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which constitutes the characteristic tubercles is destroyed, whereas the intermediate portions of healthy skin are scarcely acted upon. On the third day the application becomes very painful, and remains so for some time, even when the parts are dressed with a neutral salve like vaseline. Reaction in the surrounding tissues seldom occurs. Cicatrization of cauterized parts takes place in from one to three weeks, but is followed always by the development of new lupus nodules, which makes a frequent repetition of the application necessary. The resulting cicatrices are distinguished for their smoothness, whiteness, and softness. It seems to be effective in all forms of the disease. During three months of last year it was used exclusively in the clinic upon thirty-one cases, nineteen of which were discharged either completely cured, or greatly improved. In epithelial carcinoma its effects were somewhat doubtful, but Kaposi speaks of its action here as remarkably favorable.
Combination of Lupus and Carcinoma. In an able review of the histological relations of these affections, in explanation of their occasional combination, Kaposi concludes that the epithelial cancer takes its origin from the exuberant epithelial hyperplasy which characterizes lapus, while that later in its course the carcinoma may develop also from the connective-tissue corpuscles, exudation, and lupus cell elements.
Pruritus Vulvæ. - Dr. Thomas, of New York, in a lecture on this subject, states that leucorrhoea is usually at the bottom of the trouble, and this of that peculiarly acrid variety which causes stinging of the finger after a vaginal examination, or which gives rise to urethritis in the male after connection, which can only be distinguished from that of a specific character by its short duration and easy curability. If in any case it is desired to test whether vaginal leucorrhea is the cause of pruritus, the vagina may be thoroughly tamponed with cotton, which should be thoroughly saturated with glycerole of tannin. If it is really the cause, this mere damming up of the discharge will make the matter clear, for in twelve hours the patient will experience the greatest relief from her suffering. The Botanical Relations of Tricophyton Tonsurans. — Dr. Atkinson, of
- , Baltimore, publishes the valuable results of his cultivation of the fungus in tinea tricophytina (ringworm). His experiments were carried on with extreme care, and were as free from error as it seems possible to make them. Although germination was very slow when thus conducted, the results, when not negative, were uniform, “ invariably a multitudinous and simultaneous outburst of hundreds of spores.” Hyphæ were then thrown out in abundance from the spores, which branch and interlace, and with the mycelium generate sporangia. Although foreign growths penetrated the culture cells from without and developed luxuriantly, they were easily distinguished from the vegetation of tricophyton. Dr. Atkinson concludes from his investigations that the latter is to be assigned to the mucors. The importance of such trustworthy studies of the botanical nature of the parasitic fungi of man cannot be overestimated,
1 Wiener med. Wochenschr., No. 44, 1878, in Viertelj. für Derm. und Syph., vi. Jahrg. 1 Heft.
2 Vierteljahresschrift für Derm. und Syph., vi. Jahrg. 1 Heft.
for it is by such means alone that our utter ignorance concerning them is apparently to be enlightened. Some of the work done in this direction has been so unscientific, and the hasty conclusions published as demonstrated facts are so entirely unreliable, that this branch of study has fallen into undue discredit. We are pleased to know that Dr. Atkinson is engaged in similar investigation of the other vegetable parasites of the human skin.
Demodex Folliculorum. Neumann contributes the results of his study of this animal in dogs and swine. As is well known, it produces no visible effects upon the skin of man, although of very common occurrence. Upon these animals, however, it produces various forms of disturbance, firm, yellowish globular elevations resembling milia, nodules, pustules, crusts, superficial ulcerations, cicatrices, and pigment deposits, with loss of hair. In a single follicle of the hog he has found from one hundred to two hundred animals; also great numbers in the glands of the dog. For the effect of these parasites upon the skins of oxen see report in this journal of June, 1878.
Albuminuria from Styrax Inunction. — Unna publishes? the results of a methodical examination of the urine of one hundred and twenty-four patients with scabies in the Hamburg hospital during their treatment. The latter consists of the inunction of an ointment of styrax three times in thirty-six hours, the patient remaining in bed wrapped in woolen blankets in the mean while. The examination was made on the first and third mornings, and in nine of the cases there was discovered a considerable quantity of albumen, which, however, rapidly disappeared. This, in Unna's opinion, is to be accounted for by the absorption of the balsam into the circulation and its passage into the urine.
PENNSYLVANIA STATE MEDICAL SOCIETY.
The thirtieth annual convention of this society was held at Chester, Pa., from May 21 to 23, 1879. It was one of the largest meetings that had ever assembled in the history of this association, and had nearly two hundred members in attendance. After an address of welcome by Dr. Ulrich, of Chester, of the committee on arrangements, Dr. Charles T. Hunter, of Philadelphia, read the annual address on Surgery, which carefully reviewed the recent progress in this department of medicine. In discussing the treatment of wounds of the soft parts, he insisted upon the observance of three especial principles : (1) early arrest of hæmorrhage, (2) free drainage, and (3) absolute rest. He declared that in order to secure good results it is essential to recognize the causes that retard healing, among which are prominently placed (1) the presence of a foreign body, (2) hæmorrhage, (3) separation or retraction of the sides of the wound, (4) disturbance of wound by voluntary or involuntary movements, and (5) retention of discharges which are liable to undergo de composition. The success of any plan of treatment will, cæteris paribus, mainly depend upon the surgeon's power to prevent or render nugatory all of those causes that have been found so adverse to primary union. The first step
1 Viertelj. für Derm. und Syph., vi. Jahrg. 1 Heft, from Anz. d. Ges. d. Aerzte in Wien, No. 7, 1878.
2 Viertelj. für Derm. und Syph., vi. Jahrg. 1 Heft, from Virchow's Archiv.
in the treatment is the removal of all foreign bodies, including blood clots, both large and small, which if allowed to remain would inevitably interfere with immediate union. “A still more cogent reason for the removal of all clots is the fact that minute coagula (which are always to be seen scattered over the fresh surface of a recent wound after active hæmorrhage has been checked) conceal small vessels that are liable to bleed again so soon as the wound is closed and reaction established.” Inasmuch as the result of secondary hæmorrhage is to separate the walls of the wound by a coagulum, or to persist until the surgeon opens the wound and secures the vessel, the lecturer advocated the reopening of the wound as soon as the hæmorrhage is detected, if bleeding take place early, in order to turn out the clots, even if the hæmorrhage have spontaneously ceased. Should any bleeding points be detected, he recommended the application of a fine catgut ligature cut short.
Where a drainage tube is used the need of opening the wound for the removal of clots is not so imperative.
Among hæmostatic agents the ligature is placed first; and although torsion, theoretically, has superior advantages, yet it was doubted whether surgeons generally could ever be persuaded to repose as much reliance in it as in the ligature. There has not been sufficient evidence adduced to prove that the thread ligatures favor septicæmia by lecoming saturated with the discharges, as has been asserted. The so-called catgut ligature 2 of Professor Lister was recommended as possessing all the advantages of torsion (by not acting as a foreign body), added to perfect reliability. The gut-cord is aseptic and unirritating, and becomes finally softened and absorbed. He also recommended the approximation of large nerves and tendons by fine animal ligatures. In a large wound some provision should be made for drainage; when this is provided for the dressing should be disturbed as little as possible. After dwelling upon the importance of accurate coaptation of the edges of wounds, by rather an excess of sutures than too small a number, he insisted upon the immobilization of the surrounding parts; to secure this in wounds of the extremities the first joint above and all the joints below the injury should be fixed. This he declared to find its especial application in gun-shot wounds. He advocated dry dressings of the simplest character, such as patent lint, absorbent cotton, charpie, and carded oakum. “The substances that will most readily absorb the discharges as they flow from a wound are the best agents that we have for supporting the sides of the wound and for affording gentle compression.” The latter point, that is, that of producing gentle methodical compression, is of great service in aiding early union.
In conclusiou, the importance of the daily use of the thermometer as a guide to the condition of the patient after operation and the state of the wound was dwelt upon at some length. While the thermometer is normal (not over 100° F.) and the patient comfortable, there is generally no need to disturb the dressings, but should there be irritative fever the wound should be carefully examined. He had obtained such satisfactory results from pursuing the above precautions that he had not adopted the antiseptic system in its completeness.
At the conclusion of this address, Dr. William Goodell read a practical paper on The Extirpation of the Ovaries for some of the Disorders of Men
1 Made from the peritoneum of a sheep, and soaked in carbolized oil.
strual Life, in which, after referring to the causes of pernicious menstruation and its results, expressed by emaciation, suffering, hysteria, epilepsy, insanity, and a host of evils only to be terminated by the menopause, he discussed normal ovariotomy as a procedure calculated to give relief, and gave the clinical notes of four cases upon which he had performed this operation. Two of these were greatly benefited; one died; the other, who suffered from insanity, had not given signs of mental improvement, but her physical health was excellent?
Dr. Isaac N. Kerlin, of Media, read a paper on Juvenile Insanity, illustrating the fact that insanity may appear quite early in childhood, and that it is not unknown even at three years of age.
Dr. Charles S. Turnbull, of Philadelphia, exhibited a horse which had a living filaria (about five inches long) in the anterior chamber of its left eye, and read a short account of a case of intra-ocular, living cysticercus successfully removed from the eye of a man (forty-five years of age) by Dr. J. E. Garretson, of Philadelphia.
The annual address of the president, Dr. James L. Stewart, of Erie, was delivered on Wednesday evening, May 21st. The topic selected was the labors and achievements of physicians of past generations, which it was feared are too often underrated or forgotten by those of the present day.
Dr. Hiram Corson, chairman of the committee appointed to consider the subject, made a majority report on memorializing the legislature in favor of female superintendents for female departments of state hospitals for the in
A minority report was received in opposition to this project, in which the egregious folly of the measure was briefly but pointedly demonstrated. The majority report was received and adopted by a close vote.
Dr. John Curwen, of Harrisburg, read an interesting report from the committee on epilepsy and insanity.
Papers were also read on Cholera Infantum, by Dr. Ellwood Harvey, of Chester ; On the Diagnosis and Treatment of Fractures near the Joints, by Dr. John H. Packard, of Philadelphia ; Examination of the Usual Signs of Dislocation of the Hip, and an Inquiry into the Proper Course to pursue when the Dislocation is complicated with Fracture, by Dr. O. H. Allis, of Philadelphia ; and Fracture of the Lower End of the Radius, by Dr. Richard J. Levis, of Philadelphia, with a new radial splint.
In the afternoon, Dr. R. A. Cleemann, of the Philadelphia Board of Health, read the Address on Hygiene ; Dr. William Pepper presented a Clinical Contribution to Exophthalmic Goitre; and Dr. J. V. Shoemaker gave an account of some of the points in the external treatment of skin diseases.
Dr. Peter D. Keyser, of Philadelphia, read a report on the examination of some railroad employees for color-blindness, in which he stated that he had examined the train hands of the Philadelphia, Wilmington, and Baltimore, the Delaware, the North Pennsylvania, and the Bound Brook railroads, and had found that three and a half per cent. of the whole number mistook colors one for the other, that eight and a half per cent., although able to recog. nize the colors, were unable to tell the shades ; thus making twelve per
1 Dr. Goodell’s paper will appear in our next issue.
2 This will be subsequently described and figured in the JOURNAL in a clinical contribution from Dr. Levis.
cent. of those examined who were not quick and sharp in the noticing and distinguishing of all colors or shades. But of this twelve per cent. only three and a half were of such a character of defect as to make them really incapable and unsafe to fill the positions they occupied. In the examination several methods were used, so as to make no mistake. The method of Professor Holmgren, of Sweden, in testing with skeins of colored worsted, was first used ; then that of Dr. Stilling, in which colored letters on a black card are displayed, after which plates of colored glass are held in front of a gas flame in a darkened room ; and finally the different signal lamps used on the roads were brought before the men in various ways. The men were at first tested in the evening by gaslight, and those found in the least defective were reëxamined very carefully in daylight. The refraction of the eyes was observed iu each case with the ophthalmoscope and vision taken, and of the number examined 79.4 per cent. were emmetropic, fourteen per cent. hypermetropic, 3.9 per cent. myopic, and 2.68 per cent. astigmatic. Of the color-blind, fortyseven per cent. were emmetropic, thirty-five per cent. hypermetropic, twelve per cent. myopic, and 5.9 per cent. astigmatic. Of those who only shaded badly, 77.5 per cent. were of perfect vision, 17.5 per cent. hypermetropic, 2.5 per cent. myopic, and 2.5 per cent. astigmatic.
" It will thus be seen that color-blindness is not governed by any defect of refraction. Neither has age anything to do with this anomaly, for those found defective ranged from twenty to fifty-three years of age. Of these, 49.9 per cent. were green blind, 44.4 per cent. red, and 5.5 per cent. blue. Of the eight and a half per cent. defective in shading, ninety-five per cent. were so in
greens and five per cent. in reds. I have no doubt that the cause of these being so defective in shading colors is due to the want of education. None had ever been placed in a position or condition to handle and examine colors.
My attention was attracted to two peculiarities among those found colorblind. One was the fact that two men, who could not distinguish red from green on test, had educated themselves to know that red was an intense color, and thus distinguished bright red signals; but at the same time bright greens and other bright colors were red to them, and for such they said they would stop the trains, thus being on the safe side. But green they called a deep or dull color, and dark reds, dark greens, and browns were all green to them, and they would pass them by as signifying that all was right. The other peculiarity was the power of distinguishing bright red when held within three feet of the eyes, while at ten, twenty, and thirty feet it was invariably called green. In sorting the wools bright reds and light greens were picked out together for red. Vision was normal,
“ Last winter, with the assistance of Drs. Fenton and Fisher, I examined the boys of the Keystone Grammar School, one hundred and seventy-six in number, of whom eighteen were defective ; none, however, were really colorblind, but all were defective in shading. One said that all the dark shades of yellow were brown; with eight others purples were blues ; two said that dark green was brown; one took light browns for red, and the rest shaded badly in greens."
The paper was interesting and attracted considerable attention.