ON THE QUESTION OF BLASTOMYCOSIS OF THE SKIN AND ITS RELATION TO “FOLLICULITIS EXULCERANS SERPIGINOSA NASI” (KAPOSI.) Brandweiner. (Archiv f. Derm. u. Syph., August, 1904, p. 49. One plate.)

This paper is based on a case which occurred in Dr. Matzenauer’s clinique in Vienna. The patient was a shoemaker, aged 37 years, who suffered from a papillated crusted lesion on the lower part of the left side of the nose. The diseased patch occupied the ala nasi, and extended up as far as the bridge, where it faded into the surrounding skin. It was reddish-brown in colour, raised and irregular in shape, and covered with yellowish inspissated pus. It had been noticed first about a year before. On histological examination the stratum corneum was found to contain numerous unicellular organisms of from 4 to 10 µ in diameter, which stained with polychrome methylene blue, were doubly contoured and were believed to be blastomycetes. The epithelium had proliferated and presented small necrotic pustules containing these organisms. There was a round-celled infiltration in the corium in which the blastomyces was also detected. An attempt to cultivate the organisms and to inoculate them in lower animals was unsuccessful. On the ground of this not quite convincing case the writer took the opportunity of reviewing the literature on the subject. He referred in detail to several cases described by Kaposi with the title of “Folliculitis exulcerans serpiginosa nasi,” which he regarded as most probably identical with “blastomycosis.”

J. M. H. M.

A NOTE ON THE TREATMENT OF SYPHILIS. Jonathan Hutchinson. (The Practit., August, 1904, p. 145.)

In this short communication the writer refers at the outset to the remarkable fact that mercury obtained its reputation in the treatment of syphilis almost immediately after the introduction of that disease into Europe, and “the pills—which were known as Barbarossa’s, and of which a large quantity was furnished for the treatment of Francis the First—were probably essentially the same as those which Messrs. Burroughs Wellcome and Co. now supply by the million.” In opposition to a number of writers, especially on the Continent, the writer is a strong advocate of the early use of mercury, and of what has been called the “suppression treatment.” He commences mercurial treatment immediately the syphilitic character of the sore is definite. The prevention of late or tertiary phenomena being the most important aim in the treatment of the disease, efforts should be made to this end, and he considers that the immediate use of mercury, which may prevent the secondary stage from developing, has also the effect of reducing the possibilities of the development of the late stage. With regard to the length of time the patient should continue to take the mercury the writer strongly believes in the efficacy of prolonged and continuous treatment. He does not see the object of intermitting the course and giving the specific virus any chance of renewing its activity unless the mercury is interfering with the health of the patient. The plan of treatment usually adopted by the writer is as follows: “A pill is prescribed containing one grain of grey powder and one of Dover’s powder, and this the patient is to take after meals, and only three times a day at first. If no diarrhoea follows, the pill is to be given four, five, or six times a day.” The diet is regulated, and the patient is told that the treatment must be continued without intermission for a year at least. An alum mouth-wash is ordered to prevent ptyalism. If there is debility, a grain of quinine is added to the pill. In using the iodides he considers that the iodides of mercury are much less manageable than the two separated, and prefers to give the iodide of potassium in a fluid dose along with the mercurial pills.

J. M. H. M.

URANIUM IN THE TREATMENT OF LUPUS: A PRELIMINARY NOTE. Norman Walker. (The Scot. Med. and Surg. Journ., September, 1904, p. 207.)

The method of applying the uranium which was adopted by the writer was to prepare an oxide of uranium from the nitrate, incorporate it with a negative base such as bees-wax, and spread this on leather to form a plaster of the usual thickness and the required extent. The plaster is enclosed in waxed paper gummed at the edges. The uranium plaster was applied at first in cases where the limbs were affected with lupus and later on the face. Exposure for three days and three nights to an affected arm was followed by no reaction, but on the face it was found that a slight reaction followed in cases where the exposure exceeded twenty-four hours. The plaster may be worn only at nights and removed in the morning. The results have been encouraging, and the risks appear to be negligible. The treatment is cheap, since the cost of making the plaster has been estimated at about one shilling, and experiments have shown that the plaster remains active after four months. This short paper is illustrated by reproductions of four skiagraphs, one taken by thorium and the other three by uranium plasters. These demonstrate the fact that the radio-activity of the uranium salt is much greater than that of thorium.

J. M. H. M.

OBSERVATIONS ON THE USE OF EUCAINE B. AND ADRENALIN AS A MEANS OF INDUCING LOCAL ANÆSTHESIA. George L. Chiene. (The Scot. Med. and Surg. Journ., September, 1904, p. 215.)

In this communication the writer makes some interesting and instructive observations on the value of combining adrenalin with encaine or cocaine as a local anÆsthetic for minor operations. Satisfactory results were obtained by employing a mixture of a 2 per cent. solution of eucaine B. and 1-5000 adrenalin chloride, thirty minims of the solution being injected. The chief drawback to the method was the fact that adrenalin solutions did not keep well, and readily became inert and contaminated. This difficulty has now been obviated to a large extent by the introduction by Messrs. Burroughs Wellcome and Co. of a new preparation of the supra-renal gland called “Soloid Hemisine,” which is said to represent the hÆmostatic principle of the supra-renal gland in a more stable form. The writer has had compound soloids prepared by the same firm which when dissolved in 10 c.c. give a solution of 1 per cent. eucaine B. and 5 minim. of adrenalin (1-1000.) By injecting this a carbuncle the size of the palm of the hand was excised without pain or discomfort, and at a later date the surface was skin-grafted, the same anÆsthetic being used. The writer believes that the addition of the adrenalin not only increases the efficiency but also the safety of the eucaine or cocaine as local anÆsthetics.

J. M. H. M.

DERMATITIS FRAMBŒSIFORMIS. F. Sauerberger (Archiv f. Derm. u. Syph., October, 1904, lxxii, p. 3).

In this contribution the writer describes an unusual case which occurred in Professor Janovsky’s clinic at Prague. The patient was a coal-miner, aged 18 years. At the age of 14 he began work in a mine and soon afterwards he suffered from a severe attack of furunculosis, which persisted for a year. As it got steadily worse he had to leave his work for a time. When he was able to work again he got employment in another mine. After some time he went to the original mine and the furunculosis returned rapidly and he was again compelled to leave work. He blamed bad drinking-water as the cause of it. Several other miners in the same pit were similarly affected and among them was the patient’s father. Soon after leaving work for the second time the pustular lesions began to be replaced by raised papillomatous masses which were especially well-marked about the face and neck. The eyelids, forehead, tip of the nose, nasal orifice, lips, chin, and left side of the cheek became covered with crusted papillomatous lesions. A few similar lesions developed on the body in the inguinal regions, and both the cervical and inguinal glands were enlarged. A microscopical examination of one of the lesions showed a proliferation of the interpapillary processes, and a dense cellular infiltration in the papillary and sub-papillary layers, consisting chiefly of leucocytes and mast-cells and dilatation of the capillaries. The lesions did not react well to local treatment, but eventually with tonics and by persevering with local remedies a cure resulted. There was no history or evidence of syphilis. The disease was similar in many respects to tropical framboesia or yaws, and corresponded closely to a case which Lewin described as sporadic framboesia.

J. M. H. M.

ON THE RADIO-THERAPEUTICS OF RINGWORM. Sabouraud. (Ann. de Derm. et de Syph., July, 1904, p. 577.)

In a previous paper (published in January, 1904, in the Annales de l’Institut Pasteur) Sabouraud had proposed a method of treating ringworm with X-rays, which he sums up as follows: “The application in one sitting upon a given point of the scalp of a quantity of X-rays equal to 4-1/2-5 H-units of Holzknecht is made; fifteen days later a complete epilation will occur on the region treated, healthy as well as diseased hairs being shed. New and healthy hair will commence to grow ten weeks after the treatment, and will be completely restored within ten weeks. The infectivity of the disease will cease with the fall of the last diseased hair, within twenty-five days at latest of the treatment.” This formula, Sabouraud maintains, has been amply proved to be true by his experience of the six months which have intervened since his paper of January, 1904. Some very striking results are quoted. Thus while in six months before this treatment was adopted 57 patients were discharged as cured, in the past six months 134 such patients were discharged; moreover, a very large number of patients were treated without admission and also cured. An entire section of the hospital, consisting of one hundred beds set apart for favus cases, has been closed and will be converted to the uses of general medicine, as being no longer required for its former purpose.

Certain additional knowledge has been afforded by the experience of the past six months, which may be stated in the following practical rules: The penetration of X-rays is proportional to their number; the more penetrating they are, the more numerous they are. The danger of X-rays is proportional to their penetration; it is thus more dangerous to handle X-rays of 8°-11° (on Benoist’s radio-chromometer) than rays of 3°-5°. Now tubes change progressively with use and these changes are marked by colour changes in the glass. At first, after about ten hours’ use, the tubes take a violet coloration; with this there is no impairment of function. But with further use, after about thirty hours, a brown tint becomes marked, and the tube is said to be “smoked.” With this change it becomes increasingly difficult to obtain rays of a low degree of penetration. For epilation rays of all degrees of penetration serve equally well; rays of 3° are as effective as rays of 11°, but the treatment must be for a longer time. Thus a tube working at 3° caused an epilation in twenty-five minutes. The same epilation would result in eleven minutes from a tube at 8°-11°; and if one used the latter tube for twenty-five minutes, a dermatitis would result. This is entirely unnecessary for epilation and is attended by mischievous consequences, even when quite slight, and must be avoided. All forms of dermatitis, except that of transient erythema, produce permanent baldness. Permanent alopecia may also result without dermatitis in cases where the amount of X-rays given has been insufficient to cause epilation, and a second sÉance has been necessary. In this case certain hairs will have received a dose beyond the maximum for safety, and these will be permanently destroyed. For safe working, it is necessary to have a measure of the rays coming from the tube at any given time; and the measure must be constant for every variety of tube. This is obtained by certain colour changes taking place in specially prepared substances, these changes being proportional to the amount of X-rays derived from the tube. The pastilles of Holzknecht have been used for this purpose, but they are a secret preparation, expensive, and not everywhere procurable. Sabouraud has devised small discs made of paper which is the same as that used for screens and is coated with a preparation of platino-cyanide of barium. These discs change in colour in a fixed manner, comparable from time to time with test-colours, and their use makes it impossible, with care, to overstep the limits of safety.

E. G. L.

SYPHILIS AND CANCER. Etcheverry. (Ann. de Derm. et de Syph., August-September, 1904, p. 797.)

This research was undertaken in Audry’s Clinique at Toulouse, and the consideration of the connection between these two diseases was directed to the occurrence of lesions on the tongue and buccal mucous membrane. These facts are grouped in three classes, according as: (1) cancer supervened, in syphilitic patients, upon a preceding leucoplakia; (2) without leucoplakia, but in the presence of other local syphilitic lesions, such as gummata, scars of gummata, or of hard chancres; and (3) in the absence of all local signs of syphilis. Thirteen cases of epithelioma developing upon syphilitic leucoplakia are detailed under the first heading. This sequel is relatively frequent. In the second group twenty-two cases are noted. In the third group no direct transformation of syphilitic into epitheliomatous lesions could be established, but the fact of previous syphilis was ascertained in all the fifteen cases quoted. Etcheverry, struck with the singular frequency of association of the two diseases, speculates whether there may not be some direct predisposition in syphilitic patients, as such, to develop cancer. In epithelioma of relatively young patients he states that syphilis may almost always be found as a previous accident. The greater frequency of cancer of the mouth in men than in women coincides with the greater frequency of syphilis in men; according to Fournier, syphilis is eight times more common in males. Etcheverry hazards the suggestion that the cachexia produced by syphilis may be a directly provocative cause of ensuing cancer. As regards the treatment of these mixed cases of syphilis and cancer, the administration of mercury, preferably by injections of calomel, influences favourably the syphilitic element of the disease, and occasionally, as a temporary effort, the epitheliomatous development is checked by this drug. On the other hand, iodides are distinctly mischievous to the malignant growth, and should not be given.

It is probable that the same close connections obtain between cancer and syphilis of the rectum as has been here noted in the case of the mouth, but observations on this point are too few to be of value.

A very full bibliography is added to this careful paper.

E. G. L.

ON ADENOMA SEBACEUM. Buschke. (Derm. Zeitschr., Bd. xi., Heft 7, p. 467.)

The patient was a boy, aged 13 years, in whom the eruption of small tumours had occurred at the age of five, coming out suddenly after an attack of measles. The distribution and appearance of the single lesions on the face was of the characteristic type of reddish-brown nodules situated on the nose and contiguous portions of the cheeks. He had also numerous fibromata on the back, and a widespread eruption of small, pale yellow, seed-like tumours all over the back, the little tumours resembling milium, and on close examination appearing to be pierced by lanugo hairs. A histological examination of all classes of tumour showed them to be either pure fibromata or angio-fibromata, though Buschke admits that in the case of the face tumours the excision was so superficial that it is possible that deep sebaceous glands might be present below the point at which the excision took place. The boy was clever at work, and generally showed no physical or mental defect other than the presence of the cutaneous anomaly.

A. W.

ON THE PATHOGENESIS OF COLLIQUATIVE BULLÆ. Kreibich. (Derm. Zeitschr., Bd. xi, Heft 5, p. 315.)

After reviewing shortly the theories at present put forward for the production of colliquative bullÆ, Kreibich enters into great detail in the description of his experiments. He finds evidence that in Zoster hystericus there is an acute oedema consisting of fibrinous exudation which enters into the cells and causes their necrosis without separating them from their deep attachments. By irritating the same part three times running with the poison of urtica urens Kreibich was able to produce a colliquative vesicle, since the oedematous process then reached to the papillary body. Similar is the pathogenesis of true herpes zoster and in all probability of hydroa vacciniforme. To sum up the results of the investigation he states that “Colliquative bullÆ are found in processes which are allied to urticaria but differ from this in the greater duration of the vascular lesion and by its situation in the papillary body. The colliquation of the epithelium is produced by the action of an exudation rich in fibrin on the epithelial cells, which have suffered in their nutrition but which have maintained their connection with the cutis. The disturbance of nutrition is a combined result of the vascular lesion, the pressure of the exudation, and the resultant anÆmia.”

A. W.

FORMALIN AND ITS ACTION ON FAVUS MOULD. Bogrow and Scharkewitsch-Scharschinsk. (Derm. Zeitschr., Bd. xi, Heft 5, p. 329.)

This is the record of careful investigations of the action of formalin on the achorion, both culturally and on the diseased scalp. The results show the absolute futility of using formalin in a watery solution, but the authors think that further work on the action of spirituous solutions and vapour is desirable.

A. W.

ON A CASE OF ERYTHEMA NODOSUM OF UNUSUAL COURSE AND ATYPICAL LOCALISATION. Einis. (Derm. Zeitschr., Bd. xi, Heft 7. p. 493.)

A little boy, aged 2-1/2 years, was brought up with four slightly raised swellings, two, each as large as a half-crown, being situated symmetrically on the cheeks, and two, each as large as a sixpence, on the temples.

The history showed that exactly a year before the child had suffered from a similar eruption on the lower legs, and the doctor who treated the child for former attacks identified the eruption with the fresh one. The peculiarity in the course showed itself in the access of colour and pain in the nodes every day about noon, though there was no fever, and the child seemed to be in very good health with the exception of a few swollen sub-maxillary glands.

A. W.

SEVERAL CASES OF ATROPHY OF THE SKIN. Alexander. (Derm. Zeitschr., Bd. xi, Heft 5, p. 338.)

Four cases in all are alluded to in this paper. The first patient, a man aged 31 years, showed all the symptoms of an epidermolysis bullosa, with slight ulceration, but the affection was said to have begun at the age of 18 and only to occur periodically. The second case was that of an old woman, aged 70 years, who also had an abdominal tumour, of which she died. Material showed that there was a complete loss of the papillÆ, the elastic tissue had disappeared to only the slightest traces, and there were signs of inflammatory infiltration present. The third case was that of a woman, aged 55 years, with marked syringo-myelia; and the rash, which appeared as small nodules, terminating in atrophy, affected the axillÆ, the inner sides of the upper arms, the groins, the inner sides of both thighs, the back, and abdomen. The author says that one is tempted to connect this with the condition of the cord, but to do so is the purest theoretical speculation. The fourth case was a woman, aged 42 years, who showed on the left side of the nose a circular patch as large as a sixpence, over which the skin was of a bluish-red colour, and somewhat infiltrated. There were some scars caused by the therapeutic use of electrolysis.

(From the short description of this last case it does not seem clear why the diagnosis of Lupus erythematosus was not made.—A. W.)

A. W.

ON THE TREATMENT OE TYLOSIS PALMARIS IN ADULTS. Mayer. (Derm. Zeitschr., Bd. xi, Heft 5, p. 865.)

Mayer recommends the rubbing in of rheumasan, a salve-soap containing 10 per cent. of free salicylic acid. This should be massaged in for at least five minutes and then glacÉ gloves should be worn at night. The patient should be cautioned to discontinue the use of the drug for a few days on the first appearance of redness.

A. W.

PSORIASIS VULGARIS OF THE SKIN AND MUCOUS MEMBRANE, ITS PATHOLOGICAL POSITION AND ÆTIOLOGY. P. Thimm. (Monatsh. f. prakt. Derm., July 1st, 1904, p. 1.)

Dr. Thimm gives the history of a patient, a man aged 36 years, who had been under his care for five years. He had an obstinate recurring extensive psoriasis eruption of the skin of the trunk and limbs, typical psoriasis lesions of the upper and lower lips, extending on to the mucous membranes of the mouth and nasal cavities. In addition, the mucous membrane of the mouth showed, while he was under observation, various circumscribed diseased patches, setting in synchronously with the eruption on the skin, which also disappeared at the same time after general treatment with arsenic. Schimmer’s typical leucoplakia was also present, the patient being an immoderate smoker, and this continued in spite of all treatment. There were no signs of syphilis.

Microscopical examination of two mucous membrane lesions showed great oedema, enlarged intercellular spaces, thickening of the epidermal covering in toto, but a thinning of the rete over the elongated, high-reaching papillÆ. Small-celled infiltration of the upper layers of the corium, extending even up into the epithelium, was also present.

But what was not visible, nor present in any of the sections, was the parakeratotic heaping up of scales of the psoriasis lesions. Exceptionally this may be wanting in cutaneous psoriasis patches, but its absence is, as a rule, or even always, characteristic, in psoriasis of mucous membranes. In certain sections, however, the uppermost epithelial layers, one found, to a depth of three cell layers, were pressed together to form a dark-coloured narrow band, but having regard to the smooth contour of the surface this could hardly be looked upon as a partly developed scale. The pathological characters of any lesions are to a certain extent altered according to the position in which they occur. By the word “parakeratosis” is understood, apart from the heaping up of dry, scaly formations, a condition in which we find the following changes of the epithelium: parenchymatous oedema, extension of the basal horny layer, abnormally scanty fat contents of the same, want of keratohyalin, and abnormally good preservation of the nuclei. Such are, however, pathological changes of the external epithelium, but normal conditions of the mucous membranes. Parakeratotic changes of the mucous membranes of the mouth cannot be considered diagnostic of psoriasis. But the changes in the papillÆ, the infiltration of the upper layer of the corium, the widening of the blood-vessels, the dilatation of the lymph-channels, taken in conjunction with the clinical symptoms and the results of treatment, leave no doubt that the case was one of true psoriasis vulgaris of the mucous membrane of the mouth. Previously, very few cases of scaly lesions of the mucous membranes had been described, and in psoriasis of the skin the extensive and destructive infiltration seen in these lesions of mucous membranes is unknown.

The Ætiology of psoriasis, whether of the skin or mucous membrane, has been, and is still so hotly discussed, that the translator can but mention the author’s conclusion that the pathological picture of his case points anatomically to an inflammatory origin, and Ætiologically to a parasitic origin of psoriasis.

J. L. B.

ERYSIPELAS NEONATORUM GANGRÆNOSUM. E. Nohl. (MÜnch. med. Wochenschr., September 13th, 1904, p. 1648.)

The child was born on February 29th, and was apparently healthy at birth; she developed diarrhoea on the fourth day, and redness and swelling of the genital region on the sixth.

Seen for the first time on March 7th, the labia majora were much swollen, red and shining and painful. Both thighs presented a firm oedema and looked blue and marbled. There were frequent motions like pea-soup. On March 9th the temperature rose above normal for the first time and, with the exception of the first two evenings, when it sank below normal, it remained elevated till the child died, reaching 40° C. on March 11th, and 40·5° C. on March 15th.

On March 12th a large ulcer appeared on each labium following a bullous upheaval and casting off of the epidermis, and at the same time the skin over the trochanteric region on each side commenced to necrose. The oedema had involved the whole of the lower extremities, the affected parts being pale and flecked with blue; small bladders filled with yellow serum appeared on the dorsal surface of each foot.

Fresh areas of necrosis developed. The ulcers on the labia turned black. On March 15th the child died, with symptoms of meningitis. A post-mortem examination was not allowed.

The author discusses the differential diagnosis between erysipelas and oedema neonatorum. He quotes a passage from StrÜmpell, as well as a case of his own, to show that fever sometimes appears after the eruption in erysipelas. He further records the fact that there had been a great deal of infectious illness in the house before the birth of this child—severe measles, whooping-cough complicated by empyema, ulcerated throats with otitis media—whilst the mother developed parametritis on the second day.

W. B. W.