cent. of oxide of zinc added, may be used; the
surface is to be kept freely powdered. Astringent lotions may be
employed in place of the dusting-powder, or, what is often advisable,
may immediately precede the latter, the lotion being first applied,
allowed to dry on the surface, and then the powder freely dusted
over. A lotion of alcohol and water and sponging with vinegar and
water may be prescribed.

Pompholyx.

Under this head (and also that of Dysidrosis) a rare disease of the
skin has been described, characterized by peculiar vesicles and blebs
and an excoriated state of the skin, with subsequent exfoliation of
the epidermis. It consists at first of deep-seated vesicular lesions,
which resemble small boiled sago-grains implanted in the skin,
accompanied by a variable degree of inflammation. As the lesions
grow they incline to coalesce, thus forming small or large blebs
showing but little if any disposition to rupture. Sooner or later the
fluid is reabsorbed or exudes, the epidermis peeling off, usually in
large flakes or pieces, sometimes in the form of a cast of the fingers
or hand. In most cases burning sensations, tenderness, and
soreness are complained of. The disease pursues a variable course.
Ordinarily, the process lasts from two to eight weeks. Relapses as
well as recurrences of the disease may take place. It attacks by
preference the hands, more especially the palms and the sides of the
fingers, from which circumstance it was originally designated cheiro-
pompholyx; but it may invade the feet and also other regions.

The same disease has been described with the two names given,
some observers regarding it as being due to a disordered state of
the sweat apparatus, others as being an inflammatory affection. We
incline to the latter view, looking upon true dysidrosis as a form of
miliaria. The disease under consideration is without question
neurotic in origin. It occurs chiefly in those suffering from nervous
debility or prostration arising from varied causes. It is due to
impaired, faulty innervation. It is most liable to be mistaken for
vesicular eczema or pemphigus. The treatment should be general,
consisting of such remedies as quinine and arsenic, together with
good food and proper hygiene. Local treatment may be prescribed
as in the case of eczema, but the result in most cases is not as
satisfactory as in that disease.

Pemphigus.

Pemphigus is an acute or chronic bullous disease, characterized by

the successive formation of variously sized and shaped blebs. Two
varieties are met with—pemphigus vulgaris and pemphigus foliaceus
—the symptoms of which differ considerably. Pemphigus vulgaris,
the usual form of the disease, appears with or without precursory
symptoms. In marked cases headache and fever may precede the
cutaneous outbreak. All portions of the body may suffer, but the
extremities are more commonly the seat of the eruption. The
mucous membrane of the mouth and vagina may also be involved.
The lesions, as a rule, are rarely seen in large numbers, a dozen or
so usually being present at one time. They vary in size from a pea to
a large egg, and are generally rounded or ovalish, fully distended,
and according to the size are elevated from a few lines to an inch
above the surrounding skin. There is but little inflammation
attending their formation. In some cases the blebs arise from
erythematous spots or wheals, but generally from apparently normal
skin. The fluid is yellowish, later often becoming cloudy or puriform.
At times slight hemorrhage occurs, giving the lesions a reddish or
purplish color. Spontaneous rupture of the lesions seldom occurs, the
contents usually disappearing by absorption. Each bleb runs its
course in from two to eight days. Itching and burning are rarely
prominent symptoms, in some cases being scarcely noticeable or
absent, in others present to a marked degree, constituting
pemphigus pruriginosus. In children pemphigus vulgaris is usually
attended with systemic disturbance; in adults, as a rule, only in
severe cases. The disease may be acute or chronic. Acute
pemphigus is rare, and occurs, as a rule, only in children. It usually
runs a favorable course, except in ill-nourished children, in whom it
may take on a malignant type and have a fatal termination. Chronic
pemphigus may be benign or malignant. In the benign form the
eruption may persist several months by successive outbreaks, and
then disappear, or the blebs may form irregularly and indefinitely. In
the former case there may be but the one attack, or, as commonly
occurs, relapses may follow after months or years. In the malignant
form the disease is more violent, with marked systemic depression
and ulcerative action, and may frequently have an unfavorable
termination.

Pemphigus foliaceus, the other variety of the disease, is rare. The

blebs are loose and flaccid, with milky or puriform contents, rupture,
and the oozing liquid dries to crusts, which are cast off, disclosing
the reddened corium beneath. The blebs may coalesce and involve
considerable surface, and may appear in rapid succession on other
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