down; the respiration and heart-beat are arrested for a short time; it is unable to move, but consciousness is preserved. This is followed by deep intermittent respirations and regular heart action; the paralytic phenomena subside; there is vomiting and profuse perspiration. Sub cutaneous injections are painful, local anææsthesia developing at the end of some time. In intravenous injections the symptoms are similar, with a strikingly sudden drop of blood pressure. The alkaloid seems to act especially upon the medulla oblongata. F. R. DERMATOLOGY. IN CHARGE OF HOWARD FOX, M.D., Clinical Assistant in Dermatology, New York Skin and Cancer Hospital, and the College of Physicians and Surgeons. On the Present Position Jonathan Hutchinof the Leprosy Question son (Trans. 6 Internat. Dermatol. Cong.). Some new arguments are brought forward by Hutchinson to support his well-known theory that leprosy results from eating decayed fish, and not from contagion carried from one person to another. He has received many communications from different parts of the world in regard to his work on "Fish Eating and Leprosy." Most of his correspondents agree that the fish theory explains the facts in the regions with which they are acquainted. Some who do not agree with Hutchinson, and he admits that there are few avowed disciples of his theory, adduce certain arguments which the writer attempts to turn to his own favor. It has been claimed that in Basutoland, "The Switzerland of South Africa," leprosy is prevalent, whereas very little fish is eaten. The writer tells of a Basuto leper who told him that he had eaten much salt fish, and that all his countrymen did so whenever they could get it. The writer also states that the Basutos travel about frequently, and so expose themselves to the possibility of contracting the disease away from home. In 1896 an outbreak of leprosy occurred in Switzerland, an inland country, and one where presumably little fish was eaten. Thinking that this would probably be used as an argument against his fish theory, Hutchinson made a personal visit of investigation. He discovered that in the districts where the cases of leprosy occurred salt fish was freely eaten by the peasants, and that this fish was apt to become decayed in warm weather. The fish was brought to these regions to supply the catholic portion of the community during their days of fasting. Thus, far from disproving the writer's theory, the recent appearance of leprosy in Switzerland gives it support. Against the theory of contagion it may be said that there has been no spread of the disease in the past 50 years, although no precautions against this have been taken. There are at present only four, cases in Switzerland. Hansen admits that the presence of leprosy in Norway cannot be explained by contagion. He does not, however, believe in the fish theory of the writer. Hansen states that the inhabitants of Finmarken are great fish eaters, though they suffer less from leprosy than their fellow-countrymen and neighbors on the west coast of Norway. Hutchinson replies that Finmarken is a very cold region, where the fish are frozen during two-thirds of the year. The west coast is, however, very different. There it is warm, and the fish which are caught de- pellagra. In the course of the last few compose if kept, and do not freeze. The theory of contagion receives a blow from the experience in South Africa. The lepers in Cape Colony have been segregated for many years, whereas the sale of fish has not been regulated. As a result there has been a steady increase in the number of cases not, it may be said, near leper centers. The writer considers that even though there are few believers in his theory, some good has yet been accomplished by calling attention to the details of fishcuring, the importance of the supply of good and cheap salt and the dangers attending the consumption of badly-cured fish. In conclusion, the writer states that in his opinion leprosy will eventually be found to be a form of tuberculosis, in which a specialized bacillus finds its entrance almost solely by the mouth. The Etiology of Deckenbach (CenPellagra. tralblatt fur Bakteriologie, 45, 1907). The present status of the question concerning the etiology of pellagra was recently summarized by a prominent investigator in the statement. that this remains entirely obscure, at the present state of our knowledge (Neusser). In a general way, however, it is an established fact that there exists a close connection between maize and pellagrapoisoning, an interpretation which recent writers have not been able to refute; but the cause of the toxicity of this grain is variably interpreted by individual authors. Since the publication of Lombroso's pioneer work on the subject (1892) the pellagra research has progressed in two distinct directions, bacteriological and mycological. The majority of investigators studied different kinds of bacteria, which were regarded as the agents of years a number of articles were published along another line of inquiry, meaning the systematical investigation of all the species of fungi found on maize, especially the hyphomycetes. These Italian writers deal with the manifold varieties of penicillium and aspergillus, which are held to be responsible for the origin of pellagra. In 1905 an article appeared from the pen of Tiraboschi, who (besides aspergillus and penicillium) made a detailed study of cospora verticilloides saccardo. The same investigations on cospora verticilloides saccardo had already been carried out by the author in 1895-96, and the results were published in Russian and German from 1896-99. It was found that this fungus, which lives as a parasite on the plant, gives rise to a disease of the maize grains. Certain investigations concerning the morphology and biology of the fungus yielded facts which confirmed the author's opinion to the effect that the maize is rendered injurious precisely by this fungus, which enables it to produce pellagra. At the time of the former publication the author called attention to the great importance of the study of the micro-organisms growing on maize, in regard to the etiology and prophylaxis of pellagra. This dangerous disease, which leads to insanity, and prevails in Italy, is likewise widely spread in Bessarabia, as results from medico-statistical figures in those regions where the population lives almost exclusively on maize. In a general way it may be considered as an established fact, according to the articles of Italian and German investigators, that pellagra appeared in Europe immediately after the introduction of maize; that this disease is referable to intoxication with the products of a chemical transformation of the grain, under the assistance of micro-organisms, and that the aetiological connection with pellagra should be sought in the chemical changes which the grain of maize may undergo through the action of bacteria and fungi. In this respect the above-named fungus is entitled to very careful study; furthermore, cospora verticilloides should claim the best attention of mycologists, being a parasite of one of the widest-spread foodplants, which nourishes millions of inhabitants of the Old and New World. The author's observations upon this fungus, coupled with other facts, served to convince him that this parasite of maize plays the same part in regard to pellagra as claviceps purpurea, or ergot, in the epidemics and symptoms of ergotism. F. R. result of several years of steady work upon the subject: 1. The opsonic treatment of boils is uniformly successful and is the only form of treatment for general furunculosis which is in the slightest degree reliable. 2. In sycosis the treatment is a valuable aid, but must be continued for long periods in proportion to the duration of the disease, and it is best combined with X-ray depilation. 3. In acne the treatment is uncertain, in some cases being most brilliant, in others without the slightest avail. 4. In septic dermatitis and ulcers the treatment is of very distinct value as an auxiliary. 5. In Bazin's disease the treatment is somewhat uncertain, but it is sometimes of assistance. In tuberculous ulceration it is of great value. 6. In lupus the treatment alone is too slow and uncertain to be recommended. It is, according to Bulloch, a valuable auxiliary in preventing relapse after Finsen treatment, and I have found it of value combined with the X-rays. OPHTHALMOLOGY. UNDER THE CHARGE OF W. M. CARHART, A.B., M.D., Assistant Surgeon, Manhattan Eye and Ear Hospital, New York City. Dr. Charles H. Wounds of the Eyeball. Beard, speaking before the Chicago Ophthalmological Society of the more extensive perforating injuries of the sclera, emphasized that early treatment is important. If quick healing, without complications, cannot be effected, the treatment is in vain. Even in the most severe cases, with extensive involvement of all the tunics, it may be in the ciliary zone, such healing may take place if conditions are favorable. How make them favorable? Make sure of the absence of a foreign body; use copious, scleral opening with absorbable sutures and the conjunctival with silk. Indeed, it is usually best that these wounds do not correspond, even if a piece of conjunctiva constituting one lip of the wound must be excised to prevent coincidence. The wound is not only freed from dirt and vitreous, but from shreds of chorioid and retina if these are present. Double-armed interrupted sutures are preferable, so that the needle can be introduced from within on both sides. The thread should, if possible, be made to include only the outer layers of the sclera, and in no case should the uvea and retina be included either in the wound or in the suture. Thread and needles should be very fine and the latter sharp. For the after-treatment little is to be said. Trust more to thorough, even exhaustive, first aid than to occlusive bandaging, rest in bed, diet and general or constitutional treatment. Argyrol in solution is a valuble adjunct to the dressing.-Medicai Standard. Treatment of Simple W. C. Posey (JourChronic Glaucoma. nal A. M. A., October 24) discussed before the Section on Ophthalmology of the American Medical Association at its Chicago meeting the question of miotics versus iridectomy in the treatment of simple chronic glaucoma, giving an analytical study of 65 cases treated with miotics over a series of years. He says in conclusion: First, miotics should be relied on as the sole means of treatment only in those cases which are free from attacks of so-called "glaucomatous congestion," the presence of such congestive symptoms being the chief indication for iridectomy; and second, to gain the full benefit of miotics it is necessary that they should be administered properly. Beginning in doses small enough to avoid creating spasm of the ciliary muscle, and rapidly increasing the dose until the pupil of the affected eye is strongly contracted, this degree of contraction should be maintained as long as life lasts by gradually increasing the strength of the solution, from time to time, and by instillations of the drug at intervals of every three or four hours. Conjunctival irritation may be avoided by employing only fresh and sterile solutions of the drug. Suitable cleansing washes should be administered, and attention given to the general health, and especially to the condition of the blood vessels. Careful and repeated correction of the refraction error should be made, and restrictions enjoined on the use of the eyes. tically all cases, not glaucomatous, below 48 years of age and in some cases above this limit. 5. In such cases atropin should be used. Children. 2. Homatropin in 2 per cent. solution, Amblyopia in provided it is used with ordinary precaution, is a safe cycloplegic, and if properly used is effective in the vast majority of cases. 3. It should be repeatedly instilled, and the examination made not less than an hour after the first instillation, nor until a test of the accommodation has shown that the latter is as completely abolished as possible. 4. The cases in which homatropin proves inefficient are few. They are marked by varying vision and varying acceptances, discrepancies between the subjective tests and the skiascopic findings, and the persistence of an undue amount of accommodation (more than one D), even after prolonged action and repeated instillations. Sydney Stephenson (Ophthalmoscope, August) says that children are sometimes brought to the oculist for refractive error in whom normal visual acuity is impossible with any correcting glass. An ophthalmoscopic examination discloses incomplete post-papillitic atrophy of the optic disc, usually in Stephenson's experience bilateral. A careful inquiry into past personal history often elicits recital of infantile illness marked by such symptoms as "fits," temporary paralysis, squint, etc. The conclusion is inevitable that the child has had an infantile meningitis, one of the results of which is the incomplete optic atrophy consecutive to an optic papillitis. Stephenson reports six such cases, which need but to be looked for to be found. OTOLOGY. IN CHARGE OF R. JOHNSON HELD, M.D., Assistant Surgeon, Manhattan Eye, Ear and Throat Hospital, New York (Ear Department); Attending Otologist, New York Red Cross Hospital. toiditis. Meatomastoid Opera- Ballenger, Chicago tion in Chronic Mas- (Journal of American Medical Association, September 26, 1908). In this article the author calls attention to the modification of the mastoid operation as practiced by him and to which he gives the name of the meatomastoid operation. The technique followed is much the same as practiced by Heath, except that it is more radical. The posterior wall of the meatus is removed as deep as the annulus tympanicus and a complete removal of all pneumatic cells. The cavity is made as smooth as possible for the promotion of healthy granulation tissue and epidermitization of the walls of the mastoid wound. The remnants of the drum and ossicles are not disturbed. The cells should be completely removed to insure proper drainage and ventilation; the walls being rendered smooth, leave no recesses for foci infection. Drainage must be ampie. and is accomplished by diverting the secretions from the mastoid antrum and cells through the window in the posterior wall of the meatus into the external auditory canal and by passing blasts of air via the aditus ad antrum through the middle ear. If these conditions are established in properly selected cases of chronic mastoiditis the results will be as good as if the radical operation had been performed, and in one respect better. |