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divided doses, the first about three hours before bed- time, and the second portion shortly before retiring Opium at times acts well, but the after-effects and the constipation produced are unfavorable factors in its use. The two important indications are to eliminate the intestinal self-infection and thus purify the blood from toxic agents, and at the same time do away with the starvation of the tissues from unassimilated and insufficient food. The symptoms, as a rule, will dis- appear without other special treatment if these matters are successfully combated. The question of intestinal putrefaction and infection as a cause of acute insanities has for some time been recognized. From time to time writers have called attention to this matter, and its importance has im- pressed itself upon every asylum physician. The ten- dency of late years has been turned to the germ theory as productive of disease. It is probable that the sep- tic products of active bacterial growth in the ill- digested and decomposed contents of the intestinal canal may be absorbed as a toxic agent in the circu- lation and result in the various forms of melancholia. Germs themselves may gain entrance to the blood, and it is a theory for our consideration whether many forms of mental disturbance may not be manifestations of bacterial activity. Certainly, treatment directed to the relief of indigestion when present, and of consti- pation with its attendant evils, which is an invariable accompaniment, and the administration of remedies which shall render the intestinal canal in some degree aseptic, has met with the best possible results in my own experience. This course renders the giving of large amounts of nourishing food possible, and leads to a gain in fat and blood and in weight, and certainly promotes a cure. These cases of moderate melancho- lia are most hopeful: the treatment is usually some- what prolonged, and as the patients are often intelli- gent and, in the event of recovery, appreciative, most cordial and pleasant friendships are often formed. Your cases are thus rendered most interesting, and at the same time satisfactorv. OX THE RESTRICTION OF MEAT IX THE TREATMENT OF PSORIASIS. 1 By L. DUNCAN BULKLEY, A.M., M.D., PHYSICIAN' TO THE NEW YORK SKIS AND CANCER HOSPITAL, ETC. In spite of much research as to the microscopic anat- omy and bacteriology of psoriasis, and notwithstand- ing frequent studies of its clinical history and reports as to its therapeutics, all must acknowledge that the disease is as yet but little understood, as far as relates to its etiology and to its permanent cure. Thus far reports in regard to its treatment have been too largely confined to the use of local measures, and but little definite information appears in regard to its constitutional conditions and treatment; and even in text-books but little can be learned as to a course of treatment calculated to permanently cure the disease. We know, of course, that arsenic has been lauded by some as really curative: but I question if many who have seen much of the disease and have watched their patients for a long time find this drug often permanently successful. Indeed, as far as I have been able to interpret literature, the general pro- fessional opinion tends rather to the view that psoria- sis is an incurable disease, even though the existing eruption may commonly be removed more or less easily by a number of remedies and measures. All writers certainly agree that psoriasis is exceed- ingly prone to relapse, and Crocker sums up the pre- vailing experience by saying: "We know of no means of preventing recurrences, which are almost sure to occur, sooner or later, in at least ninety per cent, of the cases." Surely this is a discouraging outlook, and it behooves the profession to study the underlying causes of the disease with a view to its better treat- ment. It has been far too much the tendency to regard all skin diseases as either of purely external origin or else as idiopathic affections of the integument, to the neglect of internal causation. This has undoubtedly been fostered by tire readiness with which the skin has been reached by outward applications, and perhaps also by the ease with which it has been subjected to microscopic research of late years. The recent ten- dency to attribute so much of disease to the local agency of the lower organisms has also contributed toward directing attention from internal causation. But there are few who will contend that psoriasis is a wholly local disease, either in the line of idiopathic 1 Read at the Third International Congress of Dermatology, LondoD August ~, 1S96. 42 MEDICAL RECORD. [January 9, 1897 cell derangement or of external causation; although of late the microbic origin has been claimed by some. The latter, however, seems quite far from proof, and many of the clinical features and relations of the dis- ease point almost conclusively to an internal origin. Among these may be mentioned its common appear- ance at the developmental period of life, its more or less hereditary character, its periodical recurrence with the change of seasons and food, its remarkable symmetry of location, etc. . When an internal etiology of psoriasis has been more or less acknowledged, various elements have been considered as causative. The older views were expressed under the words constitutional, dyscrasic, diathetic, etc.; and more recent research has looked toward the nervous system wooden boy slot for a solution of the prob- lem. At the present writing I do not know if much attention has been given to the possibility of lym- phatic derangement as a cause of the disease. As yet, however, we are greatly in the dark in re- gard to the real cause of the eruption, and little is positively known as to constitutional states existing in these patients. As a rule, they claim to be, and in- deed seem to be in good health, and the eruption ap- pears to be the only element that requires attention. This has far too often led to its consideration and treatment from a local point of view, and to the at tempt at its temporary removal only, without endeav- oring to reach its constitutional cause. All who are familiar with the disease know only too well how tem- porary and relatively unsatisfactory this treatment proves to be. The question arises: Can we not dis- cover and remedy some of the causes underlying the eruption, and so effect more in the direction of pre- venting relapses or modifying their character? I be- lieve we can. Time prevents any elaborate study of the disease on the present occasion, nor is it necessary. The present writer submitted his views, with an anaylsis of one thousand cases of psoriasis, to the First Interna- tional Dermatological Congress at Paris, 1 and also in a later article." It may only be stated wooden boy slot review that a total dis- belief in any local cause of the disease was there enunciated, and its constitutional nature vindicated. Nor do these researches lend any support to the possi- bility of a nervous or lymphatic origin of the erup- tion. Observation and study, however, have led to the conclusion that the disease is dependent upon a blood state closely allied to that belonging to gout

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