on his urgent request and to satisfy my own desire, I wrote to the gentleman whose name was given in the paper. Within a few days thereafter I received from him a most interesting account of his sickness. While not at liberty to use this gentleman's name, I can, with no violation of trust, briefly quote his case. I am moved to do this that one more case may find its way on record, hoping thereby to arouse a little extra interest in the study of this malady, which is not only so mysterious in its etiology but, thus far, absolutely unyielding to any known method of treatment. CASE No. III.-W. U. C., male. While his mother told him he had it when a child his first recollection of having had it was in 1867. It did not trouble him again until 1879, since which time he has had eight attacks, varying from three to eight years apart. Its advent is generally ushered in with a chill, after which his hands and feet begin to swell, and his whole body turns a deep red. This redness lasts from six to forty-eight hours, after which an intense itching comes on and lasts until the skin of his hands and feet comes off. Extreme prostration is another symptom from which he complains. He further claims that quinine sulphate, grs. iv., or a small dose of belladonna, will excite an attack at any time. No other member of his family, nor any of his grandchildren have ever been afflicted with it, and he is positive that there is nothing about it that is in any way contagious. He further adds that after more than forty years of experimentations and disappointments with doctors, he has been forced to believe that none of them know anything about the disease or any relief for it. He kindly enclosed a specimen of epidermis, which was removed during one of his attacks. This you will find among my other exhibits, so marked as to identify it from those of my other cases. 67 E. MAIN STREET. CLINICAL REPORTS. Presentation of Specimens' BY J. HENRY DOWD, M. D., Buffalo, N. Y. PROSTATIC LOBES. CASE I. In presenting these two specimens which will speak for themselves (specimens shown). I merely wish to call attention to two or three points. It will be noted the three prostatic lobes weigh 26 drams, the weight of the normal prostate being about 6 drams. These were removed by the perineal route nine months ago and in a report from the patient May 12, 1909, he says: I can hold my urine from five to six hours and feel as well as when a boy." After most careful consideration of this subject, summed up from many perineal and suprapubic sections with observation of the cases of others, the writer would express his conclusions as follows: I. The mortality in prostatectomy is not high, but in many cases the condition following operation is far worse than it was before; I refer to rectal fistula, permanent incontinence, orchitis with suppuration, and the like. 2. Life, although accompanied by slight inconveniences, is usually far more acceptable than death, especially when the condition can be more or less modified and the distressing symptoms relieved by remedies judiciously employed. 1. Reported at the pathological section, Buffalo Academy of Medicine, May 18, 1909 3. Where life is almost a burden, even though the physical condition is bad, and in cases where early operation may prolong life, preventing serious complications, prostatectomy is advisable. PHOSPHATIC STONES. CASE II. These five stones which are of the phosphatic variety, weight 1980 grains. They were removed by the suprapubic route, a perineal tube being placed in the bladder for drainage. There was an uninterrupted recovery, in three weeks the patient being able to hold his urine four hours, and only an occasional drop appearing at the suprapubic opening. It is not so much the fact of the perfect result from operation that I would emphasize, but the prevention of recurrence of such a condition. This patient's urine before operation was alkaline, having a very low phosphatic index. It is well known that alkalinity favors the precipitation of phosphatic crystals; that we rarely find them in acid urine, in the absence of phosphatic calculus of the kidney or bladder. Acidity of urine is due to the acid sodium phosphate; therefore, to change the urine from an alkaline to an acid reaction is the problem. The treatment is most happily demonstrated by the phosphatic index, which in this case was very low. During the stay of three, weeks in the hospital the patient's neuroinedic condition was carefully attended to. Examination of the urine four weeks after operation showing acid reaction with the phosphatic index. gradually rising, and no crystals present. A 40 NORTH PEARL STREET. A Case of Erysipelas BY G. B. STOCKER, M. D., Buffalo, N. Y. MONG the three hundred or more mal-conditions which the practitioner is called upon to treat, there are few which tax his skill more severely than erysipelas. Because of the rapidly progressive and overpowering nature of the infection-its tendency to spread over a larger and larger area of skin surface and to surcharge the system with its toxins-treatment must be administered with dispatch. In a large proportion of cases erysipelas develops because the vital resistance of the patient has been lowered by disease or operation; for this reason the situation is particularly serious-this lowered resistance being a handicap to the patient which may easily prove disastrous. Therefore, the value of supportive measures becomes apparent. Absolute rest in bed, a nourishing diet, and stimulants of one kind or another are indicated. And later, during convales cence, bitter tonics do good service when recovery of strength is slow. Of the numerous special remedies recommended for erysipelas the one that has enjoyed the most favor is the tincture of ferric chloride. One writer speaks of it as follows: "The internal treatment of this disease par excellence is the plentiful use of the tincture of the chloride of iron-twenty to thirty minims-well diluted, four times a day." While apparently of some service, this drug is certainly not a specific for the disease and should be withdrawn if it disturbs digestion. The therapeutic status of antistreptococcus serum has not yet been definitely determined, but it has frequently been administered in severe cases with good results. The application of ichthyol is considered by many practitioners the best local treatment of this disease. It is usually employed in the form of an ointment-20 to 30 per cent.-in lanolin. I have used ichthyol in past years but more recently have taken up the organic peroxide. In the case under consideration this agent proved successful after ichthyol had failed to accomplish good results. An undertaker who had recently buried a man who died of erysipelas developed, two days later, a bad case of the disease. I was called in and treated the condition locally with ichthyol. A few days after my first visit I was hurriedly called and found the patient with a temperature of 106° and a fresh infection, beginning at the collar line and extending over the entire back, and, also, in streaks, from the shoulder down the chest. The patient could no longer tolerate the odor of ichthyol, he informed me, so, after consultation with Dr. Frank McGuire, who was called in, we decided to try acetozone. We made a solution of the drug-10 grains to one quart of hot water—and applied compresses dipped in this solution as hot as could be borne. These were changed every twenty or thirty minutes and continued all night; in the morning the temperature had fallen four degrees and the sick man was much improved. This treatment was kept up for thirty-six hours. In addition, a mixture of acetozone and collodion was painted on the streaks and along the borders, which procedure seemed to check the infection and to prevent its spread. The patient made an uneventful recovery. Others have reported equally good results from acetozone after applications of mercury bichloride, ichthyol and other remedies had failed to check the progress of the disease. I believe this drug deserves to be more frequently employed in erysipelas. 901 GENESEE STREET. SOCIETY PROCEEDINGS. Buffalo Academy of Medicine Reported by HARRY R. TRICK, M. D., Secretary. Report of the Commission on the Municipal Contagious Hospital: Your Commission on the Municipal Contagious Hospital herewith presents a summary of work accomplished for the purpose of the establishment of a hospital for Acute Contagious Diseases. We have at various times enumerated the reasons why such a hospital should be maintained: 1. Because people in fear of quarantine, if sending for a physician allow their children to go unattended; thus a focus of infection may ever be present for the dissemination of the disease. 2. When such cases are thus reported, the Board of Health placards the house: especially for variola, scarlatina, diphtheria, quarantine is maintained; the patient and all living in the same. dwelling are isolated. As at present conducted, quarantine, rigidly enforced without proper facilities for the segregation and treatment of communicable diseases, is a hardship on the following peoples. 1. If a case of infectious disease necessitating placarding occurs where shop and home are in the same building, business is stopped and the source of income is interfered with. 2. If a case occur in a boarding or lodging house, the house is placarded and the business ruined. 3. If a domestic employee becomes infected, the house in which such employee lives is quarantined, the children are not allowed school attendance and the business of members of the family is interfered with. 4. If occurring in the family of wage earners, their means of livelihood is stopped. 5. If occurring in the family of a char woman, the means of livelihood is stopped. 6. If, as so often happens, the disease develops in a tenement, its spread under conditions of crowding and unsanitary environment is great because the enforcement of quarantine is difficult and impossible. 7. Travelers and residents in hotels in the City of Buffalo are at once placed in a dreadful plight; they must leave the hotel within an hour's notice or the hotel is placarded; the law forbids them to hire a public conveyance without first notifying the owner of the conveyance of the purpose for which it is to be used; the law forbids them to leave the city or to go upon the public streets or in public places; they are not allowed to receive visitors. |