olive oil 50, crude petroleum 100. Sig. Apply twice daily; or the following ointment, recommended by Lassar: B Hydrargyri sulfurati rubri 1.00, sulfuris sublimati 24.00, olei bergamottae gr. xxv, vaselini flavi ad 100.0. Sig. Apply twice daily. A condition of the eyelids is occasionally met with in school children which is apt to be considered a blepharitis marginalis. It is really a pediculosis of the eyelids due to the pubic louse, and is readily cured by soaking with olive oil, and then applying the well known Pagenstecher's yellow ointment. Of course, it is with the nits, in pediculosis capitis that the great obstacle to a cure is encountered, and the author's experience leads him to say that there is no one drug which will hold out any hope of rapid removal. With boys, the hair should be clipped short, while, with girls, clipping the hair should be the last resort. "Tight braiding in the class-room and unbraiding at home for care and treatment should be insisted upon." The only plan for pronounced cases is the patient, persistent, painstaking, removal of the nits, strand by strand, with the hand or fine comb. Education of the parents to the nature and cure of the trouble is of the utmost importance. For the associated, or independent, impetigo contagiosa, he recommends the usual white precipitate_ointment (5%) in unguentum diachyli. (The editor has always found white precipitate 2% in vaseline sufficiently strong.) For localized spots a protective dressing of ichthyol collodion (10%) is excellent. The individual lesions heal and dissemination is guarded against. This remedy, however, may be objected to on the face near the scalp, and, of course, cannot be used in the hair.

In con

sidering tinea corporis he warns against a condition which is often diagnosed as eczema, but which, he says, is due to the trichophyton. It consists of more or less irregular, scaly, ill-defined, eczematous looking patches on the face, and sometimes three or four cases are found in one class-room. They yield usually to sulphur or white precipitate ointment. For ring worm of the body, he reports excellent results from the use of formalin, 40% solution diluted two or three times. Several applications are frequently sufficient. sensitive skin, it is well to avoid vigorous rubbing, and, if the smarting or burning is intense, the application of ammonia water will give relief. He has had the usual discouraging results with tinea tonsurans, but has found the 40% formalin solution useful bere, too. A form of ring worm of the scalp that is often mistaken for eczema, with corresponding rebelliousness to treatment and danger of spreading, is evidenced by many disseminated, small areas, which are dry and

scaly and without much apparent loss of hair. There is, also, a sharply defined and marginated eruption, occurring on the upper or lower lip, or both, in school children. It is caused by lip sucking, or by the intermittent protrusion of the tongue, and its excursion over the upper and lower lip. A constant source of irritation is thus afforded, and a suitable soil for fungus growth. Diluted white precipitate ointment will cure the condition, provided the lip sucking habit is discontinued. In the treatment of scabies, he has abandoned the usual sulphur ointment. Instead, after the preliminary bath with green soap and hot water, the patient is furnished with powdered sulphur, and told to rub this thoroughly into the affected regions twice daily, and to dust a quantity into the bed sheets before retiring. more cleanly than the usual ointment treatment, and, he claims, less irritating and more rapid in its results. After the itching is controlled, the following ointment, recommended by Kaposi, is applied twice daily: R Beta naphtholi, cretae albae aa 10.0, saponis viridis 50.0, axungiae porci 100.0. He oloses with a plea for the more careful epilation and treatment of cases of tinea tonsurans, and the necessity of such patients being required to keep their hats, books, pencils, etc., separate from those of other scholars, if they are not excluded from school until cured. They should, of course, have individual towels, soap, combs and brushes.

It is

Pur

The Erythema Group of Skin Diseases.Brayton (Indiana Med. Jour., Nov., 1905) calls attention especially to the visceral and nephritic lesions so often associated with this interesting group of troubles whose correct diagnosis is often so difficult, and the nomenclature of which is so confused. pura, angio-neurotic edema, urticaria and simple erythema are often quoted as the skin manifestations in these cases, which are admitted to hospitals suffering, also, with arthritis, severe, and often paroxysmal, attacks of abdominal pain, albuminuria, hematuria, and vomiting of blood. Of course, not all of these are present in each case. Sometimes only one is, sometimes several. In several cases operated on, the findings were, dark patches in the intestinal walls, due to extravasated serum and blood. In one case, which ended fatally, there was hemorrhage into the wall of the colon, leading to paralysis of the affected part, and to increased muscular contraction, with colic, in the adjoining part of the bowel, and a consequent intussusception of the cecum and adjoining portion of the ileum into the colon. Gangrene and acute general peritonitis were the immediate cause of death. Osler

says that the subjects of the erythemas, with visceral manifestations, are usually by young. Twenty-one out of twenty-nine cases collected by him were under twenty years. Seven of the twenty-nine died, proving the condition to be a serious one. As regards the causes of these affections, certain diseases are known to be frequently associated secondarily with definite skin lesions. Severe purpura goes with Bright's disease; urticaria and purpura with cirrhosis of the liver; urticaria with asthma; and all forms of erythema with chronic valvular heart lesions of children. Urticarias are usually due to autotoxins of gastrointestinal origin, which Osler says may be bacterial, protozoal, vegetable, or metabolic in character. To quote the same author, "It is not likely that the poison in itself, of whatever kind, is of less intrinsic importance than certain transient aspects of cell metabolism, for there is no constancy of action of the same poison in different persons, or even in the same person at different The chronic forms of urticaria probably illustrate a morbid and persistent sensitiveness of the cutaneous vessels to poisons of either intestinal or tissue origin." The local status is also important, and a peculiarity may be transmitted through several generations, as in angioneurotic edema, which is only urticaria "writ large." Here there must be either a morbid susceptibility of tissue, or an inherited peculiarity of metabolism, or both combined. "The relation of the erythema to infective processes is interesting. Certain types of exudative erythema behave like an acute, febrile disease, there may be symptomatic erythemas. Many of the graver cases of purpura have followed an acute infection, puerperal fever, gonorrhea, otitis media, etc. The rheumatic poison is responsible for many cases. But in the large group of cases persisting for years, an infective process is out of the question." The complications of the erythema group fall under two classes: (1) the angioneurotic, (2) the inflammatory. To the former belong the swelling of the fauces, edema of the glottis, changes in the bronchial mucosa causing asthma, and the colic, which is due to the localized edema of the gastro-intestinal walls. To the inflammatory group belong the more serious complications, endocarditis, pericarditis, pleurisy, pneumonia, and nephritis. edema of the glottis may cause death. Both croupous and lobar pneumonia have followed an exudative erythema. Endocarditis and pericarditis have occurred in connection with intense arthritic purpura. As would be expected gastro-intestinal symptoms are the most common features of the group, but the renal complications are the most fatal.

The

Of

the seven deaths in Osler's 29 cases, fire were from uremia. The poisons, whatever they are, that cause the erythema cause also the nephritis, which comes on, as a rule, at the height of the skin lesions, or even as late as a week thereafter. Of a series of 14 cases in which nephritis developed, five died of uremia. In four, purpura alone, as a skin inanifestation, was present; others had mixed types, edema and urticaria, but purpura also occurred in thirteen of the fourteen cases. Arthritis is, of course, a frequent complication, but is often quite independent of the rheumatic poison. There is undoubtedly a toxic, or blood factor in the causation of these serous and sero-sanguineous effusions such as urticaria, erythema, erythromelalgia, and even purpura, but they may be caused by the same factors that determine undoubted nervous manifestations, the effusions being due certainly in part, and perhaps sometimes entirely, to the neuro-vascular irritability and irregularity which form the essential element of nervous (hysterical) conditions. "The hysterical patient (in this sense) has lost his vasomotor equilibrium, and is the victim of a vasomotor ataxia." "It is, then, a question of dual causation, and both the toxic and the neuro-vascular factors are met with in diferent proportions in different cases, just as they are met with in epilepsy and other neuroses in varying quantities."

Some Practical Points in X-Ray Therapy.Gray (Southern Medicine and Surgery, Dec., 1905) suggests, as an explanation of the occasional failure of the X-ray in cases of superficial epitheliomata, in the aged, that, in such cases, the tissues offer such low resisting power that the invading element, be what it may, finds little difficulty in spreading to the adjacent structures and deeply infiltrating them with the process of disease, and that the insufficient administration of the X-ray (which loses to a degree its destructive effects in passing through the superficial tissues) acts only as a stimulant on the disease-producing factor, and, so far from a cure, an increase in the rapidity of the growth will be the result, just as heat, in a moderate degree, acts as stimulant to cell growth. these cases, treatment should be begun with energy, and penetrating, prolonged exposures should be given, at frequent intervals, in order to speedily produce the desired destructive action on the disease-producing element." However, the inability of the tis sues to repair, in the aged, when a destructive effect has been produced, causes often a tedious recovery, and the physician is fortunate if pyogenic infection does not complicate the field, and further retard the healthy

"In

repair aimed at. He believes that the occasional failure in persons of middle age is due to lack of an accurate estimation of the condition, and a failure to properly administer the doses. He has had unusual success in the treatment of lupus vulgaris, psoriasis and chronic eczema with this form of therapy.

THERAPEUTICS.

W. T. HIRSCHI, M.D.

Ovoferrin.-Dr. Schram (Die Therapie der Gegenwart, Dec., 1905) administered ovoferrin to 100 patients in the polyclinics of Professors Litten and Klemperer, Berlin. Sixtytwo cases of chlorosis varying from mild to severe forms, received from one-half to one ounce ovoferrin from two to nine weeks, depending on the severity of the case, and in almost every one a decided increase of hemoglobin was observed. Thirty-five cases of anemia, partly primary, and some occurring in tuberculosis and gastric ulcer showed a decided improvement in hemoglobin and red blood corpuscles under the use of ovoferrin. Two cases of pernicious anemia and one of leukemia were not benefited by ovoferrin. The majority of patients could easily take ovoferrin, their appetite improved and constipation never occurred as a result of ovoferrin.

Remarks about Orthostatic Albuminuria.— (Dr. Loeb, Therapie der Gegenwart, Dec., 1905.)-Edel concludes from numerous experiments made in healthy individuals, that sodium chloride is more rapidly eliminated by the kidneys in the horizontal than the upright position, and the writer proves that the opposite is the rule, however some exceptions occur. Edel believes less chlorides are eliminated in the upright position on account of the poorer renal circulation.

So

dium chloride and water are eliminated in the glomeruli, while some water, urates, phosphates and a small amount of chlorides are eliminated in the tubules. Decreased blood pressure affects the glomerular secretion more than tubular secretion. Glomerular secretion usually is alkaline, and tubular acid. The author believes vascular renal circulation is better in the upright than in the horizontal position.

Spinal Analgesia.-Tuster (Beitr zur klin. Chirurgie, Vol. XLVI, No. 1) reports 235 patients anesthetized with spinal injections of tropococaine. The full physiologic effect occurs from forty-five minutes to one and onehalf hours. They should not be made in septic patients on account of the autointoxication. The injections are made between the

2d and 3d lumbar vertebra by first removing about 7 com. of cerebro-spinal fluid, in which is dissolved 0.07 gram of tropococaine, and then injected. Nausea and vomiting, collapse and incontinuence of stools and urine at times occur during the operation. Not all patients will respond to the injections. The analgesia is most pronounced in the lower extremities. At times a slight rise of temperature occurs after the injection. Better results are obtained if cerebro-spinal fluid is used for a solvent than if normal saline solution is used.

The Treatment of Incarcerated Hernia. Dr. Boix (Deutsche Med. Wochens., No. 27, 1905) uses ethyl chloride spray locally in preference to ether on account of its more rapid and intense action, producing a local anemia and diminution in the size of the tumor and a dilation of the ring. This method is to be used in cases before resorting to an operation or where an operation is reThis fused, or impossible to perform. method may be entrusted to the patient to be used until the arrival of a physician.

The Prevention of Vomiting in the Use of Anthelmintics.-Apolant (Deutsche Med. Wooh., No. 44, 1905) administers one to two powders of menthol and sacch. lactic aa 0.3 from one-fourth to one-half hours before the anthelmintics are given, and he has rarely observed any nausea or vomiting, even if male fern or pomegranate were used. Otherwise the same precautions and directions should be followed as is usual with these remedies.

Edema of the Feet and Legs as a Result of the Excessive Use of Sodium Chloride.-(Bryant, Practitioner, No. 8, 1905).-An apparently healthy individual complained of edema of the feet and legs, and the writer after a thorough examination of the urine found nothing abnormal except a large increase of sodium chloride. All other organs were normal. As the patient consumed about four times the usual amount of salt in his food, the writer advised him to use much less salt, with the belief that this caused the edema. After three weeks the edema entirely disappeared and the urine contained a normal amount of sodium chloride.

Thiosinamin in Scar-Contractions. (Dr. Mellin (Deutsch Med. Woch., No. 5, 1905) reports a patient with extensive scar-contractions of the face and arms as a result of burns which was decidedly benefited by the use of thiosinamin injections. Thiosinamin is used in 15 to 20% alcoholic solutions, begininng with one-third syringe and increasing it to one, or if these produce pain a 10% aqueous

The in

or glycerine solution may be used. jections should not be made in the area of the cicatrix, or while there is any inflammation, as they would exaggerate the trouble. The writer has used twenty-five injections in a single individual.

The Treatment of Gastric Ulcers and Gastric Hyperacidity.-(Kohler Vienna Med. Woch., No. 21, 1905.)-Pyloric spasms due to ulcers or fissures are quickly relieved by the administration of olive oil. The oil has a soothing action on ulcer or fissure, thereby overcoming the spasm and pain, and indirectly reducing the secretion. On carcinomatous ulcers oil acts as an anesthetic, and is also somewhat nourishing. To patients who object to the taste and smell of olive oil, it may be administered in gelatine capsules, or with some more palatable substance.

The Present Method of Treating Fractures. -(Martens, Therapie der Gegenwart, No. 12, 1906.)-A correct diagnosis is most essential for the successful treatment of fractures, and after a careful consideration of the classical symptoms of fractures, i.e., deformity, abnormal motility, crepitation, extravasation of blood, pain and impaired function an X-ray picture will be of great assistance. The X-ray also should be used after the bones are placed in proper position. The fracture should be set as soon as possible and an anes thestic used if necessary. The limbs are placed in such a position that if ankylosis occurs the patient can derive the greatest. benefit from the limb. Plaster of Paris or splints are usually preferable to any other means of fixation. Cotton padding is generally applied over the skin, but frequently this is unnecessary, and is not advisable in hot weather. Limbs which are encased should be elevated to prevent swelling, and if necessary the cast is loosened. The first cast remains from one to three weeks depending on circumstances, and massage and passive motion used as early as possible to prevent muscular atrophy and ankylosis. At times extension is necessary (especially in fractures of the femur). At times the fractured ends. must be sutured in order to hold them in position, e.g., patellar fractures, and olecranon fractures and pseudoarthrosis. Great care must be exercised in suturing to prevent infection. In compound fractures all foreign material and bone splinters are removed, and the wound is well drained. The complications of fractures, e.g., shock, fat emboli, delirium tremens, thrombosis, injury to nerves and blood vessels must receive close attention. The after-treatment is very important, and consists of proper massage, active and passive motion, baths, electricity, etc.

SOCIETY PROCEEDINGS

MEDICAL SOCIETY OF THE NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL.

Stated meeting held January 8, 1906. The President, Dr. J. J. MacPhee, in the chair.

URETHRAL FISTULA AND PROLAPSED KIDNEY.

The

Dr. Charles H. Chetwood showed a patient on whom he had operated two years ago for urethritis and who at the present time had an incomplete fistula. When first examined his symptoms seemed to point toward the urethra and prostate, the latter being about the size of a small orange and very hard. The history indicated a gonorrheal infection, and, apparently, a syphilitic abscess of the prostate. The patient urinates every half hour, day and night, and the bladder contains about twelve ounces of residual urine. appearance of the urine is indicative of kidney pus. Both kidneys are prolapsed and the right one is very palpable, enlarged and tender. The interesting feature of the case is the prolapse of both kidneys without any apparent explanation. There is no tuberculous history and none suggestive of kidney disease. The speaker's intention was to drain the prostatic abscess through a perineal incision, examine the bladder through the opening, and possibly catheterize one of the ureters.

SYRINGEMYELIA OR LEPROSY?

Dr. A. J. Bodine presented this patient. She was 21 years of age, and her family history was negative. About six years ago she first noticed that she was unable to distinguish the impact of the soles of her feet against the sidewalk and began to have aching pains in her feet and legs. Later, pus formed beneath callous spots on the feet and discharged, leaving sinuses leading down to the metatarsal bones. Rest in bed healed the sinuses, but on resumption of her occupation they reopened. Three years ago her feet began to pain in the axillae and in both groins. Pain was also present in her spine from the neck to the coccyx. She was operated on for the contractures of the feet in 1902. feet in 1902. Her general health is now fair. The soles of her feet are covered with multiple perforating ulcers. The discharge is thick, brown in color, and has a peculiar sickening, penetrating odor. There is an abscess under the skin in one thigh and another over the sacrum. There are marked motor and sensory disturbances of the feet and legs. The case was presented for diag

nosis, which the speaker thought lay between syringemyelia and leprosy.

Dr. W. B. Pritchard said that, he considered this patient an example of syringemyelia presenting the exception in a distribution of symptom in the lower rather than the upper extremities, though both were involved. The trophic disturbances in the feet, with bladder symptoms, scoliosis, and, finally, dissociation sensory phenomena, indicated with fair clearness the diagnosis. It was not leprous neuritis, as the nerves showed no bulbous enlargements and the skin was quite free from the characteristic plaques. Tabes had been suggested, but there was little in the symptom picture to sustain such a suggestion. Absence of the Arygl-Robertson pupil, the persistence of one knee jerk, with absence of true ataxic gait and characteristic pains were collectively conclusive in negation.

The paper of the evening was read by Dr. Andrew R. Robinson, and was entitled

THE TREATMENT OF SYPHILIS.

He referred to the different views held on the subject of the treatment of syphilis, and stated that he would endeavor to show that syphilis is a serious disease in a considerable percentage of cases, and especially on account of the tendency after immunity is reached to fatal parasyphilitic affections; that the tendency to these parasyphilides depends as a special predisposing factor upon the dyscrasic condition accruing in the active contagion stage; that the intoxication producing the dyscrasia and leading to immunity often is most severe in the period between the rec. ognition of the primary sore and the appearance of lesions upon the cutaneous surface, and, there, that syphilis should be treated actively as soon as a positive diagnosis of the disease is made.

The object of such treatment is to inhibit the life action of the organism, so that only a small amount, comparatively, of toxin is produced, giving immunity with only a mild dyscrasia, and producing a minimum amount of injury to the tissues, and consequently a comparatively slight tendency to parasyphilides, or even tertiary lesions. He maintained, also, that in the acute infectious stage it is a rule that the less toxin produced in a given case, the earlier the system acquires the condition of immunity; and in syphilis this is important not only for the individual affected, but also from social standpoint, as the sooner immunity is obtained the less danger of contagion to others.

An example of early immunity is that acquired by a mother in a case of parental syphilis, when she is not invaded by the syphilitic organisms, but acquires immunity by

toxins from the fetus. Under these circumstances the amount of toxins passing to the mother must be small in quantity, and therefore the immune condition is acquired in a comparatively short period as compared with the time necessary in acquired syphilis.

Syphilis is a serious disease, not only on account of the liability to fatal parasyphilitic affections, as locomotor ataxia, but also on account of its destructive action of the progeny of syphilitic parents when produced during the active stage of the disease, hence the shorter this period exists the fewer syphilitic children are produced.

If the tertiary and parasyphilides depend very greatly, or principally upon the severity of the dyscrasia, and this condition upon the amount of intoxication, that is, the amount of toxins produced, and this upon the number and activity of the syphilitic organisms in the system, it follows that in this special parasitic affection the treatment of syphilis must be based upon the microbes, the toxins preduced, and the ground of the individual affection. Proper consideration of these three points constitutes the fundamental basis for the best treatment of the disease until the last microbe is gone; hence the division of the disease into stages is not scientifically correct, although for clinical description it is of some value.

In the period between the appearance of the primary sore and the so-called secondary stage, represented by cutaneous lesions, the general nutrition of the person is lowered, fever is present in varying degree, the redblood corpuscles are diminished in number, the lymph glands throughout the body may be affected, the spleen swollen and tender, liver enlarged and the nervous system injured, as shown by the presence of neuralgia, headache, lassitude, pains in the joints, bones and periosteum, and occasionally by an extensive multiform erythematous eruption. This shows that before secondary lesions occur upon the skin there may be intoxication of the general system, which leaves its impress on the tissues and acts as the main disposing factor in the causation of parasyphilides. If this be true, it follows that treatment should be commenced in every case as soon as a positive diagnosis is made, and if this is done at a stage before cutaneous lesions appear, so much the better for the patient.

Existing lesions in the secondary stage are treated to lessen danger of contagion, remove deformity and save tissue, but surely it is better, more philosophical, to prevent the formation of lesions, especially as they are hot-beds for toxin formations than to wait until they are formed and damage has