" I propose to give to this eruption the name of tar acne (Theeracne). Its occurrence, of course, renders the discontinuance of the remedy absolutely necessary.

"Again, tar has often and most justly been recommended against the subjective sensations caused by cutaueous diseases, but its influence in this respect is liable to certain exceptions. In most instances we do find that the itching is relieved or altogether removed by the inunction of this substance. Sometimes, however, an exactly opposite effect is observed, the itching becoming insupportable; and yet there may be nothing in the objective symptoms to explain the peculiar action of the tar in such a case.

"Moreover, when tar is robbed into the skin of the whole body, there arise symptoms which prove incontestably that it is absorbed into the blood, and discharged by the excretory organs, and particularly the kidneys and the intestines. In some persons these symptoms appear within half an hour; in others only after a longer interval, perhaps three or even six hours after the inunction of the remedy. They vary in different cases. Sometimes the patient vomits a black fluid; sometimes he passes black foots; sometimes (and most frequently) he voids urine which, though transparent, is of a dark olive-green color, or even as black as ink and possesses a distinct tarry odor, made still more evident by the addition of a few drops of sulphuric acid. In several cases in which I have employed inunctions with tar, it has thus been excreted in the urine and in the faecal evacuations, and this fact is interesting to physiologists as proving that, even while the epidermis is uninjured, it is possible for substances to pass through the skin and be absorbed into the circulation, and also as being opposed to the hypothesis that bodies in the state of vapor can alone penetrate the cutaneous tissues. One of the Viennese chemists who supports this hypothesis has, indeed, stated with reference to this point, that black urine is excreted, not only by those who have actually been rubbed with tar, but also by those who are in their neighborhood, as, for instance, by patients occupying the adjacent beds in a hospital ward. But although I have many times looked for such an occurrence, I have never succeeded in observing it. In my clinique black excrements smelling of tar have been passed by those only to whom this substance had been applied, and never by any other patients or by any of the nurses who were constantly in the ward. This surely goes to prove that the tar is absorbed as such by the skin, and not in the gaseous form through the lungs.

"The entrance of tar into the blood is by no means unattended with signs of reaction. Sometimes the patient is attacked by shivering; sometimes he suffers from nausea and vomiting, and from oppression of the head; sometimes he passes several fluid evacuations soon after the application of the remedy. These unpleasant symptoms are, however, never of long duration, and subside entirely when free diuresis has established itself. And they may very easily be obviated by making the patient (both before the tar is rubbed in and afterward) take plenty of water, eau sucree, tartaric acid, or some other diuretic, so as to increase the quantity of his urine. When tar or any of its preparations, instead of being rubbed over the whole body, is applied to certain parts of it only, the effects I have been describing are never observed.

Before applying pure tar or any preparation of it to the skin, it is necessary that the morbid products which are present in greater or less quantity should be removed. In treating a case of psoriasis, for instance, the scales must first be detached, in order that the tar may be brought as intimately as possible into contact with the vascular structures of the integument. Hence, to attain a successful result, it is always requisite before using the tar to place the patient under one or the other of the above-described methods of treatment, by which the epidermis may be softened and the masses of scales removed. He may, for example, be kept in a bath for a considerable time, or subjected to the hydropathic method; or water-dressings may be applied to the parts affected. Afterward either of the above-mentioned kinds of tar may be applied, the best being the Ol. rusci. A small quantity of it is to be placed on a brush made of long bristles, and rubbed forcibly into the skin of the patient.*

* I am convinced that it is not a good plan to apply tar, as is generally done, in large quantities, and with but little force. The object should evidently be to bring the remedy as intimately as possible into contact with the skin; and this is. of course, effected more completely by energetic friction than by spreading a thick layer of tar over the surface.

"Now, when he has in this way had his skin impregnated with tar, the patient must not resume his ordinary dress, particularly if his underclothing is made of cotton or linen. For the capillarity of these fabrics favors the penetration of the remedy into their substance, and thus removes it from the surface of the skin. Hence, it is necessary to cover him with clothes made of textures which have little or no power of absorbing tar. Thus, a jacket and trousers of sheep's wool may be made beforehand, and put on as soon as the inunctions of tar have been commenced. Or we may adopt another plan, and spread over the patient's usual bed a large blanket or (in the case of a delicate individual) a sheet made of flannel for the purpose. Upon this he is to be laid in a state of perfect nudity, after having been completely covered with the tar. The blanket may then be wound round him, or, if this be preferred, a similar one may be spread over him in such a way that he is completely enveloped in woollen coverings.

Thus clothed or wrapped up, the patient is to be left until the tar on his skin has become quite dry, which will take from two to six hours, according as one or another preparation may have been employed. When this has occured, however, he may be allowed to resume his ordinary linen and clothes, and need no longer be confined to his bed or even to his room. The same plan must be adopted, when, instead of pure tar, an ointment, soap, or alcoholic solution of the remedy has been used; but, as I have already mentioned, the period during which the patient must remain enveloped in woollen coverings varies according as the substance applied dries more or less quickly.

"This procedure is to be gone through once or twice daily, according to the severity of the case and the degree to which the skin is tolerant of the treatment. The same means which were employed before the first frictions may, with advantage, be repeated before each new application of the remedy for the purpose of removing the older layers, and so facilitating the penetration of a fresh quantity of tar into the skin.

"The changes which show that a preparation of tar is exerting a curative action on the affected parts of the skin consist in the red patches beginning to grow pale, and in the renewal of the scales taking place less quickly, and after a time ceasing altogether. There is, in fact, a gradual subsidence of all the morbid symptoms. When the diseased parts (in psoriasis, the patches) have lost their bright-red color, and acquired a brownish or yellowish red tint, and when the morbid growth of scales has entirely ceased, it is time to try the effect of suspending the application of the tar. And then, if at the end of a week or a fortnight no fresh redness has made its appearance, and no new scales have been formed - if the old patches continue to grow paler and their surface remains smooth and free from scales - we may in this case entirely discontinue the treatment, and wait quietly for the restoration of the skin to a per-fectly normal condition by the absorption of the deposits of pigment which remain.