logy. It is conceivable, therefore, that if the convolutions of the brain be the real source of muscular movements, these should be found to have become atrophied when patients have lived for many years without the possibility of exercising the functions concerned; as in the case of those whose limbs have been amputated, or whose power of speech has been suppressed through deafness. The four specimens recently presented by M. Luys to the Society of Biology,1 indicate the necessity of following up this method of inquiry with the utmost care. The importance of these hypotheses, in connection with the pathology and treatment of epilepsy, can scarcely be overrated. No doubt the first results will be in the direction of supplying a scientific classification of epilepsy and convulsions, rather than of furnishing much practical assistance in the treatment of those affections. But such a scientific classification will afford great advantages in pursuing the study of the causes which lead to explosion of the nervous centres, and of the processes by which explosion is brought about. We are glad to find, however, that in thus seeking earnestly for a scientific classification of epilepsy Dr. Hughlings Jackson no longer treats as idle or useless those great clinical distinctions on which the differentiation of "fits" has hitherto proceeded; much additional light must yet be gained before the classifications or groupings in present use can with any propriety be set aside. Even now, however, there are gleams of hope that this new pathology of epilepsy may soon assist in the proper appreciation at least of those dietetic and medicinal measures which have been found useful in the treatment of this formidable affection. V.-On Certain Endemic Skin Diseases.1 DISEASES of the integumentary system have occupied a very prominent position in medicine from the earliest historical periods, for we find that reference is made in the Old Testament and other ancient works to many cutaneous affections; 1 "Modifications survenues dans l'etat de l'écorce cérébrale par suite de la disparition de differentes categories d'incitations périphériques," par M. le Dr. Luys, Gazette des Hôpitaux,' July 11, 1876, p. 637. 21. On Certain Endemic Skin and other Diseases of India and Hot Climates generally. By Drs. Fox and FARQUHAR. London, 1876. 2. Chinese Customs, Medical Reports for the Half-year ending September, 1875. Shanghai, 1876. 3. The Fungus-disease of India; a Report of Observations. By Drs. LEWIS and CUNNINGHAM. Calcutta, 1875. 4. On the Psoriasis or Lepra. By GEORGE GASKOIN. London, 1875. but, from the imperfect descriptions given in many cases, it is rather difficult to know exactly to what skin diseases they refer. As in every other abstruse subject influenced by innumerable and changing conditions, knowledge has been slowly progressive, but not, perhaps, to such an extent as the importance and distribution of diseases of the skin demanded. In fact, it must be admitted by every one conversant with the literature of skin affections generally that dermatology is yet in its infancy, for frequently some new investigation into the pathology of many affections of the skin dashes to pieces in an instant the theories on which medical opinions have rested for ages. In addition to increased facilities and improved methods of research, the microscope, for example, in the hands of competent observers, has done wonders in placing a knowledge of skin diseases on a more scientific and, therefore, satisfactory basis; nevertheless, there is still a great and unexplored field open to the practical investigator, who will be sure to obtain his reward. To our continental neighbours the French, and especially the Germans, the chief credit is due of instituting searching inquiries into the morbid anatomy and histology of the skin in various diseases, and of thereby indicating the future line of research from which the best results may be anticipated. It may seem invidious to mention names, but it is impossible to do justice to the labours of Hebra and Bazin in connection with skin affections. Perhaps no class of diseases are more influenced by temperature and climate than those of the skin, and undoubtedly the same diseases become much modified, if not somewhat changed, in different countries. A very novel contribution to the literature of skin affections, as they occur in various places, especially hot climates, has been recently published by Drs. Fox and Farquhar. These gentlemen, recognising the uncertainty which prevails amongst the profession as to the real nature of some of the common forms of skin disease endemic in the colonies and tropical countries, have, at the recommendation of the Army Sanitary Commissioners, prepared a short account of what was already known of each, and framed a number of questions, all of which were published in 1872 under sanction. of the Government of India, and copies were distributed to army, naval, and civil medical officers serving in various quarters of the globe, with a view to elicit certain desired information. The work under consideration contains the answers and reports of the medical officers, in reply to the queries put to them, prefaced by a critical abstract and analysis of the reports by Drs. Fox and Farquhar. The subjects regarding which information was asked were fifteen, the most important and most common in hot climates being Framboesia, Delhi sore, Ainhum, Elephantiasis Arabum, the Fungus foot of India, and Leprosy. We have read through the reports of the various medical officers, and we must admit that it is difficult to cull any further knowledge in the majority of instances regarding the nature of the skin affections of which they profess to give an account, and if proof were wanted of the old saying that "doctors differ," it would be found amply illustrated in this report. We do not, however, find much fault with the physical descriptions of the various skin affections, though in most cases they are very brief and fragmentary; but we do think that officers belonging to a scientific department should have made less use of theory and more of practice; in other words, made more use of their microscopes and other means of investigation if their reports are to be really of value. One of the most important contributions in the work is that from the pen of Dr. Vandyke Carter, Indian army, who has given interesting accounts from actual examination of the diseases known as "bouton de Biskra," "bouton de Crete," aud "bouton d'Alep," with five coloured drawings representing the appearance of those affections. Very little information has been given in addition to what was known of framboesia or yaws forty years ago, and there is no notice of any histological examination having been performed, at all events, in recent years, though the disease is very common amongst the negroes in Africa, America, and especially in the West Indies. Judging from the latest description of yaws in Dr. Tilbury Fox's work on skin diseases, it appears to us that there are some points in common with that severe affection known as "Delhi ulcer;" but until its pathological anatomy has been worked out its nature will be purely speculative. Nothing has been added to our knowledge of "Delhi sore" as it occurs in India; but Dr. Carter has contributed accounts of allied if not identical affections, as already mentioned, during his recent travels in Crete, Italy, Algeria, &c., while engaged prosecuting researches into the nature of leprosy. He succeeded in proving to his own satisfaction, and his opinions are supported by those of other medical officers serving in Arabia, &c., that Aleppo boil or bouton, Biskra bouton, Scinde and Delhi boils, are examples of the same disease. He has also made the discovery that, in addition to the cell growth first discovered and described by Fleming (Army Me dical Reports' for 1869) as constituting the principal histological feature in the disease in India, there is in Biskra bouton "a true vegetable organism (including a distinct mycelium) within the lymphatic vessels in and around the clou (or bouton) at a certain stage of development." Hence, he adds, "a clue to the unravelling of many mysteries concerning this remarkable skin affection, which otherwise seem quite inexplicable." This is a very important discovery, because it will assist to confirm the view that the disease is local, and that it should be treated by local remedies, as recommended many years ago, and now practised successfully, as regards Aden ulcer, Mooltan and Delhi sore, Scinde boil, &c., since these diseases are of the same nature. Carter proposes for the disease the name "mycosis cutis chronica," now that he has discovered a fungus; but it would be well before accepting it to wait for the results of researches which we understand have been commenced in India long since by Drs. Lewis and Cunningham, regarding the Delhi sore. If a fungus is present, and if it is the cause of these troublesome contagious affections, we hope it will be readily detected; though many authorities deny that fungi have any share in the production of disease, and when they are observed associated with morbid states look on them as secondary, or as the result of diseased conditions. We should expect, however, if the cause of Delhi sore and its allies be traced by further investigation beyond a contagious cell growth to a fungus with mycelia in the lymphatic vessels, that the lymphatic glands, at all events near the sore, as well as the lymphatic vessels themselves, would show some signs of irritation. On the contrary, we know from experience that such is not the case, for there are no outward appearances or constitutional disturbances to lead us to believe that in such diseases the lymphatic system was affected in any way. Other microscopists have not been so successful as Dr. Carter, for we learn that two sections of the Biskra bouton from early and advanced cases were examined by Drs. Fox and Farquhar, but they failed to detect any fungoid elements in the structure of the bouton, excepting some common mycelial filaments in the superficial cuticular layers, evidently accidental. Further, we know that sections of the Delhi boil, in every stage of the disease and under the effects of various reagents, have been examined by high powers without detecting mycelia or other fungoid elements permeating the tissues; yet it is quite possible that they may have escaped notice. It is surprising with what tenacity some writers stick to the theory that Delhi sore and its allies are the local manifestations of a constitutional disease, because they cannot, by any process of reasoning, bring their minds to comprehend the possibility of the disease being due to purely local causes; but one writer (Dr. Geber) goes farther, and after a lengthened practical examination of Aleppo evil, during a residence at Aleppo, he has come to the conclusion that, in the majority of cases, it is a syphilitic, lupoid, or eczematous disease! No one will be disposed to deny that syphilitic disease may coexist with and modify these affections, and may make them difficult to diagnose; but the history of the cases and the appearances will, in the majority of instances, be sufficient to distinguish them. In persons suffering from Delhi sores we are certain there is no special cachexia; they affect the strong equally with the weak, and there is no apparent constitutional disturbance either before or after their appearance. Further, the cicatrix resulting from a Delhi or Mooltan sore is, in almost all cases, smooth, not depressed, and particularly white; whereas that from a syphilitic sore is depressed, rough, and of a brownish or dark colour, and the cachexia is well marked. The report on Delhi sore contains many statements to which we take exception, notably those of the Army Sanitary Commission, who, in their official report for 1873 and 1874, attribute, we think, without sufficient data, the diminution of the disease in Delhi (presumably also amongst the European troops) to the improved sanitary condition of the town compared with former years. They say: "This improvement was attributed to the ameliorated sanitary condition of the town; the drainage and sewerage had been cleansed, flushed, and improved, and the city itself and the water supply had been purified." The Army Sanitary Commission seem to have forgotten that since 1869 or 1870, when the contagious nature of the disease was proved satisfactorily, and, as one of the results of such discovery, a line of treatment was adopted to prevent the disease spreading, it has been to a great extent under the control of the medical officer, and the consequence has been that it has very considerably diminished, since open sores which propagated the disease have been easily cured, and on the same principle there is no apparent reason why it should not be entirely got rid of. We are sorry that the Army Sanitary Commission are not more particular and inquisitive as to why there is an increase of the disease during some years and a diminution during others, as we cannot accept their explanation which may be true regarding the cause of diminution of zymotic diseases; but we venture to predict that they will eventually agree with us that the diminution has been owing to measures which prevent the disease spreading, viz. early treatment by local and destructive applications, |