CHILBLAINS (or KisE; Erythema pernio)  , a mild form of frostbite, affecting the fingers or toes and other parts, and causing a painful inflammatory swelling, with redness and itching of the affected part . The chief points to be noticed in its aetiology are (1) that the lesions occur in the extremities of the circulation, and (2) that they are usually started by rapid changes from heat to cold or vice versa . The treatment is both general and local . In the general treatment, if a history of blanching fingers (fingers or hands going " dead ") can be obtained, the chilblains may be regarded as mild cases of Raynaud's disease, and these improve markedly under a course of nitrites . Cardiac tonics are often helpful, especially in those cases where there is some attendant lesion of the heart . But the majority of cases improve wonderfully on a good course of a calcium salt, e.g. calcium lactate or chloride; fifteen grains three times a day will answer in most cases . The patient should wash in soft tepid water, and avoid extremes of heat and cold . In the local treatment, two drugs are of great value in the early congestive stage—ichthyol and formalin . Ichthyol, 10 to 20% in lanoline spread on linen and worn at night, often dispels an attack at the beginning . Formalin is equally efficacious, but requires more skill in its use . It can be used as an ointment, 10 to 5o % fordelicate skins, stronger for coarser skins . It should be replaced occasionally by lanoline .

If the

stage of ulceration has been reached, a paste made from the following prescription, spread thickly on linen and frequently changed, soon cures:—Hydrarg. ammoniat. gr. v., ichthyol Ili,x, pulveris zinci oxidi 3 iv, vaseline ss .