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'■'^Si / ARCHIVES 



n F TJ M A T O T O n Y 



lis. 



\ KEt 



STORAGE 



PACKER'S PINE TAR SOAP. 



This Soap is confidently offered to the medical profession and the public 
as being a detergent agent which not only is entirely free from any of the objec- 
tions which have been brought against soaps of ordinary manufacture, but which, 
/ram the nature of its compoiition, possesses 

HEALIIS QUALITIIS. 

It is well known that the largest proportion of the soap consumed is made 
from animal oils or soap-fat, which is collected and utilized in various stages of 
decomposition, and is liable at least to the admixture of foreign ingredients, which 
Aa7'e been kncruiti to be POSITIVELY INJURIOUS TO THE SKIN. This source o£ evil 
is obviated by the 

EXCLUSIVE USE OF VEGETABLE OILS 



in the production of Packer's Soap. 

This is shown by the following certificate : — 
Messrs. Packer Mpn. Co. 

Dear Sirs / have made a care/ui examination of the samples o/your Tar Soap submitted 

to me for analysis, and find that it is composed of pure Vegetable Oils and Refined Fine Tar, 
combined by a process tvhich otliers have tried mnd/ailed. /consider it the best soap/or alt pur- 
poses thentiofud in your circular which 1 have ever used or examined. 

Yours, very truly, 

W. A. Wetherbke, M. D., 
Aprils, 1874. Prof, of Chemistry and Toxicology, 224 East i4tli St., N..y. 

This soap has already been used in mar- Public Institutions, as Nurseries, 
Infant Asylums, Hospitals, Dispensaries, etc., and abundant evidence can be 
given those desiring it (from them and from private physicians), which will bear 
out all that is claimed for the remedial excellence of Packer's Tar Soap 

In the treatment of 

DISEASES OF THE SKIN 

this soap is of special service, first, because while other soaps, if used, may and 
probably will exercise some injurious effect, tlu^ is the /east irritating of all soaps ; 
and second, because by virtue of its tar^rf^hich it contains a very large per- 
centage. '^ 

It is especially urged that this soap be employed exclusively in the 

Surgeons find it the best soap for cleansing wounds, ulcers, etc., and for 
antiseptic and deodorizing purposes. 

THE PACKER MANUFACTURING CO., 

146 WILLIAM STREET, NEW YORK. 

P. O. Box, 4885. 
IgV' ' Physicians will be supplied with sample cake, upon application, accompanied by their 



'.•.I i I 



Contents of No. 



TiTlll. 



Cci|taal C*MHnintiM«. 



I* * nmybotnf-^A' II* KoHwif <* ••>..*....* 

II. C«««»«< Pi i mn «ttl»«»Mi< « | i «» di«» o« Www Ih I u m I. ». j»w»tt 

Ill C-MnclHm-fipiaaChllPabteiaSrpUlHkaKUnm.— Taw u >'-.» 
IV. TKt R th ri — Eikaacbww Eof» i»J furi Mh — Ko— t 
V l^PMM«na<H«nMZMM», ClinaU*CaM4m4.-CMa»' 
VI. Nuw* am At Veal Twiful W Cnvia Phw«« <4 iIm >. 
B<AWt 

CltaWat V(y«n« 

I. Foor ti>r« ..I 0<; .' :■: EcwiM tioHwl by Mm Tuek* and ElMUibiy.— W. H. 

»ltlH 



JvWwtV 'nMMfnMM- 



0i(<»t *f f iitntiirr. 

tH«SA%n or TNB Sciii. 

XlMagy, TWrafMntio, CWwnl T<ifK<.-fcn«A>o H. »» n B»1.., 

,.,.. I»fc»«iili III ; Atwj i«<l Co»txi».»«. — I ««»K P. CotTvi 

'III. tiilnwwiiiiii . Inn I t" • -[ .1 '• *" 

Q— «>a»» b gjwMlli.TWiip— tin, €<c.— K. W. T*«i' • 

»lM4to<i»»<U« t w> m « J uaTitmnm ttrnt 

■< *• MoMk, TkraM. 1*4 Lwyu.— Gaoau M. La>>>. 



I. 
II. 
111. 



III. TW Tmmc Timm w W d »y»Mlh— By K. L Kt» 

IV. «>> iW fiitiluT m4 Tmwiii tt <{«««wli— J . I. H>i,t»« 



.«) 



III. Etblorul. 

CONTRIBUTORS TO VOLUMES 1. AND 11. 

D, Ceo. il Vc. V.^cl rt,. , Or,^ »• V 



K..Y«kCl<^ 

. «k OlT. 

, -i r.tr. 



I i>u>«. A Ltm m ij l *, kaMacky. 



Dr. HANBURY SMITH'S 
JViii^ei^kl ^priiig Wktei',^. 



Compared with their prototypes, it can no longer be 
necessary to argue identity of composition and of 
mediqinal effects, as characterizing properly-prepared 
Artificial Mineral Spring Waters. 

The former when kept, however carefully bottled oi 
barreled, in a large proportion of cases, become flat, 
altered in composition, often inert ; while the artificial 
retain their virtues many years. 

They have been before the Medical Public upwards 
of fifty years, and the original English and Continental 
establishments, for their manufacture, enjoy to-day the 
confidence of the Profession in a still increasing ratia 

HANBURY SMITH & HAZARD, 

35 UNION SQUARE, NEW YORK. 



Absolutely what the label calls for, with the excep- 
tion of those named after Mineral Springs, whose 
composition is approximate only to that of the water. 



Fig. IV. 




Fig. IV. A large vesicle and two smaller ones. The large vesicle is of a 
few days duration, and the entire section shows changes which are described 
in the text. Pus cells are present in great number in the liquid of such a 
vesicle, and in the structures directly beneath it. Here the origin of the 
vesicle A from the pajnlla beneath it is very distinct. Also the origin of the 
vesicles j9 and C, from their respective papilla; b' and C' is well marked. 
The vesicles B and C have become united by rupture of previously separating 
bands. I'art of the corneous layer has here become removed. 

In all the drawings the corneous layer is represented by non-granular, non- 
nucleated celN, with the exception of a few cells in Fig. III., but in reality 
there was not this sharp distinction in the sections. Where the corneous 
layer is so thick as in these specimens, very many of the cells have a more 
or less distinct nucleus, and occasionally .some granular matter, and they 
color in carmine. Only when the corneous layer is thin, is the line of 
separation well defined. 



■ Bterity, indeed, npoa tone occaaiona, b ■ real excellence." 
— Cicuo, Btirr. iyyx 



ARCHIVES OF DERMATOLOGY. 

JULY, 1877. 
(Drijinal ConniBniratiotM. 



POMPHOLYX. 

JRO-POMPHOLVX (HVTCHimON) : DYSIDR08IS (TIUtntY FOX.) ] 
BY A. R. nonVWtt, M.BL, L.ILC.P.*S^ KOIN. 
S/trml ^ilkikgiM * «lr //tw Ytrt CUf Aiyhimfir ikt /mmm. 

HISTORY : In the American Journal of Srahilography and 
IX-rmatoIogy, Jamiary. 1873, Dr. Tilbury Fox, of London, 
published the first art ° ' ' . disease. He named the affectioii 
dysidrutis, and stat' ^ ciiancterixcd by the icientioa in 

the follicles of the sk nidlv and frcciv accreted. The dis- 

ease bears the same r ' - .icne does to the 

•eiMiceous glands, l . d distension o( 

the follicles are fbllowcu scconaaniy oy congcsuon of the meat 
foUides, by the Connatioa of bulhe, nacetatiooaf theepklaraisaad 
perhaps more or leea dennatitis. The aweat ciands are fr eq u e ad y . 
so -re and there over the affected surface, and never 

si' r their proper character. 'Ilw origin of the disease 

u a oiMcnMon of the sweat dact, not only of its saperficial, but aho 
of its deeper part, and this is followed by the oontinaed distension 
of the duct, and the aggregation and coalescence of the vesidea. 
It depends on a paresis of the nerve >i>n>lT of tbe sweat apparatus, 
whereby its functions become deranged. 

Mr. Hutchinson, of London, a soigeon of mnisual attainments 
and of high and well-earned reputation as an original and trust- 
worthy clinical obser\-er and pathologist, published, in 1876, in his 
** Illustrations of Clinical Surgery," a drawing of this disease to 
which he gave the name chciro-pomphol)-x. He made no mention 
of Dr. Fox's article, and said he did not think any correct clinical 
description of the disease had been previously given. He consid- 
>9 



29© A. J?. ROBINSON; 

ered the contents of the vesicles or bulte to be serum, and the dis- 
ease itself a neurosis. His description of the disease will be- given 
further on in this article. Upon the publication of this article, Dr. 
Fox (Lancet, April 15, 1876, page 553) attacked Mr. Hutchinson 
for not referring to his article on dysidrosis and for not having 
recognized his assumed claims as the first to have described the 
disease. He drew attention to the similarity in their descriptions 
of the disease, and in the use of certain terms such as sago-grain 
appearance, a coincidence which he imagined to be due to Mr. 
Hutchinson's familiarity with his (Dr. Fo.x's) paper. He consid- 
ered Mr. Hutchinson had failed entirely in comprehending the na- 
ture of the disease, " which is an affection of the sweat glands and 
consequently the contents of the vesicles or bullae are sweat and 
not serum as maintained by Mr. Hutchinson." It was shown, how- 
ever (Lancet, April 22, 1876, page 618, and April 29, 1876, page 
639), that Mr. Hutchinson was quite familiar with the disease 
years before Dr. Fo.x had recognized its special character, and that 
in fact the patient from whom Dr. Fo.x obtained his first impres- 
sions of the disease had been fifteen years under Mr. Hutchinson's 
observation before Dr. Fox saw her. This was the same patient 
of whose hands a drawing was given in the "Illustrations of Clini- 
cal Surgery." This drawing had been used by Mr. Hutchinson 
for years previous to the appearance of Dr. Fox's article, to illus- 
trate his lectures upon this disease given by him at the London 
Hospital and at Blackfriars. There is therefore no ground what- 
ever for Dr. Fox's claim to priority in the matter, neither was 
Mr. Hutchinson, to use his own words, indebted to Dr. Fox " for 
even a sago-grain." As to whether it is a disease of the sweat 
glands or not will be shown conclusively when I treat of the nature 
of the disease later on, and give the result of my own studies on the 
subject. 

Whilst, therefore, the credit of having first recognized and 
lectured upon the disease belongs to Mr. Hutchinson, it is never- 
theless to be regretted that he did not sooner publish his views and 
thus not only have done justice to himself but also have aided 
science. 

Through the kindness of Dr. Fox, who showed me several ex- 
amples of the affection at his clinic in University College Hospital, 
and drew my attention to its characteristic diagnostic characters, I 
was acquainted with the disease whilst studying in London, and in 
this city I have seen a considerable number of mild cases of the 
affection. I have had also a most excellent example of the disease 
in a patient who has been for some time under my observation and 
care, and from whom the material was obtained which now enables 
me to discuss the disease and to decide as to its true nature. 

Symptoms : I will give Mr. Hutchinson's and Dr. Fox's de- 
scription of the clinical characters of the disease in preference to 
one by myself, partly because they are more familiar with its symp- 
toms than I am, and consequently their descriptions are of more 
value J and partly because I wish to show by them that the case whose 




POMPHOLYX. 



391 



history and symptoms I will afterwards relate, and from whom por- 
tions of skin were removed for microscopical study, was a most excel- 
lent example of this disease. 

Mr. Hutchinson's description of the affection is briefly as 
follows : The more severe forms which I have seen have always been in 
women, and usually in association with a highly nervous temperament. 

The disease appears to be characterized '■•• — ■■' -•■-' — "rical 

development, by tcndencj' to spontaiK-' .lity 

to recur over and over again in the sai inds 

are the parts first affected ; the feet come next ; and iii a (cw in- 
stances a rash appears over the rest of the body. In the majority 
of cases the hands alone suffer, and in all they are the parts most 
•everely affected. A temlcncy to spontaneous absorption of the 
fluid contained in the vesicles or bulbe, even when the latter are 
very large, is a very remarkable feature. It is not connected with 
any local cause nor is it influenced by local treatment. The erup- 
tion begins with intense burning and itr>>i'<'' '■•< ">me part of the 
hand, usually between the fingers. Af mc — a few hours 

Of a day or twf>— there are seen, deep 1 the skin, small 

aci ' ir serum, looking like M^'>;;r4ins. These are 

p- atul not unfrequcntly resemble the vesicles of 

S' • excite suspicion. 'iTicy differ, however, from 

til ing much more deeply placed, h.iving flatter 

t'<| ■ closer grouped together instead of scattered, 

and in UK' I'liiiri' tiisence of burrows. In some it occurs during 
hot weather, but in most instance no cause can be given for its occur- 
rence. Those who have had it once will very probably have it 
again, and several of the fads in its clinical history coincide pretty 
nearly with what is true of herpes of the lips and of the prepuce. I 
do not recollect even to have seen a well-marked example of it in a 
patient under the age of puberty, nor io a very old patient. The 
tendency to speedy and spontaneous disappearance, leaving the 
skin quite sound, supplies a feature of positive difference from 
ecxema, of which the indefinite duration and the tendency to persist 
and become aggravated arc such marked characters. Symmetry, 
spontaneous cure and liability to relapse are iu clinical character- 
istics. In minor degrees the affection is tolerablv common. Many, 
indeed perhaps most of us, are liable at times m connection with 
slight dcrangententsof health, or possibly with exposure to the sun, 
to the occurrence of a very irritable sago^rain eruption on the 
sides of the fingers. The so-called sago-grains are deeply placed 
effusions of serum, but in a large majority of cases they undergo 
spontaneous absorption after a few da}^ and not even peeling of 
the epidermis results. They never by any chance result in eczema. 
In those liable to this slight affection the disease is prone to recur 
repeatedly at intervals perhaps of a few years. More severe cases, 
in which the vesicles coalesce and develop into bulke, are not very 
uncommon, their subjects being, so far as my experience has gone, 
almost invariably young women. In several of the most severe 
cases which I have witnessed the eruption was attended by ex- 



292 A. E. ROBINSON; 

treme depression of spirits. Although the eruption always shows a 
tendency to spontaneous disappearance, yet, in some instances, it 
may last a couple of months and require treatment. In one case 
under my care the liability to attacks had extended over thirty 
years. In this case the vesicles always broke, and a state much 
resembling that known as psoriasis palmaris resulted in the palms, 
whilst on the sides of the fingers it looked more like eczema. 

Dr. Fox's description of the disease coincides very closely with 
that of Mr. Hutchinson's, an occurrence not to be wondered at 
since the same patient furnished both of them the best example of 
the affection perhaps that they have ever seen. Independently of 
this patient, however, Dr. Fox has very carefully studied the clini- 
cal characters of the disease in a great number of patients, some of 
whom he kindly showed me and explained to me his views of the 
disease. Dr. Fox says " the disease, in its slightest form, is confined 
to the hands, occurring in the interdigits, over the palm and along 
the sides of the fingers, and on the palmar surfaces. It makes its 
appearance in those who habitually perspire freely, and the patients 
feel weak and depressed. The eruption consists of minute vesicles 
deeply imbedded in the skin, and are at first isolated. They do not 
readily burst, and when a few days old look like sago-grains imbed- 
ded in the skin. The vesicles afterwards become more distended 
and raised. They are not pointed, but oval, eventually become 
faintly yellow in color, and run together and form bulte. The hand 
is then stiff and painful. If the eruption is left undisturbed, the 
fluid is partly absorbed, partly evaporated, the cuticle then peels 
off, leaving a non-discharging, reddened, exposed derma. In some 
of the milder cases only vesicles are formed. When disappearing 
altogether from the hand the palm is left harsh and slightly scaling. 
In some cases a red, dry, slightly scurfy, painful surface is left be- 
hind and becomes chronic. No patient is well who has this disease. 
In severe cases there is great nervous debility." 

From this curtailed description of Dr. Fox's, it is readily seen 
that both Dr. Fox and Mr. Hutchinson are describing the same dis- 
ease, though their views as to its nature are so widely different, as 
has been already stated in giving the history of the affection. 

And now to the history of my patient. 

L. S., born 1846, is of medium height, light complexion and 
weak muscular development. In 1849, one of his thighs was 
fractured twice, after which time his mother says he was sickly and 
nervous for a number of years. In 1866 was married, and six chil- 
dren have been born to him since that time, three of whom are dead 
and three living. Two children (boy aged 5 months and girl aged 
2 years) died of spinal meningitis, and one (a female child) died of 
pemphigus. The pemphigus commenced on the ninth day after 
birth, as a small blister the size of a pea, on the right side of the 
abdomen, below the umbilicus. Within twenty-four hours the bulte 
had reached the diameter of one inch. A few days later, another 
appeared on the left side of the neck, which rapidly increased in 
size and attained a length of three or four inches. At the same 




POMPHOLYX. 293 

time smaller bulls appeared on both temples near the eyes, in the 
armpits, and over the rest of the body. On the 12th day (3d of 
th'i sickness) the pulse was 140 and temperature 103'* F. On 14th 
day pulse 100 and temperature 103^. It lived fifteen days during 
wliich time its bowels were regular and it nursed well until the 15th 
day. The bulls left a raw, sore surface behind. Luke-warm water 
was used for bathing it. This was the fifth child of the family. 
The sixth child has had eczema capitis. In February, 1871, he 
received an appointment in the New York fire departntent. since 
which time he has always been connected with this - ■ Pre- 

vious to his marriage a few vesicles would appear oci 'lis 

hands, but the first severe attack was in July, tSyi. I i>>t- 

ed about two months, appearing both on the hands an m- 

nencing on the hands. The feet were not attacked rte 

mor-' ' 1 1 . r -i-i... : :_..!.. =■-..>. ihc 

h.ii umofthe 

pi 1 ippcared 

or! ■>, ffom which ii r iver 

of I •>. According to :p- 

tier ' ••■' cd 

ar.' '.c. 

Th --d 



uijit .-v. v.. ... ... i,..>,^.... .cs 

or bulbc, '. t.. : of the skin, .od 

beneath was a : -fare. Vari .ore 

made to the hi it having been 

regarded .xs an trom their use. 

He •'— " ■ - - ...v ....^.4 ,»pcared sponta- 

Dc ! about two months. In 1M73 he was bitten 

in • 1 dnj, and thp drear! of h)-drophobla made him 

!>ruary, 1877, the sec- 
^icles appeared e\'ery 

.X years. During this 

last au.1' lues (June 14th), he has been under my 
care. '\\ i^tcd about three weeks when I first saw 
him. It h.iti Ciiriuiu-nccil on the palms of the hands near the wrist, 
and spread over the entire palms and between the sides and on the 
palinir Miif K.-^ i.f the fingers. UTien I saw him the majority* were 
Hex :>gers. The eruption has changed but little in 
it> : .'.^ and in its course «inrc I first saw him. An 
outbrc.ik IS alw.us preceded by a tin_' ::i<j sensation in 
the parts, and the patient is more than ressed and ner- 
vous. 'Ilie eruption appears as small cl s, deeply placed 

in the skin. They may be single or collected in groups of two, four or 
more. Very frequently the vesicles forming a gn^up are all of the 
same age and size. The eruption always was symmetrical, and I 
have very often observed that exactly corresponding parts of the 
hands or feet became affected at the same time. If but a single 
vesicle existed it almost invariably dried up. Where there was an 



294 A. J?. ROBINSON; 

aggregation of vesicles they were at first isolated, but afterwards 
frequently united and formed a bulla. If then the liquid was ab- 
sorbed, the skin covering them became very hard and dry. I stated 
that the vesicles appeared to contain a perfectly clear liquid, but 
this afterwards generally became more or less opaque, though 
scarcely ever yellowish in color. This latter occurred only when 
large bulls were formed and the liquid slowly absorbed, i. e., in 
other words, it was observed only when the bulte were of several 
days' standing, and, as will be seen afterwards, was owing to the 
number of pus cells present in the liquid. The vesicles were never 
seen to have a red base. The walls of the vesicles appeared of a 
darker color (from compressed cells) than the surrounding skin or 
the contained liquid. This really made the vesicles look like sago- 
grains imbedded in the skin. The vesicles gradually become 
larger, and raised. Isolated vesicles in the palms of the hands sel- 
dom became raised above the level of the skin previous to absorp- 
tion. Where they appeared in groups they always became raised 
above the general surface, as also most of the isolated vesicles be- 
tween the fingers. They were never pointed, but always had a more or 
less flattened top. After the absorption of the contents or rupture 
of the vesicles or bullae, a reddened surface (on account of the thin- 
ness of the epidermis) was left behind. At no time was there a 
cracked or discharging surface or any appearance resembling that 
of eczema in this region. Occasionally the eruptions spread peri- 
pherically, especially in the palms of the hands. There has been 
no change in the appearance of the vesicles since I first saw him, 
but at present the disease is not so severe, the eruption consisting 
principally of isolated vesicles and but very few bullae. Occa- 
sionally, however, an " outbreak " occurs lasting two or three days. 
Then the eruption presents more of the character it had in an earlier 
period of the disease. The feet are also affected, but only in a 
slight degree, a group of vesicles appearing occasionally here and 
there. Their appearance is always preceded by a tingling in the 
part. They appear symmetrically, and often on exactly correspond- 
ing parts. There has never been any accompanying eruption on 
the other parts of the body. I have tried various local applications 
and naturally without any benefit except keeping the parts soft. 
Internally he has taken iron, strychnine and pure phosphorus, and 
evidently with some benefit. To-day I have prescribed Fowler's 
solution of arsenic in five drop doses, three times a day.* 

The patient is exceedingly nervous and depressed in spirits. 
He was so nervous that he hesitated several weeks before allowing 
me to remove a second portion of skin from his finger. Even 
then I was obliged to benumb the part with ether spray before 
using the knife. He says his forearms and hands feel benumbed 
and " sleepy," especially in the morning, if he keeps them elevated 
above the bedclothes. He sweats a great deal, yet the hottest 
day in summer is not too hot for him. 

Before proceeding to give a description of the mode of forma- 

• July 1 2th. After taking the arsenic one week the eruption disappeared en- 
tirely, but reappeared seven days after ceasing its use. 




POMPHOLYX. 



»9S 



tion and structure of the vesicles and bulls in this disease, I will 
give a short account of the clinical characters and structure of the 
eruption in the different skin disenses in which vesicles or bulbe 
oc( iir ; in order the better to be able to decide the question as to 
\vi . • .r ,>,,■„,. I, Jvx is a separate and distinct disease, or only one 
< : ;sly known vesicular or bullous diseases appear- 

i : .se anatomical characters and situation influence 

i; :it and course in such a manner that it receives 

a >pecial characters. 

or bulbe occur in sudamina, miliaria, pemphigus, 

herpes, hydroa, bums, eczema and erysipelas. 

In Yiid.imina, the liquid composing the vesicle is enclosed 

!>' ' !.iycrs of the stratum corneum ; both the base and sum- 

II icles being formed of the cells of this layer. The 

r iiL'utral, and is nothing but retained sweat, the dis- 

rely the retention of sweat in the corneous layer, 

uf the walls of the sweat duct, or from some 

iN tree passage to the suiface of the skin. The 

■ consists of a smgle chamber. The disease generally 

I, ' iHck. about the shotiUIcrs and on the trunk as clear 

« ! are followed by slight 

r! : r ical in its appearance, 

•he affected part, 
miyx. 
\ inina, and in this 

case \\\K. luiitciua ot tlic >' ' and not acid. The 

structure of the vesicles r ■ same as in sudamina. 

I ' II... . , ^,,^. Luiiccinest uf this explanation of 

i: t lie present summer p—ea away to further 

ii: 

I;i j -s of blebs sealed upon an in- 
flamed over by the enlarging bulUc. 

The 1 .1 -■! or oval form, elevated 

alx'vr ■: ' .^ ::uximum of size in a 

few !. i:-> 1 inrl transparent; but 

afitu ir ^ ' in nature, being 

der:.c [ ! ' e bullx is SOTOC- 

tiiii'^ 1 - ' :i|> without burst- 

in:;. A: MM : ulceration takes 

■•'•. nipture of a 
> sanguino- 
ps, and is 

, ...v,.^. ,,...'1 attacked. 

iiead, palms of the hands or soles 
^h, according to my experience, 
Iren within the first few days 
:ows itself on the two latter loca- 
lities. In the bull.. , ;•_• the contents are more pustular 

than serous, and dry to a thick scab. According to Haight 
(Sitzungsberichte der K. K. Academie in Wien, i868, Bd. Ivii.), 



pl.li I- uiiiu- \\v I ■ 

bloodvessel occurs asul t 
lent. The eruption gcii 
accompanied withs!'"><' - 
The disease, rarely 
of the feet in a<' 
pemphigus appea r : 
of extro-uterine lit' 



296 A. R. ROBINSON; 

the summit of the bulliE in pemphigus is formed from the corneous 
layer whose cells do not color in carmine, and its base is formed 
from the mucous layer over which a double layer of flat cells lies. 
" The cells of the under mucous layer are somewhat elongated, 
those of the upper layer flattened, with their long axis parallel to 
the corium surface. The papillae are somewhat swollen and higher, 
penetrated by fine spaces, and their blood-vessels insignificantly en- 
larged. From this drawing out of the cells of the malphigian layer 
the bulla is at first fan-shaped, but afterwards it is simple, the 
effused liquid filling the entire bullous space."* 

Herpes is characterized by the appearance of vesicles or bullae 
seated always upon an inflamed base. They are collected into groups 
of two or more vesicles or bulla; which are distinct from each other. 
The vesicles of a single group are generally of the same age, and 
they do not as a rule burst ; but dry up and the contents disappear 
by absorption. The liquid is at first clear and alkaline, or neutral ; 
but afterwards becomes opaque and acid. The eruption is preceded 
and accompanied by burning pain, heat and tension in the affected 
part. The disease is generfilly unilateral. The local forms of 
herpes resemble each other very closely, differing only in the mode 
of arrangement and number and size of the vesicles in the groups. 
In the vesicular syphilide the vesicles are seated on a dark base, are 
met with most frequently on the body and limbs, and probably never 
on the feet and hands alone (Fournier). In herpes zoster a perpen- 
dicular section through a bulla shows, according to Dr. Haight 
(1. c), the corneous layer raised, the corium surface exposed, and be- 
tween them a flattened compartment containing the effused liquid. 
" The corneous layer consists of several layers of flattened cells 
without nuclei, and has on its inner surface one or more similarly 
flattened cells of the upper malphigian layer containing nuclei. The 
cavity is divided into several large spaces by thick bands, which 
spaces are again subdivided by a fine network. The thicker bands 
lie stretched perpendicularly between the corneous layer and the 
interpapillary part of the corium. They consist of several rows of 
closely-packed spindle-formed cells, having a nucleus which colors 
deeply in carmine. In every space bounded by these bands a 
papilla projects, and the number of spaces in a bulla depends 
upon the size of the latter and the number of papilla. The spaces 
are covered by a network which passes in every direction, and is 
formed partly from spindle-shaped nucleated cells, and partly from 
nucleated cells provided with several branches, and also from fine 
fibres. Epithelial cells are attached to the surface of the corium 
and between them small round cells similar to those lying in the 
corium. In the loose corium tissue a few round, granulated cells 
about the size of white blood corpuscles are found. The nerve 
fibres in the corium are swollen, the mark substance softened and 
the axis cylinder lies eccentrically." I cannot accept without fur- 

• In the description of the formation of the vesicles or bullae in pemphigus, 
herpes, erysipelas and burns, I quote the statements of other observers, as I have 
not studied the subject myself. 




POMPHOLYX. 997 

tlier proof than that derived from the section of a single nerve 
trunk, that the above-mentione'd condition of the nerves is always 
present in herpes, or that it has anything to do with the pro> 
duction of the cniptinn. I am rather inclined to rc^rnrd the condi- 
tio ia his section as a • .md occa- 
ti" l>y the excessive .r lid in the 

pai; i V ^ >-; the herpetic ertjp; . ..- :iumber of 

the thicker bands also cannot depend upon the siie of the bulla but 
only upon the numhcr of papilUe affected. 

In tr isionally occur, but the cl! icter 

of the understood and so c-i L-nt 

from tlu: . . , , . :!ut it is unnecessary to ^ the 

description of the formation of the bulbe in this disease, further 
than to state, that they closely resemble those of herpes, with the 
addition, that there is extensive infiltiatioa of the corium with 
•unim and round cells. 

In eczema vesiculosum the vesicles appear u\vm\ a swollen and 
nddened base, the vesicles burst and the •«.• to crusts, 

upon the removal of which, a moist, red sec: is seen. 

The disease can attack any part of the cutaneous sunace, is of 
uncertain duration, and when seated on the palms o( the bands 
produds a rou?h. n.iinfiil. cracked surface, wi^cfa showS but slight 
til treatment. 

<<7«hericht der K. K. Acad. Wien, 
is broadened and leniphened 

I)'. ! lie connective tissue corpus- 

cN and increased in number 

Ni- ' from the papillx into the 

Riu r from each other, and reach 

even as lar as mc corneous i.ucr. 1 ncy oftc-! ' ' ' -he mucous 
layer a thick network, within which lie the c; If the 

process stops at this stage onlv .1 i>.i;>iilt.- is forin< ' passes on 

to ■' ' ■!> of vesicle- . is a greater increase of cells 

in the supert: : the mucous layer become 

sw ' i'ut the cpiucrniis is elevated. According to the 

qii issing nrom the papUlc to the corneous layer 

w.l. '-vesicle. ■'« 

la '. tiums of the first grade the papiike are widei 

and Ion- ipillary blood-vessels three times their normal 

txTT < ' ' -ipilhc the epidermis b raised, and on the 

in: a single layer of contr.ictcd epithelial 

ctl is l.iycr and the corium thin fibres are 

spread out. If the '-tc 6ne fibres become 

torn and are found rface of the epidermis 

and upper surface of in. v.w.ii..ii. i^i.,,^..,, mcse fibres the stretched 
out cells of the mucous layer appear, and a Ibw round cells are 
present within the vesicle. 

As the term hydroa has not as yet been employed to represent 
any special vesicular or bullous disease, but rather anomalous 
forms of pemphigus or herpes, and as the anatomical structure of 



298 A. R. ROBINSON; ' 

the vesicles has not been studied by any miscroscopist, it is unneces- 
sary to here reproduce the description of the disease as given by 
those authors who have made use of the term, further than to state, 
that as regards location and clinical characters there is no resem- 
blance whatever between this disease and pompholyx, except the 
presence of vesicles in both affections. 

In studying the nature of the liquid in the vesicles and bulte 
of pompholyx the contents of the small vesicles were examined 
microscopically after mixing them with serum obtained from a 
frog's eye, whilst that contained in the bullae was examined without 
the addition of any indifferent fluid. The contents of the small 
vesicles and of all vesicles of only a few hours' existence were 
examined in serum, as without this procedure the liquid dried 
up before it could be properly examined. In the very earliest stage, 
i. e., during the first few hours of the existence of a vesicle, the con- 
tents contained no formed elements ; but in a later stage small, round 
bodies of the size of lymph corpuscles were to be found, and the 
number present was as a rule proportionate to the age of the vesicle 
or bulla. It is owing to the presence of these bodies in the 
liquid that it frequently assumes a yellowish color in the later 
stage of the vesicles or bullae. In the earlier stage these bodies 
show amoeboid movements similar to those observed in white blood 
corpuscles. They color in carmine and haematoxylin. They are, 
in fact, nothing else than out-wandered white blood corpuscles. 
Their presence pointed to the probability of the liquid in which they 
exist having had its origin in the blood, i. e., that it was effused 
serum. 

Examined chemically the contents were always slightly alkaline 
or neutral, and never acid ; and although sweat is generally acid, yet 
in this case that fact would not have been sufficient to have proven 
that the liquid was not sweat, and consequently that the disease was 
not an affection of the sweat glands, since the sweat also was neu- 
tral. The sweat in the immediate neighborhood of a group of vesicles, 
as well as on other parts of the hand, was found to be neutral every 
time I examined it. In the later stages the liquid frequently 
becomes acid. Testing, however, with nitric acid to decide as to the 
serous or sweat nature of the contents, gave decisive results. An 
albuminous coagulum was immediately produced, with the nitric acid 
in the usual proportion obtained from serum, whilst testing the sweat 
in the same manner, not a trace of a precipitate was observed. Thus 
the disputed point between Mr. Hutchinson and Dr. Fox was clearly 
decided by this simple test, and it is surprising that neither of the 
gentlemen engaged in the controversy thought of this means of 
deciding the question, or of defending their position, and more 
especially Dr. Fox, as he was the attacking party. Before coining 
a new name for a disease, and especially before making use of a 
term so suggestive as dysidrosis, one certainly should enter into a 
thorough study of its real nature, and thus avoid the error which so 
often follows supposition or mere guess work. Everything in pom- 
pholyx points against its being an affection of the sweat glands ; 




|.,, I '—>-—'-•-• -.-ryeartjraucc of lb« *cakle<bnBMi«i. Tketrcaicie 
« )< )>k>otlircMel» of Ike papilla MM dinctlybcacalli it. 

Til' yoaag voicla arc ilcar Mm*, awl so mand cdb 

an u. .^ -. .lim tkc papilla or facfwcca il aarf Ihc *eurlr. Tkc 

nil* between il ami ibc vnicic arc paler in color aad Miairwiial dnafcd in 



fofta. 



Vis. II. 




Fic. 11. cshibiu a Ulcr slan than Fig. I. The celU in the vicinity at 
the liqoid become mnrr prcwTind flattmed i« the micle incrcaies in »iie. 

The <.orno)iis by, r .,,1 ,he „\\^ detached in two 

(In. -. in thi. hj; : ,. cime rrom the papilla >itu- 

at.;.l U-l..» xnd «l,_ |,. The wood-cnt doe* not 

■'"'* ''"' *"'li'.Ui\ , in mjr drawing on paper. 




rOMPHOL YX. 



«99 



therefore there was all the more necessity for previously examining 
chemically the nature of the contained liquid, before claiming to be 
the discoverer of a hitherto unrecognized disease of the sweat glands. 

Thus the ordinary test for albumen would have decided the 
question bad it been empi ' i my hands did decide, that as 

^ as the contents of ttu < ul bullae were coocemed, the 

twtat glamis had HO farl :. ■: their frodtutwt. Hence the 

term dysidrosis, for this disease at least, cannot be any longer 
employed and consequently must be stricken from the nomenclature 
of skin diseases or used synonymously with ^ ' 

In laying so much stress upon this test id I do so 

with a full knowledge of the experiments i ,( entr. f. d. 

Med. Wissen. 1869), by which he proved the uccasiuual excretion 
of albumen by the sweat glands. The quantity found was alwaj-s 



very sm 
These 1 

Hist 
tion, course, cic.,U Uic vt- 
trcn separate vesicles in (!. 
fiom iNv . ' •■ - " parts ot uv- tiii:^trs. 1 
about t tween the time of the ti 

The <:\ of skin were washed \w 

\. uikd placed, first in Mti 
klcohol, until they bci 



L.ii«; 



how its presence. 

I>resent question. 

<--. mode of forma- 

: lining in all ihir- 

nent, were taken 

• ilof 

•ing. 

any 

. and 

ifor 

cer- 

: the 

irge 

■ Itult: pro- 

' um, to its 

>i iii<.-«.ontcntsby 



number of vesicles ' 

c«;ss from its comn. 

{,.r...:.. ..:.... i,y abso((nM.ii i.i nil- imiiMi , 

n.: cells covering the vesicle, 

1 i comes from the blood-vessels of the papilla^ and if 

the vehicle is very small the entire liquid comes from a single 
papill.1. It passes through and between the cells of the lower 

malphigian layer and collects i-: '■'' indifferent 

Vesicles. 'riii-Te is no definite re ir»t collec- 

tion of th- Hq 1 I. i>i'>ugh the ru 1 the upper 

ni I .1 distance of two or three Uycr:i of cells from 

til t the corneous layer. Sometimes, however, it 

coi.^v, ,.. ,., ., beneath the corneous layer, between this layer 

and the upper surt.tcc of the cells bordering on the stratum corneum, 
i. e., between the mal|>hi^i.in and corneous layers of the epidermis. 
If but a single papilla is afTccteil. thi: is, if the liquid comes from 
the blood-vessels of a sinjjle pipiil.v the vesicle has but a single 
chamber (see figure i). The liquid at the pl.ice of collection press- 
es the cells apart in ever)' direction. On this account the cells 
become changed in form. They are gradually flattened and drawn 
out, more especially those cells which line the sides of the vesicle. 
The more the vesicle increases in size the more the cells are flat- 
tened out, until they at last appear as fibres in which no nucleus is 



300 A. R. ROBINSON; 

visible. The cells forming the summit of the vesicle are not so 
much flattened, and even when the vesicle bursts and the liquid 
escapes to the free surface, this occurs, not so much by a flatten- 
ing out of the cells forming the covering, as by a rupture and 
separation of these structures. In fig. 4, where the vesicle has 
attained a large size, the cells of the malphigian layer immediately 
beneath the stratum corneum will be seen to still maintain much 
of their original shape. The cells of the corneous layer at an early 
stage of the vesicle are affected, and in different places over the 
vesicle become detached from each other, leaving spaces filled with 
a watery fluid. On this account a portion of the corneous layer is 
frequently removed even when the vesicles do not burst. The blood- 
vessels in the papilte are at first but slightly changed, and but few 
round cells are found outside of their walls ; but in the later stages 
they become more dilated ; though they seldom become what one 
would call widely dilated. In these later stages also out-wandered 
round cells appear in greater number in the papilla, and passing in 
the same direction as the effused serum, they are found also in the 
malphigian layer and within the vesicle. Sometimes the collection 
of those round cells is so great in the malphigian layer that it is 
impossible to distinguish the form and outlines of the cells forming 
the lower two or three cell-layers of this structure (see fig. 4). The 
serum in passing from the papilla to the place of collection causes 
marked changes in the form and appearance of the cells between 
which it passes. They become drawn out, paler in color, and less 
granular in appearance from the imbibition of serum. Generally 
the change of form and appearance is so great that their outline 
becomes indistinct, and only occasionally is the nucleus to be seen. 
Sometimes they appear to reach from the corium to near the cor- 
neous layer. It is, however, frequently impossible to see where they 
terminate, as the malphigian layer has more the appearance of being 
composed of long bands or fibres than of cells. 

Thus we see in the case of a single small vesicle that the change 
in the parts depends upon the age of the vesicle and the amount of 
fluid effused, consequently a vertical section of such a vesicle would 
show different appearances according to the period at which it would 
be examined. In the earliest stage only the cells of the lower mal- 
phigian layer would be drawn out, and those cells surrounding the 
liquid slightly flattened. But few round cells would be seen, and 
the blood-vessels of the papilla would be scarcely changed. The 
number of layers of cells from the upper malphigian layer lying be- 
'twen the vesicle and the corneous layer would be greater than in 
a later stage. This of course would not be true of those cases in 
which the liquid at the commencement is situated between the mal- 
phigian and corneous layers. 

In the later stages, the vesicle is larger, the cells more flattened, 
their margins more indistinct, the blood-vessels more enlarged, and 
a greater number of round cells present in the papillae, malphigian 
layer and vesicles. The liquid will also lie nearer the corneous layer 
and the corium (as the vesicle increases in size in all directions), 



Flu. III. <l>o«« the iteiUlmcaas fannMioa of three roidci frooi ihrec 
adioininx papilLr. Tlw IwiMk •cfiamiiac ibe «Mcir« corre<f>>n<l In ihc 

wier-|a|HlUr]r tfOif^ f* ' -- ' " "'■ — '■*• ' ''*■ '••■•■■•■ 

vcnr munm, whiUs 

and flattening nui "! 

diawiag. In fi |.u-. ■ ■ .■- vi- •' 

papilbt ana in thai part oi the Milp«i;^ 

aad the vnkln. itn ihe righi i« !•• !•« «■• 

Thw fliBiring doo not »ho« the urigtn ut i; :.-.. , 

papilbe, bat a dnwia^of lbi« <cvIhmi was made because ii <huw. ihc luAuucr 
of ihc fCfiwaliaa of the vewcle« in ibe bcfinninc <>( the pnice*« an<l »( their 




POMPHOLyX. 301 

and the corneous Ia}*er will be more broken up. Thus it is clear 
that from a single vesicle or a single section the structural changes 
which occur in this or any other vesicular disease cannot be found out. 
If mr.rc than one papilla is affected the appearance is changed, 
ti in some points. The liquid which comes from the 

«! !lae does not at first collect in the same place, but the 

1 1 tch forms a separate vesicle, which afterwards unite 

a ijjle larger vesicle. In figs. 3 and 4 such a condition 

i-, 1. The condition of all the cells except those between 

the dittcrcnt vesicles is similar to that already described as occur- 
ring when only a single papilla is affected. The cells lying between 
the different vesicles become riattened out into long fibres, and their 
nucleus gradually disappears with the lengthening out of the cell. 
In figs. 3 and 4 we have three vesicles separated by two bands com- 
pMed of cells from the malphigian layer. As the vesicles arise from 
tfie papilUc these bands therdfore mast, sod do oonespond to the 
interpapillary portion of the stratum mstphigii, and their sue depends 
consequently upon the size of the vesicles and the resulting amount 
otf pressure exerted upon those bands bv the enclosed liquid. At 
first they are neariv as broad as the interpapillarv space ; bvt 
gradually become tlkiiiaer and thinner, and the cells compoaiiv 
them more and more flatteoed and drawn out, until finally they are 
ruptured, and the vesicles which it had previously separated become 
united. In fig. 4 the vesicles b and c have become thus united. 
Therefore we are not justified in saying that a given vesicle is 
chambered because such bands are present, since they separate 
different vesicles from each other and not different parts of one 
V affected papillc adjoin each other, as in ngs. 3 and 4, 

.1 in fig. 3, then titey may appear to the naked eye as 

fornini^ .1 single vesicle. A >-er}- common occurrence in this disease 
however is the formation of bulkc from the coalescence ol two or 
more vesicles. In this case the vesicles are orif[inally separated 
from each other by a greater or less distance according to the number 
ofpapillx lying between them. When this occurs the vesicles spread, 
in the usual manner, and the liquid extending horizontally between 
the cell layers, the vesicles unite befbra tbeaummit is raptured. By 
this union of the effused liquid bulhe are formed, corrnpooding in 
size to the amount of liquid contained in the coalesced vesicles. 
The liquid passes horizontally cither between the corneous and 

rr-' ' : • ' '^r between the cells of the latter, and the inter- 

\ < ired in the same manner and its cells become 

r! ' way as when the vesicles arise from adjoining 

]i lescribed. This union of separated vesicles and 

I n of bullz is accidental, depending upon the 

auK'U.ic w> i<.^.-.i....^o offered to the escape of the liquid to the free 
surface by the structures forming its covering, and upon the distance 
between the separate vesicles. The disease must therefore be 
regarded clinically as a vesicular and not as a bullous eruption, 
though that is a matter of little importance, as the line of separation 
is so ill defined and merely arbitrary. 



302 A. R. ROBINSON; 

In the later stages of the disease, in which several adjoining 
papillae are affected, the cell infiltration is greater comparatively 
than when a single papilla is affected. Instead of being restricted 
to the papillae there is considerable round-cell infiltration along the 
course of the blood-vessels close to the mucous layer, between the 
papillje. This infiltration of the upper part of the corium and into the 
malphigian layer is well seen in fig. 4. On account of the amount 
of cell infiltration into the latter their cells are no longer to be dis- 
tinguished. This out-wandering of round cells accounts for the 
occasional opacity of the vesicles in the later stages, as they appear 
also in the liquid, as I have already written. No change whatever 
was to be found in the subcutaneous tissue beneath any of the vesi- 
cles. The sweat glands were found to be perfectly normal, and 
there was no distension whatever of their ducts with sweat. In one 
case the sweat duct was the principal structure separating two vesi- 
cles and delaying their union. Neither are the local changes of a 
catarrhal nature, as suggested by Mr. Hutchinson, as the cell infiltra- 
tion consists only of round cells, and not of spindle-shaped or 
epithelial-like cells, as in catarrhal inflammations. As regards the 
nerves, they appeared quite normal. I studied carefully a considera- 
ble number of sections of nerve fibres, and I do not believe that they 
are changed at their periphery ; at least in such a manner as to be 
observable with the miscroscope. I believe the disease to be a 
neurosis, and dependent upon a change in the central nervous sys- 
tem not of the brain but of the spinal cord. Hence the little value 
ef local applications in this affection. 

We thus see that this disease is not one of the previously known 
vesicular or bullous diseases, but an affection entirely distinct in 
its clinical characters and in the changes which occur in the part 
affected. 

In giving a name to this disease I have been guided by the wish 
not to add a new name to an already overburdened nomenclature, 
as is that of skin diseases. The term dysidrosis, as used by Dr. 
Fox, has been shown to be such an incorrect term, that it must be 
entirely discarded. As the disease so frequently attacks the feet as 
well as the hands, the term cheiro-pompholyx, as given to it by Mr. 
Hutchinson, cannot be retained. Recognizing, however, Mr. Hut- 
chinson's claims and also the fact that the term pompholyx has not 
been employed by recent writers to designate any skin disease, the 
term pemphigus being employed instead of it, I have chosen to 
name it simply pompholyx. It is not intended by the use of this 
term to signify that the disease has any relation with pemphigus, 
indeed a study of its clinical characters and the mode of formation 
of the vesicles will shov/that it bears no closer relation to pemphigus 
•than it does to herpes. I therefore use the term pompholyx to 
represent this disease, and think that it should no longer be synony- 
mous with pemphigus, but that the latter should be used to denote 
pemphigus as understood by all modern writers, whilst the term 
pompholyx — a different word but also signifying a bleb — can be 
employed to designate this affection whose clinical history and 




'I hi* <<x'lioa «a* lakm rroin a twIU fivc>«i^htks of an Inch in liiamdrr. 
The I'ull I HjMi>ni|ii>^<l of If Mf 3o«c*icle> : M wakof •evctal iUy< •lurj!i<>n. 

an<l I Ml loUBcuc BmMhcr of |»i~ 

ar> iioviag iIm ooveriag ol Ike I' 

«c) lanK torn apart. PrrvioB* i il 

rxi|> iificr Malffij'hun U)cr. 

All < lajFCT, aad tnanuoi 

(r. > •>{ the Rtc Malpichii. 

I II ihI very rarvljr colwct* 

Ik : -tancc which accmnt* 



th<v 

Ih. 

•Il' 

1 

arwii 



),c kin<l. wrrr to •aitcncil oal thai 
lb o( ihe apfcr lajrcr, which fonacd 
< il«> paaily flallcMd aad wfjr ••• 

nHcad. 



> j< Urge 4 l-ulla J« hjul i 



u|a« Ua c iai i i n to lake ihc 
ap|Maf«4 d«riaf ihc dbcaac 




POMPHOUX. 303 

nature I have here endeavored to describe. I hope the term will 
meet the approval of Mr. Hutchinson and dermatologists in 
general. 

356 Weit 4id Su N"e» Vork City. 



CASES OF DISEASES OF THE SKIN DEPENDING ON 
NERVE LESIONS. 

BY J. S. JEWELL, M. D. 
Prtftsitr if M r wm u and Mtmtti Diimun, C %i n g» t MinI CtiUgt. 

A SHORT time since I enjoyed a pecaliar opportunity for ob- 
serving certain results on the skin and subjacent tissues of 
nerve lesion. 

The cases were as follows : Some thirty patients were vaccin- 
ated within twenty-four hours by means of the hypodermic syringe. 
TI1C point of the needle was inserted into the skin, and a drop o( 
Ih lining vaccine matter in solution was injected. 

>ns were practised at various points in the different 
c.i ii cm over the deltoid muscle of the left arm. The im- 

m''( : : ' ' ' ' ' : I II most cases was not very noticeable, though in a few 
tht'T< .' I. 11: :. Ii pain from the tinte of making the injection. But 
ill .1 : , > » ;l)out exception, certain unpleasant results fol- 

io .m .. ~ I and swelling, heat and redness at the point 

wlicic UiL \.iu:> iud been inserted. This was accompanied by 
rigors, and fever, either slight or severe disturbance of the circula- 
tion, headache, and general malaise. In nearly all the cases an 
abscess appeared at the point of injury. But the phenomena -to 
which I wish more particularly to calf attention were the following : 
In all the cases there was swelling of the affected member below 
the seat of the lesion, and in many if not most cases, — and before 
serious local disorder had occurred at the point where the injection 
had been made, — congested stripes appeared in the skin of the arm, 
extending downwards from the original 'seals of local disorder. 
These extended in the various cases, different dbtances down the 
arm, chiefly on its radial side, and were accompanied by swelling, 
more or less general, of the forearm, and in several cases led - to 
circumscribed patches, as a rule irregularly oval, and varying from 
one to two or o'en more inches in length, — which were red, swol- 
len, hot and tender to the touch, and the seat of a feeling of heat, 
burning, and pain. 

The situation of these congested patches was chiefly on the 
radial side of the arm, and as a rule between the elbow and wrist 
joints. The elevation of the cutaneous surface, the heat, redness, etc., 
were quite striking when compared with the surrounding healthy 



304 7. S. JEWELL; 

integument. Moreover, many of the elevated patches had an abund- 
ant crop of watery vesicles resembling herpes. These phenomena 
lasted from three or four days to two weeks, and then declined until 
they had wholly disappeared. It is particularly to the elevated con- 
gested patches, and the eruption which they sometimes presented, 
■which I desire to call attention. 

The original or first cause of the phenomena was undoubtedly 
the matter injected into and beneath the skin. Upon inquiry it 
was ascertained that it was composed of rather fresh vaccine mat- 
ter from a healthy subject, which, it was shown, by introducing it in 
a different way, was active, and led to perfect results in the cases 
in which it was used. It was further learned that the virus had been 
carefully rubbed up in a small per cent of glycerine, and that a 
considerable quantity of rose water {Aqua Roscb) had been used to 
dilute it, so that it would run through the needle of the syringe. 
The glycerine appeared to be fresh, but the rose water was found 
to have been not fresh, and to have been highly charged with bac- 
terije or mj'coderms of a kind not determined by actual observa- 
tion and study. But whether the intense irritation set up was due 
to the mycoderms or to the glycerine, or as seemed to me more prob- 
able, to both together, could not be certainly determined. But one 
fact was clear, that after the irritation was kindled at the seat of 
injury the oval patches on the forearm were to be regarded as 
among its plain consequences. 

Now, how can we explain in this case the production of the 
congested patches and the vesicular eruptions, occurring as they 
did at such a distance from the site of the original lesion causing 
them ? It may be attempted in one of the following ways : By a 
lesion of certain long cutaneous nerves which pass downward over 
the region of the deltoid, and which are distributed to the integu- 
ment of the forearm ; the phenomena in question were produced 
either : 

I. By means of a rapidly descending neuritis. The irritative 
process in this way was conveyed into that portion of the integu- 
ment to which the affected ner\'e was distributed. The red lines 
which, in some of these cases, extended from the seat of original 
lesions downwards toward the forearm, would comport well with 
the notion of a descending neuritis. 

Then, in those cases in which no such traces could be observed, 
it may have been true that the nerve trunk involved pursued a 
deeper course than did those which on account of their close rela- 
tion to the skin led to a visible trace of congestion along their 
course. This view is essentially that of N. Friedreich, Tiesler, Fein- 
berg, Kleme, and others, who have given much attention to the 
subject of neuritis in its various forms and results. I am inclined 
to receive this view as probably correct for certain cases, but prac- 
tically untrue for others. 

II. Then again, an attempt maybe made to explain the phenome- 
na in question by a reference to vaso-motor action. 

This may occur in one of two ways, in such a. case as the one 




NERVE DISEASES OF THE SKIN. 305 

under consideration. It may be owin^ either to the irritation o( 
vaso-motor fibres (vaso-dilators) contained in the nerve trunks 
which pass through the seat of morbid action. By this means an 
irritative influence is exerted on the peripheral vaso-motor appara- 
tus belonging to the vascular area, which corresponds to the region 
d distribution of the affected nerve ; in this way the congestion 
is produced. Or, the vaso-motor disturbance may be produced in a 
leas direct way ; irritation of the fibres of the sensory ner>-e, which 
is involved in the local disease produces an irritative impression 
in the nervous center to which the affected nerve leads, and the 
excitation thus of a limited portion of the sensory tract is trans- 
ferred to the contiguous va^o '"-' - -^"inal center, which, when ex- 
cited, gives rise in a reflex wa. I !se passing along the outgo- 
ing vaso-motor nerves which x vaso-motortractof tbecord 
ai^ pass out toward the peri | : n the plexuses which follow 
the vessels, or in the trunlu txrrves ; from this point on- 
wards, the action beii^ pl:....... ......Ur to that which was de- 
scribed as the result of direct instead of reflex excitation of the 
periphtrral vnv>-nK>tor apparatus. But in either case, and as I 
beii r way. may congestion be produced. But there is 
soiii in this case tlutn mere congestion, which seems to 

be a : How from lesions of the vaso-motor nerves, pure 

and simple. Congestions produced in this way have been kitown 
to endHn* for m-\r\\ months without the occurrence of demonstrable 
stru he paru which are their seat There were 

ccr' H>mcna in these cases, as in so many other 

kill. >-.ise. In the cases referred to, there is not 

only congestion, but simultaneously signs of irritative action for 
which there are no known local causes, and which can hardly 
be accounted for by a reference to nettritis. How, then, is the local 
irritative action — the pnNMWBoed tiiwie change, — so often noted 
fart fMsu with the coogestion, produced \ By some means we 
must explain the circumscribed and apparently causeless irritative 
action. 

III. It can onlv be accounted for on the supposition that certain of 
the cerebro-^pinal nerves exert an influence over the nutrition of 
the body in such way as to increase or diminish, or even pervert or 
derange the same. The nerves through which this influence is 
probably most commonly exerted on tiw intimate nutrition of the 
tissues of the body are the sensory. In this case it b supposed that 
the sensory nerves which pass thiongli the seat of disease, become 
the seat of irritation, and the impression thus produced acts in one 
or both of two ways. 

Either, (a) the imprassioos produced in the nerve at the point 
of disease are conveyed toward the periphery where the nerve 
is distributed to the anatomical elements of the tissues, and 
excite and disturb the process of nutrition in them so as to 
bring to pass what has been called irritation,— ox (b) the impressions 
produced are conveyed to the spinal cord, and an irritative state of 
the cell groups in which the related fibres terminate is produced, 



3o6 J. S. JEWELL; 

which reacts through the sensory fibres on the tissues at the periph- 
ery in the manner described, so as to produce the irritation which 
runs along parallel to the congestion. As to the central location, 
in which the irritative action is set up, from which the influence 
emanates which disturbs the nutrition of the tissues in cases like 
the one under consideration, I believe the most common, not to 
say the only one, to be the groups of cells which are on the sensory 
root, and which constitute collectively the spinal ganglia. These, 
as I have pretty good reasons for believing, may become the sources 
of a disturbance propagated in a peripheral direction, along the 
sensory fibres, which may in this way trouble the nutrition of 
the area to which the affected nerve leads. This hypothesis re- 
quires, of course, that the sensory nerve fibres, which convey, as 
we know, impressions from the periphery to the center, shall also 
convey impressions the other way, that is, from the center to the 
periphery. And this I believe to be true. I have no reasonable 
doubt of it. It also requires that the nervous system shall exert 
what have been called trophic functions, about which there has been 
so much dispute. But I am fully convinced that it is charged with 
a certain control of nutrition for either its weal or woe. 

But it is not possible for me to enter at length into a consider- 
ation of the grounds of these opinions. I e-xpect to give full ex- 
pression to my views on this subject and my reasons for them, during 
the present year. But that the local irritative action in' the cases 
related, excited in circumscribed patches remote from the seat of 
original injury, was due to an influence of some kind exerted 
by the diseased irritated nerves, or propagated along them from the 
point at which they were diseased, I have not much if any doubt. 

Many rather powerful and, taken altogether, convincing facts 
and arguments might be adduced in support of these views, but I 
cannot give them here. But passing from the local nutritive change, 
to the congestion, which accompanied it, we are led to inquire in 
what way it was produced ? It may have been produced in the 
ways already alluded to, but it has seemed to me it may have been 
in another way. 

In my present view, it may have been consecutive to the irrita- 
tion or nutritive change. In other words, it arose in consequence 
of the local irritative action. The latter, it is supposed, was in- 
duced in a way already described, and hence involved in the com- 
mon nutritive disturbance the local vaso-motor apparatuses, which 
are in immediate relation with the small muscular arteries and veins 
which permeate the tissues, and the result is a diminution in the 
tonic action of these diminutive peripheral vaso-motor mechanisms, 
and a consequent expansion of the blood vessels, or in other words, 
a congestion. Hence the congestion is chiefly limited by and pro- 
portioned to the e-xtent and degree of irritative action. 

But I shall not be able in this paper to do more than simply 
state the doctrines referred to, without discussing them. I may 
say that I have certain reasons for believing them to be some- 
thing more than bare hypotheses. 




NERVE DISEASES OF THE SKIN. 307 

Though the views I have enunciated are not novel, yet I have 
for years felt, as I have been teaching them, that they have a very 
wide range of application and are worthy of serious attention, espe- 
cially on the part of dermatologists. 



CASES OF HARE^LIP AND CLEFT PALATE IN SYPHIL- 
ITIC CHILDREN. 

BY THOMAS R. BKOWN, M. O. 

A^towr U Ct imi t atiUOftraltvt Strgtry mmj Ditmut tjf tkt Gtmttf- Vrim Ty Of 
gmi, CtUtp if Pkftkiami amd Sm- g m u , B ^ H mt n, Md. 

THE foltowins cases of cleft palate with hare-lip, occurring 
in children, one or both of whose parents were victims to 
syphilis, are reported with a brief history of each case. 

(^ASR I. Mary S — , unmarried, was admitted to the Maternity 
Hospital of the College of Physicians and Surgeons to await coo- 
fincinent, which took place in due time and was to all respects natu- 
ral. The infant at the time of birth was well nourished and looked 
to b<; vigorous. There was a deformity in its mouth consisting of a 
cleft in Doth hard and soft palate, and a hare-lip of the left side. 
The hare-lip was of such a nature as to make it impossible for the 
child to nurse, and for the purpose of meeting thb difficulty the usual 
operation was performed 10 days after birth. It would oe well to 
state in this connection that except there be some serious deprarity 
of the patient's health, modem surgery a p prove s an eariy attempt 
to remedy this deformity, for very obvious reasons. 

One week after the opentioo a nocons patch attacked the line 
of the i nciskm which enlwged rapidly to about the sise of a five-cent 
piece. The result was tMt, except at the labial border, the adhe- 
sions which had formed were broken up and the wound presented an 
ugly, ragged appearance. Somewhat later there appeared a profuse 
papular eruption over the greater part of the body, and later still 
desquamation of the hands oegan, notably of the palmar wrfacea of 
the fingers. The little patient soon loot its ruddy appearance, 
wasted and looked puny and old. 

Under specific and other tonic treatment its health improved. 
The medication consisted of the officinal " Hydrargyrum cum creti," 
which, though given in dosesof z grains repeated every^ hours, last- 
ing over a considerable period of time, caused no bowel irritation, 
nor any but good effects. \\l)en dismissed from the hospital it was 
gaining flesh and strength as rapidly as could with reason be ex- 
pected. 

It was ascertained from the mother that during her pr^^ancv 
she suffered from intractable sore throat, a diffuse eruption, with 



3o8 THOMAS R. BROWN; 

nothing definite as to sore on the genitals or elsewhere. There was 
good reason for believing that she had syphilis, but owing to the fre- 
quency of her exposures, no attempt was made to find out the source 
of her contagion. It was enough for our purpose to establish the fact, 
beyond cavil, that the child had syphilis, the appearance of which, I 
could hardly help from believing, was hastened by the depressing ef- 
fect of the operation. 

Case II. Mrs. S — , married 5 years ; has had during this period 
three pregnancies, the second of which terminated in a miscarriage. 
The first child was born with an imperforate anus, for the relief of 
which an operation was performed soon after birth by one of our 
Baltimore surgeons, with only partial success. 

There remained in the lower rectum a dense stricture so close 
as to barely admit the point of a syringe, it having been necessary to 
rely upon enemata to secure the evacuation of the bowels. When four 
years of age she attended as an out-patient at my College clinic. 
The stricture was completely divided and continuous dilatation prac- 
tised without the occurrence of re-contractions. During her attendance 
her little brother, aged 2 years, was presented for operation. He had 
hare-lip and cleft palate of the left side. In reply to inquiries, the 
mother stated that she had always been healthy and her general ap- 
pearance coincided with this statement. The father admitted that 
he had had constitutional syphilis some time ago and had been un- 
der treatment for the same. When last seen by me, though not com- 
plaining of any distinct syphilitic symptoms, he seemed cachetic and 
in ill health. Both of the children were strong and healthy at the 
time of birth. The assumption of a syphilitic taint here merely de- 
pends upon the father's confession. 

Cases III. and IV. Mrs. L — is a private patient of mine, with 
whose history I am quite familiar. She has been married three times. 
By her first husband, who was healthy, she had but one child, who has 
reached manhood in splendid health. From her second husband 
she contracted, what the physician called, " the seven years' pox." 
The tolerably clear statement which she makes of what she has 
suffered, the numerous scars on the different parts of her body, the 
history of periosteal and pericranial nodes and pains, together with 
the appearance of her mouth, confirm the Doctor's opinion as to 
her disease. After the nature and source of her malady were made 
out she separated from her husband without bearing, and before 
long was married to her third husband, who enjoys excellent 
health. 

Since her last marriage she has had well-nigh one dozen pregnan- 
cies, all but three of which, and those the last, ended in abortions. 
Two of these three which came to full time, had cleft palates and 
hare-lips, and died very soon after birth with " catarrh." It was 
during the next to the last pregnancy that my attention was called 
to her syphilitic condition, and I then instituted a vigorous anti- 
syphilitic management. Her last child is now living, and with the 
exception of some maculae scattered here and there over the trunk, 
has been all right. As a precautionary measure, mercurial inunc- 




SYPHILITIC HARELIP AND CLEFT PALATE. 309 



tions are occasionally used with the hope of subduing any s)-philitic 
tendencies that may be lurking in her system. Another case of 
hare-lip has occurred in my practice where there was reason for sus- 
pecting syphilis, but the case is inaccessible, and the history is not 
only too indefinite, but somewhat impertinent to admit of its being 
reported in this series. 

At the time my attention was being called to these cases, my for- 
mer colleague, Prof. Noel, reported to the Pathological Society two 
cases of cleft p.i{ate which he had seen in syphilitic children of dif- 
ferent parentage. In neither of these cases was the duration of the 
disease in the parents stated. This would seem to be unimportant, 
however, inasmuch as, according to my list, the occurrence of the 
deformity in the offspring bore no relation to the stage of the dis- 
ease reached in the parent. In case I, I feel quite sure that the 
syphilis was of recent origin, whilst in cases III. and IV, the mother 
had had syphilis for many jrears, long enough at least to develop 
tertiary symptoms. 

In ijringiti;; these cases to tin- notice of the profession, I am not 
unmindful of the tendciuy. ulm h !■> not altogether unreasonable, I 
must admit, to acrrcdit syphilis with a very large share in the pro- 
duction of many disorders. One would think indeed that there are 
some, not a few, who believe it to be the " root of all evil." This 
' ' ' ' ■ ' s.iy, be deemed altogether un- 

to accept the startling figures 
e to lime, showing the extent to 
wtiicli svpiiilii prevails in all of our communities. I am equally 
aware that the number of my cases is hardly more than enough to 
r ' rtainly scarcely sufficient forme 

se particular cases the disease 

of ttie defect in the children, 

rit of a general proposition. Yet I 

ther a coincidence, though not pre- 

I 1 ' '■ ■ '^{xramdi. There is abundant 

r > " re, and if I were to argue the 

<: ' I abilities, I might write at length 

t iid. Itic history and causation of all de 

It secret, and have foiled the efforts of oui 

■\h\r and ingenious explanations have been 

: ill. fail to satisfy. Plausibility and in- 

L . : , ri s f or a creed surely. 

1 :■> '':l"r consideration, we all know how 

hen-ii 1. M :. Ill : : , influence positively urged until 

coU.r '. Ill tltc coiiiiLction. And again, with what per- 

siste: . iiicn, in and out of tiie profession, have turned 

to ": r^-ions" to solve the problem. We must be- 

:> from believing, that both of these theories are 
undless, and we cannot afford to ignore either of 

:. - ....;c'fore, not difficult to understand how a common 

belief in their influence obtains, even though this belief rests on an 



310 THOMAS J?. BROWN; 

unscientific basis. Persons not trained in close and careful reason- 
ing, in cautious generalizations and inference, are apt to be hasty 
in coupling certain morbid states with conveniently supposed causes. 
And besides the abundant comfort which people seem to derive from 
tracing a trouble, be it disease or deformity, to some very indeter- 
minate source, there is among many such an enormous love of the 
marvellous and mysterious. This whole subject of causation is in- 
volved in great perplexity. While our text-books and our individual 
experience abound in evidence of the very moderate progress made 
in the department of etiology, are we not often amazed at the glib 
disposition which some make of the cause of many a disease about 
which absolutely nothing is definitely known ? With them very little 
suffices to establish cause and effect, and with them assertion equals 
argument and proof. 

To this class of persons how conclusive the following case in 
point, taken from Geoffry St. Hilaire, seems to be : "A woman, 4j^ 
months pregnant, has her attention called to a hare-lip case by her 
husband. During the last months of her pregnancy her imagination 
reproduces constantly this deformity, and she doubts not the child 
which she carries must be born with a like deformity. Some hours 
before her accouchement she announces in the most positive manner 
to the physician called to attend her that her child will present this 
vice of conformation, and her prediction is verified." With strange 
impetuosity those easily convinced forget to read the case of Nicati, 
in which "a woman, during four successive pregnancies had almost 
constantly under her eyes a child afflicted with this deformity of 
the mouth. She was convinced in each of these pregnancies that 
the child she was about to give birth to would be similarly mis- 
shapened, and still in not one were her fears realized. 

Tiedmann discards the influence of both heredity and maternal 
impressions, and refers it to what he entitles the " inertia of vege- 
tative progress " and the consequent imperfect formation of chan- 
nels of blood-supply which depend upon it. 

Vrolik and Nicati explain it, the cleft palate and ultimately the 
hair-lip, upon the ground of developmental interference, and offer to 
prove that the tongue, which is developed early in the foetus, is 
pushed up and becomes an obstacle to the union of the maxillary 
bones if the buccal cavity is too straight and contracted to contain 
it. Their proof consists in the instances where fcEtuses have been 
examined, and when they have found the tongues firmly wedged in 
the fissure. 

In support of the latter position Geoffry St. Hilaire, jr., says that 
his father entertained the same opinion as to the cause of cleft 
palate. 

For my own part, rejecting, so far as my own cases are concerned 
the influence both of heredity and maternal impressions, as neither 
apply, I am forced to the conclusion that in the six cases, well 
authenticated, in which syphilis and cleft palate were associated, 
there was more than a simple concurrence. With our knowledge 
of the dreadful havoc which this disease can and does produce, 




SYPHILITIC HAREUP AND CLEFT PALATE. 311 

especially in the mouth, is it logical to assume that it is not equally 
destructive to the nutrition or development of the embrjo or fixtus ? 
Does analogy permit us to award it the position of fell destroyer 
when it occurs in the adult, and that of a silent partner when it 
saturates the tissues of the individual inutcro? How or why it is 
that the mouth should have been the part attacked in preference to 
some other, no valid explanation can be given. Might not the dis- 
pro|iortionate vascularity of these parts, thereby securing an im- 
portation of a larger amount of the syphilitic virus to the struc- 
tures, help to clear up the matter. As a matter of clinical interest I 
trust that this report may pave the way for a (unber investigation of 
the subject. 



THE RELATIONS EXISTING BETWEEN ECZEMA AND 
PSORIASIS. • 



I 



ec/ 



BY ftOBSXT CAMPBELL, M. D. 
fkyacim M Ikt Skim Dtfartm*mt, Dtmilt Ditftmmry, Um Ymrk. 

N the present paper I desirt to correct what appears tone to be 
an erroneous impression conveyed by moat writers in regard to 

>:m.\ .ukI Dsoriasis. In reading artklet on these diseases, I was 
for <>cd by the fact that the greater number of authors, 

alt: iig to them as possessing some features in common, 

gave the impression that they were not so intimately associated 
with one another as I believe they are, and which the histories of 
cases I shall narrate, go far to prove. 

We often meet with instances in which the characteristic points 
of diagnosis are so intimately blended, that it is ver)- difficult to 
say, in a particular case, whether it is one of eczema simply, with- 
out any elements of psoriasis intermixed, or vice-vcraa. Cases are 
not infrequent in which a person may have an ecie m a at one time, 
and a psoriasis at another period. Then there are persons, who 
are sunering from an eczema and psoriasb at the same time, and 
still others who may have a simple eczema, or an ordinary psoriasis, 
in which the characters of the eruption are so badly defined that it 
b not an easy matter to make a perfectly accurate diagnosis. 

In the foregoing remarks, and those which follow, I do not wish it 
to be understood that I claim the two diseases to be essentially the 
same ; I only desire to show that they are very closelv allied to 
each other, and, in endeavoring to do' so, I shall connne myself 
chiefly to the narration of a few cases, bearing upon the subject, 
which were observed by Dr. Bulkley and m)-se!f at his clinic. 

The first patient is a girl nine years old, of strumous tendencies, 
of delicate build, with a pale countenance and flaxen hair. Her 

• Read before the New York DemulolQcical Socktx. May 16k 1877. 



312 ROBERT CAMPBELL; 

mother says that she has had the present eruption for over a year ; 
that it made its appearance about two or three weeks after vaccina- 
tion, and that it continued uninterruptedly until we saw her. At 
the time she was first placed under treatment there was a charac- 
teristic eruption of psoriasis, occupying the favorite locations of 
that disease, viz : the extensor aspects of the upper and lower ex- 
tremities, and body. On the elbows and knees, as well as on the 
left arm, at the seat of the vaccine scars, the patches were more 
numerous than elsewhere. The eruption consisted of a number of 
white, silvery, and imbricated scales, on red bases, with ill defined 
margins. These scales were pretty firmly adherent, but when 
removed left the peculiar bleeding surface characteristic of the 
disease. After remaining under treatment from January until the 
middle of the following April, she was discharged, there having 
been no appearance of eruption in three or four weeks. 

The same patient came back to the Dispensary, in September 
following, and stated that her skin had been free from disease since 
seen by us until two weeks ago, when another eruption made its 
appearance. This time she was the subject of a squamous eczema, 
situated upon theyfec^r aspect of the arms and forearms, the other 
portions of the body being only slightly affected. The single 
patches of disease were larger than those seen in the previous 
eruption, more irregular, and freer from scales, although there was 
slight scaling. There was a considerable degree of thickening of 
the skin and evidences of scratching, as was shown by the excori- 
ations. 

This case goes to show that different causes, operating in the 
same subject, may, at one time, give rise to a psoriasis, while at 
another period an eczema will be produced. The first disease 
that the patient had was, without doubt, a psoriasis, as seen in the 
situation of the eruption, the character of the scales, and the 
bleeding and exposed surface left on removing them. That the 
second eruption was an eczema, there is no question, as shown by 
the amount of pruritus, the thickening of the skin, the flexor surfaces 
being attacked in preference to the extensors, and the absence of the 
silvery white appearance of the eruption. As to the cause of the 
patient having an eczema at one time, and a psoriasis at another, 
it is difficult to give any definite and sufficient reason. Perhaps 
the alteration in the type of the disease may have been induced by 
the different season of the year. 

The next case is that of a patient in which psoriasis and eczema 
co-existed. A girl, sixteen years of age, and whose mother says 
that she has always enjoyed good health, but whose appearance 
indicates that she has been improperly nourished, has had an 
eruption on the hairy portion of the scalp ever since she was two 
years old. At that time, she had what appears to have been an 
impetiginous eczema, the head, according to her mother, being 
covered with a number of yellowish crusts, and the hair feeling as 
if glued together, so that it was with difficulty that it could be 
properly combed. This eruption disappeared, after lasting a few 




RELATIONS BETWEEN ECZEMA AlfD PSORIASIS, iiz 

months, to recur again when she was four years of age, disappear- 
ing and reappearing at intervals. Her hair has always been full 
of " dandriff." 

Sometime during the summer of 1876, the present eruption 
made its appearance and has remained ever since. On the hairy 
ptirtion of the scalp is a mixed eruption, partaking mainly of the 
chancier of an eczema, consisting of yellowish crusts, and the hair 
fc ' : I liad been dipped in mucilage. Toward the edges of 

til sease is psoriatic in appearance, being made up of 

sni_ . ir, white, and scaly patches ; no evidences of moisture 

are present in this situation : this condition also exists on the face 
and forehead. Above and behind the lobe of each ear is a moist 
cczematous eruption traversed with fissures, ' ' ^; a margin 
which insensibly fades into the sttrroaixiin^ >iics: the 

diseased skin in this sitoation is somewhat th t>n the ex- 

tensor surfaces of Ixjth arms, and especially at tltc points of the 
elbows, are several patches of disease, circular in form, and consist- 
ing of a number of silvery white scales, which, when scraped off, 
leave a bleeding and expooed surface such u is only seen in psori- 
asis. The same species of eruption exisu on the back, thighs, and 
le-^s ; the patches of disease, however, are more numerous on the 
thighs than the legs. There never has been any eruption on the 
knees, nor in the popIitc.il spaces. The margins of the diseased 
skin arc not vcr)- wlII defined. At each elbow, on the X^"-*''' aspect, 
is a typic.-il patch of moist and red eczema, about two inches by 
three in di.iinctcr ; there are no scales in this situation and the skin 
is considerably thickened. About six months ago the tinker nails 

b<:gan to be artected with psoriasis, and are now ben ' -■')l)cd, 

piesenting a coiic.ivc, instead of a convex surfac< pre- 

sent, on their exterior, a number of minute deprcN 1 are 

circular in form, varying in size from a pin's point tu a pin's head 
in diameter ; the edges also are very irregular in outline. The 
patient complains of great itching of the skin, especially toward 
evening. 

In the above case no one for a moment will doubt, from the 
description of the eruption, the fact of the co-existence of a typical 
eczema and psoriasis in the same person. The close relation ex- 
isting between eczema and psoriasis is, to a certain extent, shown 
in the ill-defined mar^ns of the eruption on that part of the body 
where the psoriasis exists. That a psoriasis does exist, on the exten- 
sor aspects of the body, is seen on an examination of the appear- 
ance of the scales, and on removing them, the fact of the peculiar 
exposed and bleeding surface remaining. That part of the erup- 
tion existing on the hairy portion of the scalp, behind the ears, and 
on the flexor aspect of the elbows, is an unmistakable eczema : 
on the head it is shown by the appearance of yellowish crusts and 
the gluey feeling imparted to the hair, while behind the ears and 
on the flexor aspect of the elbows, the skin is thickened and the 
surface bleeds readily on scratching, causing it to present a punc- 
tuate appearance not seen in psoriasis. 



314 ROBERT CAMPBELL; 

In connection with this case it may be interesting to quote 
Nayler,* who says that " psoriasis of the nails seldom exists alone, 
being more commonly connected with general or inveterate pso- 
riasis, or else supervening upon eczema : " showing that he admits 
a certain relationship between eczema and psoriasis. 

The following case will go toward showing that a person havin'g 
a psoriasis may transmit an eruption to his children, which will take 
on the principal characters of an eczema. 

J. R., aged 30, a man in good health, has had a psoriasis uni- 
versalis for at least eight years. At the time of his first appear- 
ance for treatment, almost the entire body (flexor and extensor 
surfaces alike) was covered with a squamous eruption, consisting 
of silvery-white, micaceous and imbricated scales, firmly adherent 
to the surface beneath. On removing the scales a bleeding and 
exposed surface was brought into view. Those portions of the skin 
free from eruption were of a dusky red color. The disease existed 
on the head and face ; extended downward, anteriorly and pos- 
teriorly, on the body ; occupied both axillae, and was also situated 
on both surfaces of the arms, forearms, thighs and legs ; both the 
hands and feet were spared. On the lower extremities, the erup- 
tion was of a duskier red color than elsewhere on the body. There 
was considerable thickening of the skin, in all situations, but it was 
more marked on the flexor aspect of the elbows and in the pop- 
liteal spaces. The margins of diseased skin (where they existed) 
faded imperceptibly into the surrounding healthy tissues. The 
patient complained of intolerable itching, which was so excessive 
that it caused him considerable uneasiness, more especially when 
the surface of the skin became heated. On examining the patient's 
tongue a silvery-white patch presented itself on the dorsal surface, 
from which scales could readily be detached. Under treatment the 
eruption began to disappear in the centre of a diseased patch first, 
and on the upper extremities before the lower began to show any 
signs of improvement ; it also faded from the flexor surfaces first, 
leaving a characteristic psoriasis on the extensors. He had two 
children under treatment at the same time ; one, a girl one year 
old, affected with a dermatitis of the labia majora, approaching 
very nearly the character of an eczema rub'rum ; the other, a child 
four years of age, had an impetiginous eczema confined chiefly to 
the head and face. 

The noteworthy features in this case are the existence of 
a psoriasis with the elements of eczema intermixed, and also 
the tendency to the transmission of the disease, shown by the 
children being subjects of an eruption somewhat similar in char- 
acter. As to the disease having some of the elements of eczema, 
we have in proof of it : first, that the eruption was situated on the 
flexor, as well as the extensor, aspects of the body ; second, the great 
amount of thickening of the skin ; third, the gradual fading away of 
the eruption into the surrounding healthy tissues ; and, last, the in- 

* Nayler. Diseases of the Skin, 2d Edit Lond., 1874, p. 34. 




JiELA TIONS BETWEEN ECZEMA AND PSORIASIS. 315 

tense pruritus, although this latter s)'inptoin is often present in 
|>soriasis and other diseases, but not to so great an extent as in this 
case. 

The psoriatic nature of the eruption is shown by its occupjing 
the extensor aspects <A the body, the character of the scales, the fact 
of the patches of disease clearing up and healing in the centre first, 
also the disappearance of the eruption, under treatment, from the 
flexor surfaces previous to the extensors, leaving a characteristic 
psoriasis, and the coincident psoriasis ? of the donal surface of the 
toncue. On this latter I do not insist, as I am well aware of the 
douot in regard to the true nature of the so-called psoriasis buc- 
calis. 

A boy, seventeen years old, with strumous tendencies, pale ooan- 
teaance, flaxen hair, and slightly enlarged glands, has an eraptioa 
of psoriasis, situated on the extensor aspects of the body, consistiag 
( ' ' ircular in form. While under treatment 

■> , °.s appearance on the face and head. The 

l^atii-iu > iituuicr >-> subject to rfacwmniwn and be has nasal 
catarrh. 

Anotlicr patient, a man forty yeanof age, has an ccsema on the 
:i ' ice of both legs and a few spots of psoriasis, of the 

;. V on the extensor an>ects of the elbows. The eruption 

I - '■■ -ches, ana there is considerable thickening 

: is also the subject of asthma, and, during 
I >l>ensarv, as his craptioa improved, the at- 

I rca^rd, this being probably caused by the bron- 

< brane becoming affected with ecxema — a fact 

1 '■orilies.* 

: will cite is that of a married woman about 

^ :ic has a prettr general eruption of psori- 

uurcs being that, althoogh there are a number 

cs on the dorsal sw^Ke of the hands, a number 

ot i.»u.i.^ .1.:... mat in this situation, causing an appearance like 

that presented in the eoKow rimomm of authors. The patient 

says that when she immerses her luuxb in water they become moist 

and itch p'catly. In all other re sp ects the case resembles, and is 

without doubt, one of psoriasis. 

As further suggestions in regard to the more or less close rela- 
tions existing betwee n ecaema and psoriasis I would recall that in a 
|reat number of cases of these affections, more so in the latter than 
in the former, the patients are subjects of rheumatism or gout, or 
else a tendency to these diseases exists. This fact has bwn rec- 
ognixed by several writers. Garrodt states that gout predisposes 
toward eczema and psoriasis. Murchisont also says that "in many 
cases these cutaneous diseases (referring to eczema and psoriasis) 
appea^ to arise from functional derangement of the liver, which 
often precedes gout, although neither the patient or any member of 

* AUbatt on Internal SUa Diiesics. Archives of Dennatology, VoL iii., p. 1. 
t Mordiisofi. Fonctiaaal Dataagcaients of the Liver. New York, 1875, p. 1401 
t Loc dm>. 14a. 



3i6 ROBERT CAMPBELL ; 

his family has ever suffered from this disease." Paget* believes 
that eczema and psoriasis are offen due to a gouty state of the sys- 
tem, in the same manner that tophaceous deposits in the joints are 
the result of gout. 

In both diseases, on examining the urine repeatedly, I have found 
that the specific gravity was greatly increased above the normal 
standard ; was very acid, and loaded with lithic acid and lithates, 
showing a faulty assimilation of food and deficiency in the action 
of the excretory organs. This condition of the urine in these dis- 
eases has been observed by Nayler,t and others. t Bearing upon 
this point also is the state of the digestive system, which is found to 
be at fault in a majority of persons affected with either eczema 
or psoriasis. This is shown by the great amount of flatulence ex- 
isting, the torpid condition of the bowels, and, as a result of these 
conditions, the frequency of headache, and coldness of the hands 
and feet. 

Fxzema is often called forth, or at least kept up, by the debilitated 
state of the S3'stem. As to psoriasis this cannot be so conclusively 
shown, although I believe that in certain cases a psoriasis may be 
induced by debility. In eczema the debilitated state of the system 
is demonstrated by the paleness of the countenance, flabbiness of 
the skin, by the enlarged glands in the neighborhood of the erup- 
tion, and, in the impetiginous forms of the disease, by the abun- 
dance of pus that is formed. In fact, in some cases of eczema, 
debility is the only appreciable cause that can be found to occasion 
the calling forth of the eruption. ' As to psoriasis being to any 
great extent dependent upon debility it is not so evident. We oc- 
casionally meet with cases in which the patient exhibits strumous 
tendencies, or there is a waxy appearance of skin, thick lips, flaxen 
hair and, in some cases, there is a considerable admixture of pus 
along with the scales of the disease. I have the notes of a case in 
which psoriasis made its appearance during pregnancy and was 
probably induced by the debility due to this state. Anderson § re- 
cords cases somewhat similar, and one especially of a woman, in 
whom an eruption of psoriasis made its appearance when nursing 
her male children, but when she nursed her female children this was 
not the case. 

Another feature, in both diseases, is that they are hereditary in 
nature. One often meets with patients in whom an eczema or 
psoriasis has been inherited from one of the parents. It even has 
been transmitted through two or three generations. As an instance 
of the hereditary nature of the diseases, we have the third case nar- 
rated, where the father was affected with psoriasis and two of his 
children had eczema. 

• Paget. On Gouty Affections of the Skin. British Med. Journal, p. 737, 
June sth, 1875. 

t Nayler. Diseases of the Skin. 2d Edit. Lond., 1874, pp. 40 and 112. 

} Bulliley. The Relation of the Urine to Diseases of the Skin. Archives of 
Dermatology, Vol. II., p. i. 

§ Anderson. On Psoriasis and I^pra. London, 1865, p. 14. 




HE LA TIONS BETWEEN ECZEMA AND PSORIASIS. 3 1 7 

The constitutional nature of eczema and psoriasis is shown by 
the results of treatment. If they were simply local diseases one 
would expect that, under local treatment alone, the eruption would 
b«! cured. Such is not the f.ict, except in a very small number of 
cases, while under intem.il medication the eruption entirely disap- 
pears and the patient is generally restored to health. 

Asthma and bronchitis are, in a certain proportion of cases, as- 
sociated with eczema, and Ciskoin* refers to the former disease as 
occurring in psoriatic patients. I have seen persons having an 
eczema troubled with cither .isthma or bronchitis, but have nut ob- 
scr\-ed it in psoriasis, although some patients have chronic nasal 
catarrh. 

'!' — ...:-,i .1 Iipment of the two eruptions is a notice- 

.n with the subject under consideration. If 

ail xo\ aspect of one .irm we generally ex- 

p<xt to tiiid ii developed exactly in thr rion on the other 

arm ; or. if in one popliteal space, it i^ > to be found on 

the other ■ ' ■ •" ...<--.« ., psori.^..^ m.v ^—im: reoiark holds 

true as ' 

V*i : ' t heir coone, often tasting for several 

y ' 'i«;aia ihev arc very apt to appear and disappear for 

a; number of tiroes, so that it becomes a difficult matter 

t .1 case absolutely cured. 

tment, in cases like those which I have narrated, and 
w :i>tion parukes of the nature of eczema and psoriasis 

CdiiiLiiiied, uur main reliance should be on alkalies administered in- 
ternally. Local remedies are of service as palliatives and adju- 
vants, but the cases are few in which a cure is effected by local 
measures only. 

My reasons then, in brief, for believing that eczema and 
psoriasis are very intimately related to each other, are : 

First, we not unfrequently meet with cases in which the two 
diseases coexist. 

Second, a person may have an eczema at one time and be sub- 
ject to psoriasis at another period. 

Third, the tendency towards gout and rheumatism which exists 
in eczcmitous and psoriatic patients. 

Fourth, the derangements to which the urine is subject in both 
diseases. 

Fifth, the debilitated sUte of the health sometimes seen. 

Sixth, the hereditary natures of the two diseases. 

Seventh, their constitutional nature. 

Eighth, their s)'mmetrical development. 

Ninth, their proneness to recur and their chronicity. 
50 East 29(h St, New York City. 

• Caskoia. On the Psoriasit or Lepra. Loud, 1876k p. S> 



3i8 GEORGE H. ROHE ; 

THE PATHOLOGY OF HERPES ZOSTER, CLINICALLV 
CONSIDERED. 

BY GEORGE H. ROHi, M. D. 

Lecturer an Diseases of Ike Skin, College of Physicians and Surgeons, Baltimore; 
Physician to the Skin Department, Central Free Dispensary. 

SINCE the publication of Von Barensprung's classical memoir on 
the " Girdle-disease," the opinion has been generally held by der- 
matologists that herpes zoster is essentially a neuropathy ; in other 
words, that the morbid anatomy of the affection explains its pathol- 
ogy. Apparently fully accepting this view. Dr. L. D. Bulkley* in his 
recently published classification of Skin Diseases, places herpes 
zoster among the neuroses, and justifies his action in these words : 
"***Its true nervous origin is now so ihcontestably demonstrated 
that if we wish to really base our classification on pathological facts, 
this disease should form the centre around which we may group 
others whose clinical features are wholly neurotic, but whose nerve 
origin is at present less clearly demonstrated." 

Before we commit ourselves to this conclusion, and thus upset 
and destroy a part of the grand generalization presented in the class- 
ification of Hebra, it would be well, I think, to again examine the 
question from the clinical stand-point, using " pathological facts " 
only in the way they will fit, and not endeavor to force them into 
positions where they do not belong. 

Believing, then, that the affection under consideration should, for 
the present, retain its position among the acute exudative dermatoses, 
and agreeing in the main with Kaposi, f I claim for herpes zoster 
a relationship or analogy to the specific eruptive fevers (rotheln, 
acrodynia), or neuroses (pertussis). The grounds upon which I be- 
lieve myself justified in so considering Zoster, are the following facts 
in its clinical history. 

I. The strictly self-limited characerof the disease, and its ten- 
dency to spontaneous recovery after a slightly varying duration. 

2 The constant occurrence of more or less well-marked prodromic 
symptoms. 

3. The character which it possesses with the other specific dis- 
eases, of occurring but once (generally) in a lifetime. 

4. The uselessness of attempts to " cut short " the disease by 
therapeutic measures ; and, 

5. The well-attested quasi-epidemic character of its prevalence 
at times. 

In regard to the first three of the points here mentioned, it 
would be superfluous to say anything to the readers of this journal ; 
they are facts in the clinical history of herpes zoster which are 
universally recognized. As far as the fourth and fifth points are 

•Archives of Dermatology, III., 3, April, 1877, p. 200. 

t Hebra and Kaposi; Hautkranklieiten j 2 Band; Stuttgart; 1876, p. 541. 




PATHOLOGY OF HERPES ZOSTER. 319 

concerned, I shall briefly put forward some of the evidence which 
may be urged in their support. 

Hebra • condemns all interference with the natural course of 
the affection, because other than tentative treatment is more likely 
to prolong than to abbreviate its duration. Tilbury Fox, who cer- 
tainly is not skeptical in regard to the treatment of skin diseases 
generally, says : f " The great thing is to avoid too much meddling." 
The latest American authority on dermatology X expresses himself 
as follows : " It will be borne in mind that the affection runs an 
acute course, terminating in spontaneous recovery. * * * Internal 
medication has not heretofore pro\-ed of much avail '■■'■ 4 the 

course of the eruption." Sir Thomas Watson, wl . no 

IT-- •' '-utist, asserts that very little can be .. . .> re- 

el way of treatment. "Our main business is to l<x)k on, 

ai r to set right whatever function may l>c iii.ii>ifcstly 

wrong. ") Dr. L. D. Bulkley, | gives phosphide of zinc with nux- 
Tomica. to control the pain, not to " abort " the disease. In a more 

rt-" — II- ■'■"•' the same author thinks, howerer.that he has seen 

t! :ie cutaneous manifestations as well as the pain* 

I : >re extensive experience, this effect may reasoo- 

a lied. 

: he apparently epidemic character of its preva- 
! . is sufficiently, if not equally strong. Thus 

N -. " in the summer and autumn of some years it 

\^ ..pidemic among children ; " and Tilbury Fox ;tt 

" It u :uu3i coiiinoii in the young ; of about e<}ual frequency in the 
two sexes. It seems on some rare occasions to be almost 
epidemic." In a recent discussion before the Baltimore Climieat 
iiOiU/y, Prof. Sam'l. C. Chew, in introducing the subject of herpes 
zoster, said he had lately been consulted in quite a number of cases 
of this affection, and found upon inquiry that a number of his pro- 
fessional brethren had a similar experience ; in fact, continued Prof. 
Chew, it seemed as if we were then " in a wave oif Zoster." I am 
informed by a gentleman who has practised medicine many years 
in the country, that, with one exception, all the cases of Zoster he 
h.i<l ever M:en — six or seven— occurred within three or four months 
of each other. 

The evidence here presented wilt, I trast, show that the 
essential nature of herpes zoster must be sought be^'ond the 
structural alteration in the nerves or spinal ganglia ; that, 
in fact, the local alterations in the nervous and cutaneous 
qratems are only results of a previous blood infection. Why it 

• Hcbn udKapod, Haatknakhcilen. 1. Bd. a AnO. ErUngen, 1S74. p. 315. 
t Skin DitcaMa, New York, 1S71. page 117. 

t A pract. trcatiie oo Db. of the Skm, hf Loda A. Dohring, M. D., Ptiila. 
1877, p. 1*5. 

I Lectufc* on the Practice of PhTsic. PhiL. 1872, VoL XL, p. 944. 
I Archives of DcrmatoloKj, IL, x. Jan. 1876k p. 15S. 
T Am. Toom. Med. Sd., TiiIt, 187&. 
•• Di*. of the Skin. PhU., 1852, p. 8& 
ft Loc-dt, p. 113. 



320 Z. DUNCAN BULKLEY ; 

is, that Zoster occurs so frequently as the result of trauma, or 
where epidemic influence cannot be traced, I am unable to say ; 
but this difficulty is certainly no greater than that of accounting for 
the so-called " sporadic " cases of cerebro-spinal meningitis or 
whooping cough. 

A skin disease of strictly local origin — like the majority of 
cases of eczema, for example — does not tend like Zoster to such 
rapid recovery ; the seat of an old eczema seems to be more vul- 
nerable with each successive recurrence of the disease ; such is not 
the case with herpes. If we regard Zoster as a neurosis, it must be 
looked upon as unique, for neuralgias, epilepsy, &c., are proverb- 
ially the bug-bears of medicine from their obstinate resistance to 
treatment, and their frequent recurrence ; finally, the prodromata of 
neuroses are in the majority of instances, indistinct or altogether 
absent. 

The only serious objection to the views here expressed that has 
suggested itself to my mind, is the generally unilateral character as- 
sumed by herpes zoster ; but we find an approach to the analogy in 
cynanche parotidea which rarely begins bilaterally, although it usu- 
ally becomes so in a few days. 

Subjective symptoms have not been referred to, because they 
prove nothing either way. The neuralgia which sometimes persists 
long after the eruption has disappeared, is not to be regarded as 
part of the disease, but as a sequela ; bearing the same relation to 
herpes zoster that the perversions of motion (paralysis) do, which 
not rarely follow diphtheria or scarlet fever. 



NOTES ON THE LOCAL TREATMENT OF CERTAIN 
DISEASES OF THE SKIN.* 

BY L. DUNCAN BULKLEY, A. M., M. D. 

Physician to the Skin Department, Demilt Dispensary, New York; Attending 

Physician for Skin and Venereal Diseases at the Out-Patient Department 

of the New York Hospital. 

X. Erythema. — The local treatment of erythema should always 
be of the most soothing character, remembering well the acutely 
congestive character of all forms of the disease ; and many of the 
remarks previously made in reference to acute eczema, especially in 
children, are especially applicable to erythema. Ointments are 
seldom called for, indeed grease to the skin not unfrequently serves 

• These " Notes " are intended to report, for the use of the general practitioner, the 
local measures in common use by tlie writer in the treatment of diseases of the skin, and 
which may be safely employed ; it is not intended that they shall be exhaustive, nor that 
these measures are recommended to the exclusion of constitutional treatment : the formu- 
Ise are not claimed as original, although sonie of them may be. These "notes" are con- 
tinued from pages 212 and 307 of Vol. II., and pages 24 and 127 of Vol. III. 




LOCAL TREATMENT OF SKIN DISEASES. 311 

as an irritant ; and relief is obtained from powders or lotions. 
Powdered starch is one of the best applications. Other powders 
have been already mentioned under eczema. Of lotions, I think 
the most benefit is derived from such as on dryiAg Icive a film of 
powder over the surface, and either of the following will be found 
grateful to most erythematous skins : B Pulv. calamin. prep. 3ss. — 
^i.; zinci oxidi, 3i. — 3ii. ; glycerini, 3ii — 3iv. ; aqux rosx, Jiv., 
M. B Bismuth, sub nitrat., 3i. — 3ii. ; acidi hydroc)'an. dil. 3i. ; 
Aque Aurant. flor. S iv., M. ; the latter to be used only when the 
skin is entirely unbroken ; sometimes a weak carbolic acid lotion 
(grs. ii. — v. ad. Si.) or acetate of lead (era. iii. — v. ad. Si.) with or 
without opium, or i simple evaporating lotion of alcohol and water, 
is really the best local application that can be made ; but generally 
little local treatment is required unless the burning is severe. 

Iner)'thema nodosum there is sometimes very considerable pain 
in tite node-like swellings, and when on the lower legs they will be 
relieved by elevating the limbs and keeping hot fomentations upon 
ther- --• • — • f-old water is more acceptable ; there is more danger 
of ' :ch than too little locally in this as in all forms of 

cr\ ; .veil to remember that the swellings even of erythe- 

ma nijiiu^um r.irely if ever end in suppuration. 

.\I. FiTtrus. — Fortunately this is a rare disease in this country, 
for it is generally a vcr)- obstinate one as it is ordinarily treated 1^ 
the general practitioner. When the disease occurs on the body or 
parts other thin the hairy scalp, it is comparatively easy of removal 
anil i-Ids very rapidly to a parasiticide, as dilute citrine 

oin: : sulphurous acid of full strength. On the scalp.whcn 

firnil_. ..-..V,., iiic disc— ' '■••* the utmost patience on the part 

of physician and pat greatest persistence in the judi- 

cious use of local app! < h are measurably severe. 

First, epilation, or the utraction of the hairs is an absolute ne- 
cessity in cxvrs which have lasted long, that is, months or years, for 
it is only after the removal of the hair that the agent destined to 
destroy the parasite can reach to its principal abode, the hair folli- 
cle. Some care is necessary in extracting the hairs not to break 
them off, they should be drawn out car^ully in the direction of 
their long axis ; one patch or portion of the disease should be 
thoroughly vfeAMtA at a sitting, all the hairs being removed ; any one 
portion may require to be epilated a number of times during the 
course of treatment, which at the best may last from three to six 
months, possibly much longer. The hairs are to be extracted as 
long as they are diseased, and the microscope should be employed 
from time to time to learn their condition. 

Directly after epilation the operator is to rub in a wash of bi- 
chloride of mercury (gr. i. — iii. ad. S i.), and the whole of the diseased 
surfaces are to be kept smeared night and day with an ointment, 
as the citrine diluted (1:1 or 3) or turpeth mineral (grs. xxx. ad. 
S i.), or it is to be kept well rubbed with the pure oil of cade. Of 
course if crusts exist at any time they are to be removed mechani- 
cally, softening them with oil first, if necessary. 



322 L. D UNCAN B ULKLE Y; 

XII. Fissures. — No more annoying cases are presented for treat- 
ment than are some of those which have as the main feature one or 
more fissures of the skin. Those referred to are especially seen 
about the nose, i^iouth, nipple and anus, as also on the ends of the 
fingers. Very often these are plainly but a part of eczema and 
yield to proper measures for this, but often they resist treatment 
most annoyingly. The most effective treatment I have found to be 
that of touching the base of the raw surface well with a stick of 
pure nitrate of silver, Squibb's points are the best, and then cover- 
ing them with some protective dressing until the eschar drops off, 
when the process is to be repeated, if necessary. For the mouth 
and nipple the compound tincture of benzoin answers the best, 
and by means of this cracks of the nipple may be healed while the 
child still nurses. Superficial fissures in the anus very frequently 
yield to the same treatment, except that after the application of the 
nitrate of silver an ointment of equal parts of ung. hydrarg. and 
ung. belladon. is to be kept applied. Deeper fissures, of course, re- 
quire surgical interference, rupturing the sphincter, etc. 

The ends of the fingers sometimes crack and split in a very an- 
noying manner, and from no appreciable cause. The best measure 
which I have found for this is to soak them in very hot water every 
night, then to make pretty severe friction with the compound tinc- 
ture of green soap (b Saponis viridis, olei cadini, alcohol 
aa 5 i. M) or with a wash of caustic potash (grs. v. — xx. ad S i.), and 
to keep on a subsequent continuous application (or certainly at 
night) of the unguentum diachyli, for which the formula has been al- 
ready given (page 126, Jan., 1877). Nitrate of silver is often of 
service in all kinds of fissures, which may also be subsequently 
painted with collodion or the liquor gutta perchae of the U. S. P. 

XIII. Herpes. — The little that is to be said in regard to the local 
treatment of the acute vesicular disease herpes is included under 
the one word protection, and the avoidance of irritation. For herpes 
zoster I almost invariably order the surface to be thoroughly dusted 
with finely-powdered starch, and, if it is at all possible, a linen or mus- 
lin band, also well dusted with starch, is to be tightly applied over 
the affected surface and sewed around the body or limb, it being 
left in position until the vesicles dry up, in something like a week. 
Collodion, made flexible with a few drops of castor-oil, is also an 
excellent dressing, and if there is much pain a little morphine may 
be added to it. Plasters of all kinds and poultices should be sed- 
ulously avoided in all the forms of herpes, as there is always more 
or less tendency to the formation of minute sloughs, and these may 
run together, causing sometimes an ugly sore if improperly managed. 
The calamine or bismuth washes mentioned under erythema may 
also sometimes be of service in herpes. 

XIV. Hyperidrosis. — The treatment of this annoying excessive 
secretion of sweat, especially from the palms and soles, has been 
already given under the heading "bromidrosis" or offensive sweat- 
ing (vol. ii., p. 310), and need not be here repeated. 

XV. Ichthyosis. — The local treatment of this disease is very im- 




LOCAL TREATMENT OF SKIN DISEASES. 323 

portant, because upon it depends verj' greatly the comfort and well- 
being of those whom internal measures can hold out little or no 
prospect of benefiting. Ver)- much relief may be obtained by local 
measures, all of which have for their object the macerating of the 
external layers of the epidermis and keeping them soft and pliable ; 
to this end frequent bathinc; should be resorted to, the ichthyotic 
patient may take a warm bath several times a week, or even in some 
instances daily, with benefit. The efficacy of the bath is increased 
by the addition of some of the alkalies, as mentioned (page 113, 
vol. iii.) in the treatment of eczema. The medicated bath may be 
given once or twice a week, and a simple warm bath on the other 
nights. Vapor baths are also of great service, and may be taken 
several times a week. 

But simple, or vapor, or medicated baths will usually leave the 
skiit too dry, and it will be advisable, as a rule, to apply some 
emollient or fatty matter after them ; for this purpose the glycerite 
of .»^tarch has served me very well, also cosmoline, the whole body 
being lightly but thoroughly anointed with it, the former (the starch 
ointment) being applied while the body is still wet. Any of the oils 
answir w.ll for the inunction, and in recent cases, especially in 
V' . codliver oil should be freely used to the surface. 

If - ces with the skin it may be used, diluted from three 

to M\ tunes, with Water. 

X\'I. Imp<tigo.—\xn^\\go reouires but little local treatment ex- 
cept in the way of protection, and there is far more danger of error 
of over-treating it locally than of doing too little. But the inflamed 
pustules require to be shielded from irritation, and the best appli- 
cat on is an ointment of oxide of zinc in rose ointroentfSss. ad 
5 i.) or bismuth sub-nitrat., in the same proportions. Tbe puts 
should not be washed, but allowed to dry beneath the crust formed 
by the exudation and the ointment ; it u often better even to spread 
the ointment on lint and lay it on, or to apply it with a camel's hair 
brush, to avoid unnecessary stimulation. 

.XVII. AArfr^.— The local measures described under acute 
rnrthcmatous eczenu and in erythema are those suitable to this 
affection. In fleshy persons as also in infants it is sometimes diffi- 
cult to remove the tendency to chafing of adjacent parts, the secre- 
tion from the sweat glands causinc every powder which is applied 
to become a paste ; when this is washed off too frequently and 
severely still greater irritation b caused. The remedy in this case 
is to interpose dry linen, dusted with the powder and held neatly in 
position, this to be changed as frequently as necessary, that is, be- 
fore it becomes saturated, perhaps three or four times a day ; the 
old measure of burning or scorching the cloth first is a good one, 
and I have thought that it assisted the cure. Something may be 
accomplished after the acute stage is passed, by using washes of 
tannin to harden the skin ; ointments are very frequently illy 
borne in intertrigo. 

XVII. LUken. — The different varieties of lichen demand very 
different local treatment ; the acute form is aggravated by anything 



324 L. D UNCAN B ULKLE Y. 

% 
but the most soothing measures, while in the chronic variety of the 
lichen simplex, or lichen agrius, very poweiful stimulants are not 
only well |3orne but are necessary to relieve the intolerable itching. 
The washes advised under acute eczema and erythema are all suit- 
able to acute lichen, as are also mild ointments as the oxide of zinc 
or bismuth, half a drachm or a drachm of either to the ounce. 

Chronic lichen simplex, which possesses many points of difference 
from papular eczema, which cannot now be referred to, frequently 
yields very well to frictions of the compound tincture of green soap 
(B Olei cadini, saponis viridis, alcohol aa. 5i. M.) with the sub- 
sequent application of a mildly stimulating ointment, as zinc, dilut- 
ed citrine, diluted white precipitate, etc. ; occasionally the itching 
is so severe that the continual application of a tar remedy is neces- 
sary, when the spots may be painted several times daily with a 
tincture of tar (b Olei rusci Si.; alcohol, Si. — Sii. M. et filtra), 
or tar ointment of half or full strength. 

Lichen planus, after its acute development, will generally stand 
some stimulation, although I seldom advise any local measures in 
any stage of it. Lichen pilaris requires frequent bathing and the 
free employment of such a soap as the sapo viridis of the Germans, 
a strong potash soap ; the baths may be rendered alkaline in the 
manner previously described, and if the skin is too dry after them, 
as is usually the case, any mild inunction serves to relieve the ten- 
sion of the skin, as cosmoline or any of the oils, or glycerine. 

Lichen scrofulosus, a disease seldom seen in this country, is 
best removed by cod-liver oil externally as well as internally, and 
it should be very thoroughly rubbed into the eruption once or twice 
a day, and the skin as far as possible kept soaked in it. 

(to be continued.) 



3»S 



CUnical Vrports. 



I. — Fmr aua of Chronic Efuma trtattd hy Nirvt Tbmifs «nd EUe- 
trieUy. By W. H. Fitch, M.D^ Rockford, JU. 

Some time since Dr. Bulkle)- of New York,* in an able article, 
drew the attention of the profession to the influence of the 
nervous system in many forms of skin diseases. In this he has 
done hb brethren a valuable service, enabling them now to heal 
many cases that had proved obstinate to the German plan of treat- 
men* " ■■** - ' ■'•iicnts and lotions, and the English method of arsenic 
an<l I do not care at thistime to take the space to con- 

side >^, causes or other kinds of treatment of eczema, 

hut \tiil m:iij>1, (litiil four cases in brief to illustrate, so far as they 
will, the ■• nt-rv.- tntuc treatment " of chronic eczema. 

C'a-sk I. Ii> niy dnvcs about the city I had noticed almost daily 
Miss A. I)., a{;ed 13, to be a sufferer from some affection of the face, 
which I took to be eczema. Finally in August, 1873, while passing 
the house I saw her swinging on the gate, and I reined up my horse by 
the sidewalk and asked her to let me look at her. While I was talking 
to her, her mother came out, introduced herself, and said she had 
thcM^t of bringing the child to me ^as I was the last doctor that 
had come to town), but considered it of little use, as most of the 
other phpicians had treated her for the last eight vears, with but 
temporary or no benefit, and they had nearly kept themselves poor 
by paying for medicines and treatment. I tola her I thought the 
case was curable, and I was so confident, that I promised to pay 
for the medicines and charge nothing for treatment if I did not 
succeed. With this proposition I entered the house to examine the 
patient I learned that she had suffered from the present disease 
since she was four years old ; that during this time she had had 
several attacks of acute and subacute rheumatism and asthma \ that 
when she was suffering from asthma or rheumatism the eczema 
was better, and vice versa, ta u often the case in these affections. 
The entire cutaneous surface was involved in this case. The neck, 
face, scalp, forearms and legs having been recently newly invaded, 

* ArcUrc* of Electrolofy and Newotogy, Nov. 1874 and May 1875. 



326 IV. H. FITCH; 

presented a weeping, oozing, raw, red surface, while other parts were 
covered with scales and crusts, and the remaining surface was dry 
and rough. She was slender, lean and neivous from her constant 
suffering and loss of sleep. The mother and sister had a rough 
skin, but had never been annoyed by any outbreak. 

The patient had been treated with arsenic several times, and all 
the ordinary kind of ointments. I ordered her cod-liver oil with 
phosphate of lime and camphorated cosmoline externally. 

Sept. I St. Patient has gained somewhat in flesh, but there is 
no particular improvement in the eczema. 

Ordered oxide of zinc, nux vomica, and iron, in pill form, and 
dilute phosphoric acid internally. 

Sept. 24. Patient much improved ; face and neck nearly well \ 
itching much diminished ; treatment continued. 

Oct. 15. Noimprovement since last date, ordered phosphide of 
zinc, camphor, nux vomica, and cincho-quinine in pill ; also 
phosphoric acid and hypophosphite of soda ; directed to come 
to the office every other day for electricity. 

Oct. 30. Patient entirely well. Has had galvanism applied 
every other day since Oct. 15th, at one visit it being applied 
to the sympathetic nerves, the next to the diseased surface. 

At first I only used two cells, but gradually increased to 12 of 
Stohrer's battery. 

At this time she began going to school for the first time in 
her life. She remained free from eczema, rheumatism, and bron- 
chitis up to the last of 1876, when I lost sight of her. 

Case II. Mr. M. L., aged sixty-five, presented himself June 4th, 
187s, with eczema universalis chronicus. He had suffered 
intensely for several years. Had swallowed six hundred bottles of 
regular and irregular medicine, and applied some hundreds of 
salves and lotions. His entire skin was the most pigmented from 
constant scratching that I have yet seen. The skin was thick, dry 
and leathery, and in many places would crack, if pinched. 

He was able to sleep but half an hour at a time, and generally 
rose several times during the night to bathe himself with cold water, 
carbolic acid, hydrocyanic acid, or other of the many lotions he had 
used. 

He suffered most about the scrotum and face, which parts felt 
as if ten thousand insects were crawling over them. He was an 
intelligent man, and had kept quite close observations of his 
medicines and their effects. Had taken arsenic for a year at a 
time until its specific effects were produced, with no benefit. 
Received most benefit from alkalies internally and cold cream 
externally. Had paid most scrupulous attention to cleanliness. 

I began treatment by the administration of the following pre- 
scription : B Zinci phosphidi 15 gr. ; ext. nucis vom., 20 gr. ; pulv. 
camphor., 60 gr. ; ferri redacti, 60 gr. ; cinchonidia sulph., 60 
gr. ; m. et divide in pill no. 60. Take one after each meal. 
Also a tumbler of Waukesha water three times a day. At the 
same time I began the use of galvanism to the sympathetic and 




NER F£ TREATMENT OF CHRONIC ECZEMA. i3t 

parts affected. I first began with two cells, which he bore with 
difficulty. The next day after the application he reported that he 
had slept two hours at a time, which he had not done for years. 
During the treatment I gradually increased the cells to ^i. The 
only external application was an ointment of chloral and camphor 
to allay itching. I need only say that this treatment was pursued 
more or less for three months, when he was discharged cured, and 
has so remained. 

(ASK III. Kev. M. H., of this dty, had suffered for )-ear> and 
gone through much the same experience as case II. 

I administered the same pills and gave acetate of potassa in 
place of Waukesha water ; applied galvanism once or twice a week 

— ^" - "ot for two weeks. The case was cured in about three 

m • the face, which proved obstinate to everything. 

Th' '.'ly any trace of the eczema on the (ace, but the 

fonnicatioii and itching occasionally light up. 

Case IV. Mr. L. R., aged sixty, school teacher by profession ; 
had been afflicted with eczema for six years, cspecialii- <■'• »►>•• face 
arms, scrotum, penis, perineum and legs. Had given . on 

account of the malady and gone to Chicago for ; md 

change of work. After two years of unsuccessful treattnciit, <luring 
which time he says various treatments were tried, he came to con- 
sult ^- .t tiw. . .1, ;• .fw.r,. ,.f I.;, fri.t.iis I ordered him phosphorus, 
nii acid and laxatives ; I also 

a[ ' e weeks, when he left the 

t :; 

t>ut have already sur- 

p I ; ... . ... .... ..itiicient to indicate the 

lit :it 1 have found most beneficial in cases of long 

St. 11 i.i, while recent cases generally give but little annoy- 

ance to any of us. I should be glad to hear more of the details of 
treatment of others in these cases, in this journal. 



\\,—CUni(al Cmtftnatiaiu m Dismsa 0/ tk* Skin* By the EorroR. 
Rtjxnrted by Rehtrt Om^Mi, M D.^ CJimuaJ Auutamt. 

Case I. Ecuma ruhnim ef Ufl leg, vilk furuiuks tlstwktre. 
This p.itient before you exhibits an affection which, if I mistake 
not, will some day give some one if not all of you considerable 
Uoubic, and which is one well worthy of your careful attention ; for, 
unless managed just rightly, these cases are ver)- intractable. This 
man is about fifty years old and of apparent good health, a printer 
by occupation, but he says he has not been able to work for more 
than a month on account of this leg ; dermatology is sometimes 
slightingly spoken of because so few comparatively of its cases are 
such as to endanger life, or even seriously to prevent the pa- 

• Caiettltowii and remark* made to privatadaMC* at the DcmiltDtepciMary 
New York. 



328 THE EDITOR; 

tient from working ; but here you see a case where skill may be of 
the utmost value, for this man has already been under treatment for 
some weeks with no improvement, but with a steady increase of his 
trouble. Let me advise you to pay a great deal of attention to the 
study of eczema of the legs, for such cases as the present are of 
constant occurrence in every private as well as public practice. 

Our patient tells us that, with the exception of boils, which have 
come and gone for several years, he has had no eruption on the 
skin until September, 1876, when a small itchy papule appeared on 
the left ankle. This he scratched, it became somewhat moist, and 
the area of disease increased to a patch two or three inches in di- 
ameter. He then applied some ointment given him by a druggist, 
and it disappeared, somewhere about December first. About 
May first of this year the lesion began in another locality, on the 
lower third of the leg, and from a comparatively little spot has 
spread in these seven weeks upward and downward until now you 
see the entire dorsal surface of the foot, the ankle and the whole 
leg nearly to the knee are covered completely with a red, moist, or 
scaly surface, which itches when it gets dry and burns when it be- 
comes moist, and altogether keeps him from earning anything by 
work ; the right leg is free from disease. 

Now there are several points in regard to eczema of the legs to 
which I wish to direct your especial attention. First, the disease 
is seen far more commonly in those who are over 30 or 40 years of 
age and who have worked hard : it is not an affection of idlers : it is 
often one of the first signs of a breaking down of the vital powers 
which will be presented to the physician. This man says he was 
always previously strong and well. It is therefore a disease which 
demands rest of the part or also rest of the body, and mind, if it 
have been taxed. 

Second : You will most commonly find it in those who are of 
constipated habit ; this man says that his bowels act only every few 
days, and his tongue is coated ; and I do not think it possible to 
remove entirely thecutaneous disease on the legs unless you remedy 
the inactive bowel and the sluggish portal circulation which is asso- 
ciated therewith ; therefore never neglect this. Together with the 
constipation you will very commonly find deficient or faulty urinary 
excretion, which will require to be remedied, to give permanent ben- 
efit to the leg. 

You will generally find that these patients wash the parts very 
freely, because it gives relief from the itching and in order to remove 
what appears to be dirt ; and you will find many physicians who 
counsel washing the part with soap and water once or twice daily. 
This man has been doing this \yith castile soap, and says that it 
causes it to sting and smart terribly. This is not my practice. I 
think it irrational to wash a surface devoid of epithelium, and my 
constant injunction, you hear, is, " do not wash the part until I 
tell you to," and you see the result. 

I think the greatest errors are made in eczema of the legs in the 
way of over stimulation ; thus you have repeatedly seen patients 



CLINICAL CONVERSATIONS. 319 

cfe who had strong mercurial or tar or resin ointments on just 
such legs, which caused a constant exudation and much pain. 
There are certain principles of thera[>eutics which it is well to bear 
in mind when about to prescribe (or such a leg as this ; such are, 
that continued stimulation results in inflammation, whereas inter- 
mittent stimulation, other elements being regulated, results in absorp- 
tion and health. I question if a purely acMthing treatment would 
have any efTect on such an eruption as this one ; there is already 
too much thickening of tissue, and the mechanical obstacle of the 
retarded circulation incident to the location is too great to be over- 
come by wholly mild measures. 

We will therefore relieve the bowels by oar pill of blue mass, 
coloonth and ipecac, and order that he rest from walking and keep 
the lc<; elevated above the head : this is accomplished at night as 
Will, by elex-ating the foot of the entire bedstead with two or three 
bricks under each leg. Inasmuch as he is incapacittted from work 
and can bear pretty severe treatment, we will onler the leg rubbed 
with \ht" liquor pUit aikoKmu" full strength, ooce daily, or every 
other da^ if the effect Is too severe. Some friction must be mad(^ 
with a piece of flannel. If the pain and bumiitf b severe, be may 
k(«p cold water dressing on for a while, and anerwards apply an 
ointment made at home of equal parts of mutton tallow and ood- 
liver-oil, nelted together ; if the pain is not very great, the cloths 
spread with the ointment may be laid on at once. 

The idea of this treatment is the powerful stimulation of tbe 
p:irt^ for a few moments, together with the removal ofeflete matter; 
cvmljiion then occurs, reaction sets in, the vetseb oootnct, the 
ultiiiKitc supply of blood is lessened, and tbe tissoes recover thdr 
tone. If this stimnlation is too great an occasional friction with 
Ilcbrj's tincture, of green soap, oil ol cade and alcohol, of each 
coual parts, mav be med : if line or other ointment is used to such 
a leg it should be coroparativdv weak and nnirritating.. Tbe same 
stimulation may be acconplisbed by tbe green soap alone, or by 
solutions of caustic potash from ten to thirty grains to the ounce. 

But as before indicated, I do not rq;ard this state of the skin 
as a wholly local affair : when it first appeared it came on the ankle, 
and yielded to a remedy which l es lofcd tone to tbe parts, the sec- 
ond time, soon after, it appears elsewhere on tbe leg, and spreads 
far more than on the first occasion, and has failed to yield to local 
treatment : moreover, he says that for several years he has been 
hsvin" t.,^iu oflf and on. You will therefore best help these cases 
l\ le patient's health and prescribing accordingly ; when 

t! case passes by he shouhd by all means wear an elastic 

stocking fr.r months or years to prevent its recurrence. 

Case 11. Erythamm f^fulatum. The eruption on this girl's hand 
looks so much like syphilis that it will be well to examine it care- 
fully, because the error would be very great if it were treated as 
such. 

She is, as you see, an apparently healthy and well-developed 
girl of 18 years, a maker of artificial flowers. She says she never 



33<i THE EDITOR; 

had any eruption on the skin until last year, about this same season, 
when she was similarly affected for a few weeks. The present 
eruption made its appearance about two weeks ago, and has con- 
tinued to increase and spread up to the present time. It now oc- 
cupies the lower fourth of both arms, the wrists, backs of hands, and 
to a slight degree the dorsal surfaces of the feet, affecting also 
moderately the face. It consists of red papules, mostly rather flat, 
some as small as a pin's head up to patches of even J^ inch diame- 
ter. You observe that the redness of them disappears when I press 
with my finger and quickly remove it, but returns again almost in- 
stantaneously ; moreover, there is a slight staining left even when 
the blood is thus forced out : you also perceive a small amount of 
elevation both on passing the finger lightly over the part and when 
you press upon the lesions ; for this reason it is called erythema 
papulatum, and is placed by Hebra among the exudations, because 
there is a small amount of effusion into the skin. 

When I first looked at the eruption and learned the occupation 
of the girl, the thought arose that it was due to some local cause, 
as some poison used in making artificial flowers ; but she tells us 
that there are some fifty other girls at the same work and they are 
not affected, except perhaps a couple of others have some trouble, 
which may or may not be the same ; also that she has worked at 
the same occupation for two years, and is using no different dyes 
or materials from those she has long worked with. Further inves- 
tigation, however, reveals the eruption in its same peculiar charac- 
ters upon the face and on the dorsum of the foot, showing the true 
nature of the disease, which is well recognized in dermatology. 

The eruption is mainly self-limited, although its course may 
sometimes be considerably prolonged, and really does not require 
much treatment. It is important, however, not to do the wrong 
thing, and especially would it be a grievous mistake to suppose the 
eruption a .manifestation of syphilis. The patient complains of 
headache, and says the eyes feel sore : we will order her the laxa- 
tive iron and magnesia mixture which we so often prescribe as 
Startin's mixture : locally nothing is required. 

Some one suggests if this could not be urticaria, some of the 
patches resembling somewhat the wheals of that disease, and she said 
that it itched and burned somewhat. The differential diagnosis is 
made from the smaller character of most of the spots, the location on 
the hands and wrists and backs of the feet (urticaria would never be 
thus localized), and very largely from the permanent nature of the 
lesions, those of urticaria being very transient, coming and going, 
which she says this never does. The prognosis is good, but she 
may be subject to the same eruption next spring unless some change 
is made in her mode of life or prophylactic measures are instituted. 

Case 111. Impetigo. You have before you in this girl ten months 
old, what I believe we should recognize as the impetigo of older 
writers ; for perhaps you know that some recent authors have exclu- 
ded the term impetigo from nomenclature except as associated with 
eczema or as applied to the impetigo contagiosa. Now in this 




CLINICAL CONVERSATIONS. 331 



case there is no element of eczema ; those pustules which have 
been scratched or rubbed show no tendency to run together or to 
exude, there is no thickening of tissue, nor is there anv amount of 
itching or irritation, there are almost no evidences of scratching. 
Nor have we any of the elements of the impetigo contagiosa ; there 
arc four other children in the family, and none have taken it, nor 
has the mother ; there are none of the brown-paper like crusts, in- 
deed the pustules show very little tendency to crust at all ; they are' 
all very acute. The whole body, limbs and head yon see are cov- 
ered with a scattered but pretty thickly-set eruption of pustules, 
very many of them still contain pus, mostly yellow, some of them 
quite pale in color ; there is not much inflammatory action around 
them. The pustules are mostly small, and contain a relatively 
large amount of pus, differing in this from furuncles. 

The first suggestion arises, is not this a case of scabies ; the 
eruption on the hands and feet resembles this very much. But the 
most careful examination fails to discover any traces of the acari, 
and, moreover, some other members of the family would be pretty 
certain to be affected — there are four children. The ever-present 
s) philis suggests itself, but this is not a pustular s}'philide ; the pus- 
tules are too acute ; there is no cnuting, and the region around the 
anus is entirely free from eruption, which is seldom if ever the cue 
in congenital syphilis. 

The child appears to be in good health, and is very fat ; the 
bowels move daily once or twice ; the child nurses only. The pres- 
ent eruption is not serious in character, and would probably pass 
away without treatment in a reawoablv short tiiM. The main 
p<}iiits are to avoid local irritation, and lor this purpose we will 
order a little zinc ointment ; we will also give a little rhubarb and 
soda mixture, as the mother says that the passages from the bowels 
are offensive. 

(to n CO - MI' IMUEI X) 



332 



Sonets Sraneattions- 



NEW YORK DERMATOLOGICAL SOCIETY. 

REPORTED by DR. G. H. FOX, SECRETARY. 

Eightieth Regular Meeting, January 9, 1877. 

'T^HE following cases were exhibited before the Society. 

I. Lupus erythematosus, by Dr. Bulkley. 
II. " " by Dr. Bulkley. 

III. Lupus vulgaris, by Dr. Bulkley. 
IV. " erythematosus, by Dr. Bronson, 
V. Psoriasis buccalis, by Dr. Bronson. 
VI. Psoriasis of penis, by Dr. Fox. 

VII. Chronic circumscribed inflammation of corpora cavernosa, 
by Dr. Taylor. 

Dr. Bulklev's first case of lupus erythematosus was in a young 
German girl aged 1 1 years, in whom the disease had lasted for 
something over six months. The face was occupied by a dark col- 
ored eruption of erythematous lupus, which covered the bridge of 
the nose, the cheeks down to the chin, sparing the mouth, most of 
the forehead, and the ears, and existed upon both the backs of the 
hands and the palmar surface of some of the fingers. The amount 
of the brownish, scaly, crusting was slight, but it was very adherent 
upon certain portions, as on the ears and nose, and when pulled 
off the scales showed the prolongations which extended into the 
sebaceous glands. 

Dr. Bronson referred to the confusing nomenclature of lupus, 
and to the points of difference between lupus erythematosus of the 
English and lupus erythematodes of the Germans. 

Dr. Keyes mentioned the sebaceous element as being charac- 
teristic of the latter. 

Dr. Robinson said that the lupus erythematosus of the English 
was simply a mild form of lupus vulgaris. He thought that the se- 
baceous glands were not primarily involved in the lupus erythema- 
todes of the Germans, but that the disease began with an enlarge- 
ment of vessels with surrounding cell-infiltration as shown in ob- 
servations by Thin. He regarded the present case as one of lupus 
erythematodes, with an eczematous condition of the hands. 




NEW YORK DERMATOLOGICAL SOCIETY, m 

Dr. Piffard said that if he had se«n the case casually he would 
have called it a severe eczema, that might improve speedily under 
proper treatment. And whatever doubt might now exist as to its 
nature he would treat it as an eczema. The condition of the hands 
was that of papular eczema and not lupus. As for the sebaceous 
plugs to which attention had been called, they might also be found 
beneath the scales of eczema. 

Dr. Sherweix, in speaking of the age of the patient in refer- 
ence to diagnosis, mentioned a case of undoubted lupus erythema- 
tosus occurring in a child of 8 years. 

Dr. Keves spoke of the affection as occurring upon the back of 
the hand on an 3-year old baby suffering from Potts' disease. In 
this case a cicatrix formed without any uedding of the epidermis. 

Dr. Bvlkley exhibited a second one ol trytktmatnu lufms oc- 
curring on a woman of 26 years. The emption bore a very great 
resemblance 10 svphilis, and the patient had been given the benefit 
of the doubt, and bad taken antis}'philitic treatment for three or 
four months, without its producing any appreciable change in the 
lesion. The disease was in isolated patoMS, one npon the bridge 
of the nose, where a rather thick crust was very nrmly adherent, 
but on being drawn off, it showed the sebaceous prolongations very 
plainly. Several patches existed on the cheeks, ana both ears 
were affected in a manner very similar to those of the former pa- 
tient, the child with erythematous lupas : namely, they were cov- 
ered with a dry, brownish crust, firmly adherent, and prolonged into 
the sebaceous orifices- The anterior cervical glands were much 
enlarged on both sides, and had been so for a long time ; their size 
hjid varied greatly at tiroes, but did not chai^ for the better under 
the aoti-iyphUitic treatment 

D*. woNSON thought the disease resembled tabercnlar s}-philis 
in a condition of retrogression, but would not vcotnre an aosolate 
diagnosis except by daylight. 

Dr. Keves thought tM apftearance of the eruption snceestive 
of inherited syphilis, and that its course was not charactcrotic of 
lupus erythematosus. He could not actually p rono u nce it as being 
syphilitic, but suggested that Dr. Bulkley inquire carefully into the 
patient's parentaThistory, &c. It might be lupus upon a s)-philitic 
oase. 

Dr. ButKLEY suted that the patient had been for six months 
under treatment for syphilis. 

Dr. Keves alluded to the coexistence of syphilis and scrofula, 
and cited two cases. 

Dr. Fox indorsed the view of Dr. Kej*es that these two dis- 
eases might combine in producing a given lesion. \ young man, 
recently under his care, had suppurating cervical adenitis as a child. 
A short time after contracting s)-philis the anterior cer^-ical glands 
enlarged and finally ulcerated. The appearance of the ulcers was 
not t}-pical of either disease. The progress towards healing was 
unusually slow under mercurial treatment, but cod liver oil inter- 
nally hastened the ctire- 



334 TRANSACTIONS OF THE 

Dr. Bulklev's third case was a very typically severe one of lu- 
pus vulgaris, affecting the whole face and causing much disfigure- 
ment. The patient, a widow woman, 44 years of age, had borne 
the disease for thirty-one years, it commencing upon the side of the 
nose when she was 13 years old. She had been submitted to most 
varied treatment, during a great part of this time, but with con- 
tinued increase of the disease. The greater part of the face, cheeks 
and ears was covered with a tuberculous eruption, of a dark, cop- 
pery red, with thin scales over a larger portion of it, and some 
crusting in places. The end of the nose had been destroyed, the 
lips were thickened, cracked and ulcerating slightly in some places. 
During the last two months since she had been under treatment by 
Dr. B., the disease had appeared to be arrested under the internal 
use of phosphorus, but no definite report could yet be made of the 
case therapeutically. 

Dr. Bronson presented a large stout man with an unusual red 
patch upon one cheek, which he was inclined to regard as a patch 
of lupus. 

Dr. Bulkley had seen such cases yield to the ordinary treat- 
ment of acne, and thought the eruption to be acne rosacea. 

Dr. Keyes thought the affection resembled lupus erythemato- 
sus more than it did acne. 

Dr. Robinson spoke of a patient with erythema multiforme, 
who had a somewhat similar patch upon the face, which he called 
lupus at the time, but which afterward proved not to be this affec- 
tion. 

Dr. Bronson said he had made a positive diagnosis of lupus 
erythematosus in this case at first, but its appearance had changed 
so rapidly that he was now in doubt. 

Dr. Bronson introduced a patient with a whitish patch upon 
the buccal mucous membrane. 

Dr. Keyes diagnosed it as syphilitic. 

Dr. Fox doubted the syphilitic nature of the affection in this 
case, and spoke of cases which he had observed in which neither a 
syphilitic history, nor benefit from use of anti-syphilitic remedies, 

rnii[H be obtained. 

^^^"^"^ Dr. Keyes said that the use of tobacco would prevent the ef- 
f fects of the internal treatment for syphilis. He suggested stopping 

I the use of tobacco in this case, and then adopting specific treat- 

^^ m.e nt. 

Dr. Piffard mentioned a case of ichthyosis of the tongue of 
ten years' standing. The patient was pronounced syphilitic and 
had been under the care of Ricord for three months. Considering 
the doubt existing as to the nature of this affection. Dr. P. suggest- 
the provisional name of " Alphelasma" or white lamina. 

Dr. Bronson alluded to the improvement in this case under 
mercury and iodide of potassium. 

Dr. Keyes mentioned the beneficial effect of local calomel 
fumigation. 

Dr. Robinson advised the use of nitrate of silver locally, but 
cautioned against the danger of inducing bronchitis. 




iy£tV YORK DERMATOLOGICAL SOCIETY, 335 

'Dk. Fox exhibited the following case of psoriasis of the penis : 

David M., aged 34. A scaly patch first appeared upon the pre- 
puce and glans penis nine years ago. It has disappeared several 
times, but after remaining away for a few months, has reappeared 
in the same location, gradually extending backward towards the 
root of the penis. 

Four years ago the scalp became affected, and a single psoriatic 
" drop " appeared on calf of left leg. The eruption on the scalp 
and leg disappeared a year ago under treatment, but the single 
gutute scale soon reappeared on calf of the leg in vcr)- nearly, if 
not exactly, the same spot. The case is peculiar, inasmuch as the 
eruption affects the penis, which is rare, and has never appeared 
about the elbows or knees, the favorite locality of psoriatic patches. 

Dr. Ilt'i.KLEV mentioned a case of paoriasis involving the penis 
with other portions of the body, and co-existing with buccal psori- 
asis or the so<alled " alphelasma." 

Dr. Kcves mentioned a case in which the paoriaris was limited 
to a s\r~' ■■ -n the dorsum penis. 

1)1^ ibited the following case of Laminar T\tmor 0/ 

t/u Co> • ritta. 

R. O'C, *t. 55, bom in Ireland, has been married twice, the 

first time when 15 years of a^ ; has been the fjther of 1 1 children ; 

p,.„..., ..:.,.. i! ways that of tailor. Has always been healthy; had 

id attack of ague a few years ago ; is now strong, stout, 

! howeI<i re^lar ; has Kad gonorrhoea twice, the first 

! isting about nine months, the second time 

4 about 3 months, both tiroes of very acute 

,.,„... v., .ordee. Neither times, after the ,;CiM/iiiM|^ 

/ ^ there afterwards a glectv, irregular discharge : never 

-• whatever of urethral stricture. Never had orchitis, 

iricocele. Doth tiroes be had fonorrhoea, there were 

ree sores present upon the glans penis, evidently chan- 

..r ,.ft,.., I,.,-. I i...;«.w 1, no history of syphilis, past 

on healthy. Soroetiroe last 

J it-ver he had an erection, there 

^^ 'f p.iin from about the middleof penis, shooting along 

t( t'> meatus; examining his penis, be found "a small, 

1- "^ ' „''" on the top and middle. These erections were 

:^' ' <! by a bending upwards of the organ, beginning 

jii ; f the "hard lump," **a little chordce," as he 

calls It. 

.\t first it felt to him " like a pea " iust in the centre and dor- 
sum of the penis ; at present it extends from about this point one 
inch backwards, is a flat, elastic lamina embracing both cavernous 
boclies, as he saj-s, " like a lima bean ; " it is quite tender and sen- 
sitive over any part of its surface, the point of origin in about same 
condition as at first ; the skin of the organ is in no way involved : 
he knows of no disease, accident or injurv which can be assigned 
as the cause ; is not, nor ne\'cr was, specially addicted to sexual in- 
tercourse ; masturbated to some extent before marriage ; no noctur- 
ual emissions ; sexual intercourse not seriously impeded except from 



336 JV£ir YORK DERMATOLOGICAL SOCIETY. 

pain ; pain more severe when standing ; " sensation like a burn- 
ing heat," as he expresses it, during, or at time of erection. This 
patient came to the Skin Clinic of Dr. Taylor at Bellevue Dispensary 
Dec. 2ist, 1876.* 

In the discussion Dr. Taylor called attention to two lateral 
processes extending towards the glans penis, and suggested 
for the name of the affection " laminated tumor of the penis." 

Dr. Keyes remarked that it was a typical specimen of the dis- 
ease which he had brought to the notice of the Society on a former 
occasion under the name, chronic circumscribed inflammation of the 
corpora cavernosa. It was first described by Johnson of London, 
and Warren of Boston. The erectile tissue of the corpora cavernosa 
and sheath was involved, but not the sheath of the penis. He ob- 
jected to the use of the term tumor. 

Dr. Bulkley had observed two cases occurring in syphilitic 
subjects. 

Dr. Taylor referred to a case in which two lateral horns appa- 
rently followed the lymphatic vessels down to either side of the 
fnenum. 

Dr. Taylor presented to the Society " Des Syphilides palmaires 
et plantaires, par Madier-Champvermeil. 

» (Note in June 1877.) 

Under the influence of large doses of the iodide of potassium and of the 
rather constant application of half strength mercurial ointment, he has been very 
much benefited, both as to the subsidence of the tumor and the relief of the 
symptom of bending of the penis. 



337 



Direct of Citrratnrr. 

I. 

DISEASES OF THE SKIN. 

ETIOLOGY, THERAPEUTICS, GENERAL TOPICS. 

EDWARD B. BKONSOH, M. D. 

I. Testut.— General pathology of diseues of the skin. Gaz. 
des H6pit., p. JJ5, March lo, 1877. 

3. Guibout. E.— The arthritic diathesis. LUnion MM., No. 
37, March 19, 1877, and Na 38, March 31, 1877. 

3. Meyer, F. — The influence of the mora] emotions in the 
development of cutaneous affections. Review in Lydn M6L, p. 
46a, Nov. a6, 1876. 

4. Tibbits, E. T. — On the probable relatioiuhip of syphilis, 
scrofula, tul>crclc, cancer, etc. Lancet, p. 890, Dec 33, 1876, and 
973, iX-c. 30, 1076. 

5. Pick.— The relations of diseauesof the skin to diabetes. All- 
gem. NMen. Metl. Zeit., Na 34, 1876. (Med. and Surg. Reporter, p. 
495. Dec. 9, 1876.) 

6. Pick. — The relation of diabetes to skin diseases. Mediciniscb 
Chinirg. Centralbl., No. 34, 1876. (Monthly Abstract, p. 70. Feb., 
«877) . 

7- Vidal. — Local temperatures in skin affections. Soc. de Biol. 
Le Prog. M^d., p. 389, .April 34, 1877. 

8. Ganghotner and Pribram.— The constitution of the urine 
in mclinosi*. V'icrtelj. fUr die Prakt. Heilk. II., 77, 1876. (Rev. 
des Science M«fd., p. 53, Jan., 1877.) 

9. Testut.— Symmetry in affections of the skin. Paris, A. 
Delaliaye k Co., 1877. (Gai. Hebdom., p. 138 and No. 13, 1877.) 

10. Bulkley, L. D. — Analysis of seven hundred and seventy- 
four cases of skin disease treated at the Demilt Dispensary during 
the year 1876, etc., etc. N. Y. Med. Jour., p. 357. April and 
June, 1877. Reprint, D. Appleton & Ca, New York. 

II. Greenougb, F. B. — Notes on some of the more frequent 
forms of skin disease. Boston Med. and Surg. Jour., February 33, 
1877. 

»a- Pepper, Wm. — A case of Addison's disease. Am. Jour. 
Med. Sciences, p. 75. Jan., 1877. 

13. Pepper. Wm. — Addison> disease and its relations with 
anxmatosis (essential anaemia). Am. Jour. Med. Sciences, p. 
339, .\pril, 1877. 



338 DIGEST OF LITERATURE; 

14. Pye-Smith, P. H. — Two cases of Addison's disease. Br. 
Med. Jour., Dec. 9, 1876. 

15. Butler. — Case of Addison's disease. Royal Surrey Co. 
Hosp. Lancet, p. 458. March 31, 1877. 

16. Duffey, Geo. F. — A case resembling one of Addison's dis- 
ease. The Dublin Journal of Med. Sci., March, 1877. (Med. 
Press and Circular, p. 201, March 14, 1877.) 

17. Milroy, Gavin. — On yaws and some allied diseases. Med. 
Times and Gaz., Nov. 4, 1876, and February 17, 1877. 

18. Thin. — Rare form of skin disease. Royal Med. and 
Chirurg. Soc. Lancet, p. 235, Feb. 17, 1877. 

In the January number of the American Journal of Medical 
Sciences, Dr. Pepper (12) published a very complete history of a 
case of Addison's disease, including an account of the post-mortem 
examination. In the following (April) number of the journal com- 
ments are made upon this case, while the subject of the disease in 
general is given a tolerably full discussion (13). Some of the con- 
siderations presented are, to a certain extent, new. The most novel 
as well as most interesting feature of the article is the suggestion 
of a relationship between Addison's disease and progressive per- 
nicious anaemia. In a former paper the writer had already shown 
the close alliance that exists between the different forms of leucae- 
mia and progressive pernicious anaemia in their common depend- 
ance upon defective elaborations of the blood, and for this general 
condition underlying them all he had proposed the term anxmatosis. 
The writer endeavors now to show that Addison's disease is like- 
wise an anaematosis. Tliis he does by pointing out the close cor- 
respondence between the symptoms, and, to a certain extent, the 
pathological anatomy of this disease and those of progressive per- 
nicious anaemia. For the purpose of indicating the relation more 
clearlv, the characteristic features of the two diseases are tabulated 
side by side. The resemblance is certainly very striking ; whether 
or not it implies community of origin can only be determined after 
further investigation. Jaccoud, Greenhow, and others, it is well 
known, refer all the symptoms oiE the disease solely to irritation of 
the abdominal sympathetic nerves and ganglia, occasioned by the 
disease of the supra-renal capsules. Pepper, on the other hand, 
while not denying that this has an important share in the produc- 
tion of the disease manifestations, would " call attention to the im- 
portance also of the blood changes and the signs of constitutional 
infection in this disease," and to the necessity of " more careful 
observation of the morbid appearances in those situations chiefly 
affected " in the leucaemic diseases, namely, the spleen and marrow 
of the bones. " I do not think," he says, " the microscopic ex- 
aminations of the blood and tissues have yet been sufficiently nu- 
merous and accurate to enable a positive opinion to be expressed ; 
but I incline to the belief that the essential pathology of Addison's 
disease may prove to embrace both elements, as follows : a primary 
chronic degenerative inflammation of the supra-renal capsules ; 




ETIOLOGY, THERAPEUTICS, ETC. 339 

constitutional infection, with the production of secondary caseous 
deposits (or, in some cases, of tuberculosis) ; impairment of the 
blciod elaboration (anaematosis), possibly with lesion of the marrow 
of the bones or of the splenic pulp ; consequent fatty degeneration 
of the heart ; extensions of irritation from the capsules to the nerves 
connected with them, to the semilunar ganglia and to the solar 
plexus." ^Vhile thus in general terms he expresses his views of the 
pathology of the disease, the writer does not wish to be understood 
as stating the different factors precisely in the order of their occur- 
f^r^« „,^r ^f .K,»j|. relative importance. " But," he observes, ** it is 
e\ on the predominance of one or the other of these 

fa> icnd certain peculiarities of individual cases." 

\\ uh rci^ard to the discoloration of the skin which occurs in 
Addison's disease, the writer accepts the view generally maintained 
by pathologists at the present time, nsm'-'i- thit it dcftends upon 
irritation of the abdominal synipatheti< -d to the vaso- 

motor nerves of the skin, with the prcKi.. lormal deposits 

of pigment. But it is urged that this is a symptom of only casual 
imjmrtance aix) should not be regarded as essential nor pathogno- 
monic. The facUthat other abdominal diseases— chronic peritonitis 
and some uterine affections, for example — may, by irritation of the 
sympathetic nerves, give rise to bronzing of the skin as marked as in 
Addison's diseate; that other diseases of the supra-renal capsules 
beside that under con^^ideration. such as cancer, turbercle or 
hemorrhage, not attended by the peculiar cheesv circpnrration and 
sclerosis of the capsules which characterize Ai ! ise, cause 

no discoloration of the skin, prove that thi-> ■■y not the 

result of any loss or disturfoance of function in tne supra-renml 
capstilis, but requires sone other explanation. It is only in ooo- 
ncction with the constitutional symptoms tlie writer would claim 
that it has any great significance. In view of the connections of 
the disease with the group of blood affections already mentioned, 
the writer makes use of the expression, ** amematosis with bronzing 
of the skin," at the same time disdaintinf any wish to displace the 
name AdJitoift distase, by which it is so generally known, until the 
pathological questions involved shall have been fully settled. 

Dr. Milruv (17) has been contributing some interesting obser- 
vations on frambcesia or yaws to the Medical Times and Gazette. 
Two articles have already appeared and another is to follow. It 
has been generally supposed that yaws was only indigenous on the 
western coast of Africa, and that the disease was thence transmitted 
to the West Indies. The writer, after fully describing the malady 
as it exists in these countries, and as he had himself observed it in 
the West Indies, proceeds to show that its geographical limits are 
by no means connned to the above r^ons, but that certain affec- 
tions have been elsewhere described, sometimes under other names, 
whose points of similarity to yaws furnish a strong presumption of 
their nosological identity. 

" The distinctive characteristic of yaws," Milroy observes, " is 
the eruption of raised or tuberctilate pustules of a round or ovoid 



340 DIGEST OF LITERATURE ; 

form, which become covered with a yellow or brownish scab or 
crust, and from which, on the detachment of this crust, there extrudes 
a raw-flesh fungus, resembling somewhat by its reddish color and 
granulated surface, the appearance of a raspberry (^framboise)." The 
fungous excrescence varies much in size, color, and form, depending 
upon " its situations, the chronicity of the case, the age of the 
patient, and the cachexia of the constitution." The surface is usual- 
ly moist and covered with a viscid discharge. " Sometimes, on the 
falling off of the crust, the rounded raw-flesh surface is quite smooth 
and flat, or but little raised above the adjacent skin ; or more rarely 
it becomes somewhat hollowed out, the edges being considerably 
above the level of the centre of the sore." It is not generally 
sensitive to touch nor to pressure. The discharge is scanty and 
of an unhealthy character. The most common situations of the 
eruption are " the face, neck, shoulders, front of the chest, and the 
extremities, and it often occurs also about the pudenda and in the 
neighborhood of the anus." The tuberculate pustules are usually 
discrete, but are sometimes clustered together. Occasionally they 
assume a crescentic or annular arrangement, enclosing in the centre 
aportion ofsound skin — " the 'ring worm yaws' of the Westlndies." 
In children it is common for the eruption to assume the form of a 
ring about the mouth or' anus, the tubercles coalescing to form a 
circular projecting band. The throat and mouth are said to be 
rarely affected, and then only in cases of long duration. When the 
disease has persisted for a long time the constitution becomes 
depraved, giving rise to the development of other forms of eruption 
of a pustulous or eczematous character. In such cases, especially 
•when neglected, the earlier marks of the yaw-eruption give place to 
a marked tendency to serpiginous ulceration at the seats of the 
disease. The ulcers are apt to linger for a long period, involving 
often extensive surfaces, with the production ultimately of permanent 
disfigurement or deformity. Important joints may then become 
completely disabled. 

Such being the course of the true yaw disease, the author proceeds 
to compare with it two other affections, which, though known by 
special names, bear so close a resemblance in their characters to 
frambcesia that they are believed to belong to one and the same 
family. One of these is the so-called " Parangi disease " of Ceylon. 
This affection has been described by Dr. Loos, colonial surgeon of 
Ceylon, in an official report made in 1868, and entitled, " Depopu- 
lation of the Vanni District." A further contribution on the same 
subject was made by Dr. Danforth, assistant colonial surgeon, in 
1873. The disease begins with an eruption which, according to 
Loos, " is either pustular or tubercular ; less frequently scaly." 
Danforth, on the other hand, states that most frequently the disease 
starts with a psoriasis, and is often associated with fissures of the 
skin, especially in the palms and soles. " Next in frequency," he 
says, " are the tubercles ; some of these are small, rounded, hard, 
and elevated above the level of the skin, developing in small circu- 
lar groups, with healthy skin intervening, and forming a small centre 




ETIOLOGY, THERAPEUTICS, ETC. 341 

to each patch ; while others are large, soft, isolated, and little 
elevated above the surface. These are scattered over the whole 
surface of the body. The vesicular and pustular varieties are not 
of very common occurrence, and are chiefly found in children of a 
broken constitution." As the disease continues, ulceration sets in. 
The ulcers are circular, with elevated edges, spreading widely and 
dee|)ly destroying the affected parts. The discharge is ichorous and 
not very copious. In general the course of the disease is very 
similar to that of yaws. With regard to the fact of the fungous 
excrescence so characteristic of the latter disease not being mentioned 
by Loos and Danforth in connection with parangi, the writer ob- 
serves that in an account of the same affection by Mr. Marshall, 
published forty years ago, it is stated that the ulcers occasionally 
** became the seat of a large excrescence." 

The other di^ase referred to by M. as being closely related to 
yawi, is the " Co|x) " disease of Figi. As described bv Dr. Mac- 
greg-or, the chief medical officer of the new colony, this affection 
first 'self as a pustulo-tuberculate eruption which occurs 

" < 'he face, around the mouth, nostrils, and eyes, and 

al) It may became scattered over the whole body. 

Til' irc usually of a circular form, or elongated, elevated 

al" inding skin sometimes to the extent of half an inch. 

i\ . ■•)■ are ring-shaped, with a spot of sound skin in the 

cei: face ulcerated, and, on removing the thin crust that 

fotiK ,.,...irance is presented which seems to beara close resem- 

bl.ux I' ii> the raspberry like fungus of frambcesia. 

Iiii.illy two c:\'^f'^ of yaws are cited by M. u showing that the 
(lisc.ise i '(I to no particular countrie*. Tbefirst 

is rt[xiri his work on " Morbid PoUons," and 

(K(urr< (! ..rond, which came tinder the writer's 

own (>l>s> ' ngland, and this case is reported at 

consi'-r : is to b« continued by Dr. Milroy 

in 1 M-r nt the Journal, the topk of treatment not yet 

h.i. ' hed upon. 

I , /v : . „ -, d, F. — Study of MNoe forma of simple inflammation. 
&c. \ Etude imr qiulques /onmes fu^ammatiMt limfU de la ftau, 
dicnUt Sims Us mmu de fityriasit, dtrwutitt txfoliatrice gtiiiraiiti*.) J. 
B. Bailli^re et fils. Paris. 

30. Gousset, P. — Contribution to the study of cutaneous 
eruptions in surgical diseases. Th^ de Paris, 1876. (Rev. des 
Sciences Med., p. 163, Jan., 1877.) 

at. Tremblez.— Cutaneous eruption following in the course 
of surgical affections. Thise de Paris, No 37a, 1876. (Gaz. des 
Hdpit.. p. 71. J.in. J3, 1877.) 

33. Purdon. — The diseases which prevail among workers in 
flax. The Dublin Journal of Med. Sciences, Nov., 1876. 

33. Dumas. — Eruptions produced by quinine. London Med. 
Record, Oct. 16, 1876. 

24. Bergeron and Proust. — Quinine eruption. Ann. d'Hy- 
gifene pub. et de Med. Leg. ad serie, xlv., p. 48a, ct xlvL 17. (Rev. 
des Sciences MM., p. 215, Jan. 7, 1877.) 



342 DIGEST OF LITERATURE; 

25. Denig, R. M. — Quinine ; case of idiosyncracy in regard 
to its action. Oiiio Med. Recorder, 1877, March, p. 447. (Cliicago 
Med. Journal and E.\am., p. 475, May, 1877.) (An eruption caused 
by internal administration.) 

26. Pinsker. — Skin eruption from bromide of potassium. Lon. 
Med. Record, Dec. 15, 1876. (Monthly Abstract, p. 70, Feb., 1877.) 

27. Boubila. — Some considerations in simple ulcer of the limb. 
Thfese de Montpellier, No. 13, 1876. (Gaz. des Hopit., p. 127, Feb. 
8, 1877.) 

28. Lailler. — Ulceration of the face and neck. L'Union M^d., 
p. 256, Feb. 13, 1877. 

29. Siredey. — Ulcerations of the vulva. Centralblatt f. d. 
Med. Wissen., March 24, 1877. 

30. AlekschiefF P. — Emphysema of the skin during parturition. 
Russich Med. Rundschau, Bd. 2, 1876. (Phys.&Pharm., Feb., 1877.) 

31. Savoy. — Contribution to the study of eruptions of the con- 
junctiva {Contribution a i' etude des eruptions de la conjonctivt.) Paris, 
Delahaye & Co., 1876. 

32. Otis, F. N. — Precautions against communicable diseases 
of the skin and syphilis. Ohio Med. and Surg. Journal, Dec, 1877. 
(Half yearly Comp. of Med. Science, Jan., 1877.) 

33. Bradley, S. Messenger. On precision in the use of 
topical remedies. Med. Times and Gaz., Nov. 11, 1876. 

34. Hebra. — The action of water upon the healthy and diseased 
skin. VVien. Med. Woch., Jan. 6 and 13, 1877. (Lond. Med. Record, 
March 15, 1877.) 

35. Pleniger. — Critical eruptions in hydropathy. Wien. Med. 
Wochensch., March 3, 1877. 

Prof. Hebra's paper (34) is not in all respects a satisfactory 
one. The design of the article seems mainly to have been to con- 
trovert prevalent theories which to the vigorous mind of the writer 
appear too much like gratuitous assumptions. In most instances 
therefore the arguments are destructive rather than constructive ; 
and, where the writer advances theories of his own the supporting 
evidence is not so clearly presented but that one is left with a sus- 
picion that they also may be not unassailable. 

The common belief that frequent bathing serves as a preventa- 
tive of disease is first made the object of attack. There are millions 
of people, he says, whose bathing consists in once a week washing 
the hands and face, and that not very thoroughly, who yet rejoice in 
the best of health. Again, it is urged that the prevalence of disease 
in cities, where bathing is comparatively common, is vastly greater 
than in the country where the bath is a rarity, he claims, and fre- 
quently cannot be obtained even in cases of necessity. The natural 
inference from this would be that bathing not only does not pre- 
vent but promotes disease. No such conclusion, however, is drawn 
by the writer. But as to any beneficial influence which our ablutions 
may have upon the general health or upon the cutaneous function 
the writer is silent. Indeed he speaks of bathing as simply a pleas- 



I 



ETIOLOGY, THERAPEUTICS, ETC. 343 

urable indulgence, while we are warned that it is a pastime which, 
when carried to excess, may become the means of serious damage 
to the skin. This is evinced in the production of various eruptions 
which formerly at the water-cures were regarded as denoting cer- 
tain critical events through which the materies morbi was elimina- 
ted (Plemukr 35). 

The irritating cause of these eruptions has been referred to the, 
temperature of the water, but this view is rejected by Hebra entirely. 
He appears disposed to deny to the temperature of the bath any 
therapeutic effect whatever. So far as the skin is concerned he 
claims that such extremes as 90" and 104" Fahr., have precisely iden- 
tical etfecU. He says that he has treated furuncles and carbuncles 
with ice bladders and with hot poultices, and the results were the 
same ; the disease running ju->t the same course in the one case as 
in the other. Views based upon the abstraction of heat from its 
IkkIv thr.)uj;h tho .ipplication of water are accorded but slight im- 
portance. With rojjard to the bencAcial effect of the cold bath or 
wei p.itk in scarlatina or enteric fever, he incidenully remarks that it 
has not been subsuntiated, statistics not having proved that ca.ses 
trc .•. .1 ." th.4 way show any less decree oi mortality than where 
\,\: it treatment is pursued. 

ig effect of the water is altribated by Hebra solely 
to iho maceration and consequeat tiestnictioo ol the epidermis. 
The upper layers being destroyed the deeper, younger layers of 
celU are exposed and the surface becones nore vulnerable. Little 
red pimples first appear, then coalesce into red patches, and ^rad- 
ir:ii;y .III eczema is developed. Hence when the skin is sensitive, 
irri:.il)!c, and liable to eruptions, when in a state of acute cedena 
or iitiltration, or when the superficial layers have already been re- 
moved through disease or irritating measures of treatment, the bath 
is regarded as contra-indicated. 

On the other hand, the macerating effect of water is made avail- 
able to the treatment of many skin diseases. Thus it is used in 
psoriasis, kh thyoeia, pityriasis rubra, and lichen ; or where it is 
desired to soften a dry h^rtrophied epidermis and irritate a thick- 
ened subjacent cutis, as in long-standing eczema and prurigo. The 
bath is further employed for the removal of hurtful secretions, and 
again to promote the growth of epidermis through the exclusion 
of the air, as in pemphigus and extensive destruction of the skin 
from bums and corrosives. 

As to the duration of the bath, it b determined entirely by the 
feelings of the patient and the effecto produced. For many 
years Hebra has been in the habit of keeping certain patients in a 
continuous bath of davs, weeks or even months' duration. In one 
case it was maintained for a period of nine months. He has found 
that under these circumstances the patient eats, drinks, and sleeps 
as though out of the bath, while respiration, excretion and the gen- 
eral nutrition are in no wise prejudiced. The results thus obtained 
in many forms of skin disease of the most distressing and intracta- 
able character, have been exceedingly satisfactory. Such conditions 



344 DIGEST OF LITER A TURE ; 

as menstruation, epilepsy, &c., which have been regarded as contra- 
indicating the bath, have not interfered with its safe continuance. 
In one instance during an attack of pleuro-pneumonia, the bath was 
not interrupted and the case did not thereby suffer. 

37. Auspitz, Heinrich. — On the mechanical treatment of 
diseases of the skin. Vierteljahress. f. Derm. u. Syph. 1876. Heft 
IV., p. 562. 

38. Dron, A. — The curette in the treatment of some cutaneous 
affections. Lyon Mdd., p. 115, Jan. 28, 1877. 

39. EUinger. — Sand-rubbing in skin diseases. Wien. Med. 
Wochensch., Nov. 4, 1877. 

40. Arnold. — Contribution to the study of the treatment of 
ulcers by electricity. Thfese de Paris, No. 74, 1877. (Le Prog. 
M^d., p. 217, March 17, 1877). 

41. Golding Bird. — Electricity in ulcers. Guy's Hospital 
Reports, 1876. (The Med. and Surg. Reporter, March 24, 1877.) 

42. Neumann. — Galvano-caustic in skin diseases. Lend. Med. 
Record, Dec. 15, 1876. (Monthly abstract, p. 70, Feb., 1877.) 

43. PifFard, Henry G. — On the actual cautery and its em. 
ployment in cutaneous surgery. Charleston Med. Journal and 
Rev., Jan., 1877. 

44. Prowse. — The method of bandaging in ulcers of the leg. 
The British Med. Journ. (The Med. and Surg. Reporter, May 19, 
1877.) 

45. Ory. — Treatment of herpetic affections. Le Prog. M^d., 
Sept. 30, 1876. 

46. Ory, E. — Treatment of fissures of the nipples. La France 
M^d., p. 776, Nov. 29, 1876. 

47. Ory, E. — Treatment of cutaneous deformities. Le. Prog. 
M^d., p. 3., Jan. 6, 1877. 

48. Von Mosetig. — On the treatment of ulcers of the leg. 
(N. Y. Med. Jour., p. 438, April, 1877.) 

49. Golding Bird. — On the treatment of scrofulous lymphatic 
glands by a painless electrolytic caustic. Lancet, p. 567, April 21, 
1877, p. 605., April 28, 1877. 

50. Besnier, Ernest. — Method of lessening the pain attend- 
ing blisters. London Medical Record. (The Med. and Surg. 
Reporter, March 24, 1877.) 

51. Squire, Balmanno. — On a glycerole of nitrate of bismuth 
as a remedy in skin diseases and in some other conditions. Med. 
Times and Gaz., Dec. 9, 1876, and Jan. 6, 1877. 

52. Woodman. — TayuWa — A new remedy for syphilis and 
scrofula. Lond. Med. ReCwd, April 15, 1877. 

53. Pcdrelli, Mario. — Chlorate of potash and mercury. 
Bull, dalle Scienze Mediche di Bologna, Guigno, 1876. (Lo 
Sperimentale, Settembre, 1876, p. 251.) 

54. Van Holsbeck. — Antiseptic ointment. L'Union M^d., 
p. 12, Jan. 4, 1877. 



I 

mm 



ETIOLOGY, THERAPEUTICS, ETC. 345 

B> Acid Salic>'lic, 4 grammes. 
01. Amygd. dulc, a grammes. 
Axonge 30 grammes. For indolent ulcers. 

55. Salicylic Soap. — (Messrs. Tidman & Son, Wilson Street, 
Finsbury, London.) Med. Times and Gaz., Nov. 11, 1876. 

Sanitary Eucalyptus Oil Soap. (Messrs. Whitakcr vV Gross- 
mith. Fore Street, London.) Med. Times and Gaz., Nov. 11, 1876, 

56. . Iodide of ammonium in syphilis and scrofula. 

L'Union M<fd., p 71, Jan. 13, '877. 

57. Kirk. Robt.— On the external use of salicylate of iron. 
Edin. M«l. Jour., p. 707, Feb., 1877. 

58. Wiss. — Peruvian basalni as a dressing for wounds. Berl. 
Klin. \V»Kh., Nov. 27. 1876. (Brit. Med. Jour. Dec. 16, 1876.) 

59. Perrant. — Bromide of potassium as a caustic. Med. 
Times and Gaz., Sept. 23. 1876. 

60. Charner. — !'■ - ' ' ir sore nipples. Pacific Med. and 
Surgical Journ.il (S. Record, p. 734, I>ec.. 1876.) 

61. Chauvir. — I .icid for sore nipples. Gaz. des 
H6p. (Wicn. Med. Wochcnsth., Sept. 9, 1876.) 

6a. LeDiberdier. — Quinine in the treatment of fissores of the 
nipple. Med. Press and Circular, l>cc. so, 1876. 

63. Day, John. — On the use of peroxide of hydrogen for the 
proveniion of the spread of scarlet fever and smallpox. March 
lo, 1077. 

64. Van Harlingen, A. — Convenient mode of dispensing 
ointments. Phil. Med. Times, p. 319, April 4, 1877. 

.\i ^PiTZ'long and interesting article (37) ontMtmtthamUal trmh 
matt ff distasts »f tkt skin hardly admits of condensation; it con- 
tains full reference to the works of others, and but little that is 
really new. 

M. Dron (38) writes favorably of the use of the curette in 
the treatment of skin diseases. Lupus, epithelioma, rodent ulcer 
and venereal warts are the affections in which he has found it ev 
pccially serviceable. In lupus of the face, however, he objects to 
the instrument because of the red discoloration which remams after 
it has been used ; in one case under his observation it had not dis- 
appeared four months after the operation. Therefore when the 
lupus is situated in the face, the writer prefers the actual cautery 
whenever it can be employed with safety. If the use of the actual 
cautery in the face, or any other part of the Ixxly where diseased 
tissue is to be destroyed, would be attended with danger on account 
of the liability of destroying tissues beyond the seat of disease, as 
for example in the vicinity of the mucous orifices (where atresia 
might result), the writer recommends scraping the part and after- 
wards cauterizing with nitrate of siU'er. He has found the curette 
most frequently useful in extirpating \egeUtions, especially when 
sessile. After they have been scrape4 away he touches the little 
wounds that remain with the perchloride of iron, which has the 



346 DIGEST OF LITERATURE; 

double effect of staunching the hemorrhage and preventing recur- 
rence of the growths. 

Dr. Ellinger, of Stuttgart (39), recommends in the treatment of 
numerous diseases of the skin, scrubbing the parts with sand. He 
used it first for the acne and comedones that so often disfigure 
the faces of young people. Afterwards it was employed successful- 
ly in lentigo, pityriasis versicolor, acne rosacea, eczema, psoriasis, 
prurigo, and psoriasis syphilitica palmaris. The sand used must be 
composed of medium coarse grains varying in size from that of 
poppy seed to half that size ; nor should the sand contain too much 
dust, which would make it ineffective. The writer employs two sorts, 
one finer for the face and more tender portions of the skin, and anoth- 
er coarser for the body and extremities. His method consists in keep- 
ing the surface moist for a considerable time, and then rubbing it 
with moistened sand, which is finally washed or brushed off. If 
it be the face that is to be operated upon, it is washed at night with 
soap and kept moist for half an hour before the sand is used. On 
the body or extremities Priessnitz' water dressing is applied before 
the rubbing is begun. Where extensive portions of the body are 
involved, the patient is kept in a bath for an hour or two, then 
washed with soap, and finally scrubbed with the sand. A paste is 
also recommended consisting of sand and carbonate of potash (1.5) 
and water. 

Some months ago Squire described a solution of the subacetate 
of lead in glycerine, which he had found a very valuable remedy for 
eczema and other affections. He has since discovered (51) that 
glycerine is also a solvent of the nitrate of bismuth. The solution 
first prepared was of the strength of a drachm to the ounce. It 
was ascertained that if freshly prepared, without the aid of heat, 
this glycerole could be largely diluted with water without causing 
any precipitation except after long standing. Thus diluted it is 
suggested that the solution will afford a means of administering 
bismuth both internally and externally in a much more efficacious 
form than that presented by the dry subnitrate in common use. 
In all cases where a mild sedative astringent is indicated, as in 
diseases of the stomach, throat, urethra or skin, it is believed that it 
will be found greatly superior to the dry powder. But the caution 
is given that, because of the greater activity of the soluble salt it 
should be given in smaller doses than the powdered subnitrate. A 
solution of two grains to the ounce was found to be of sufficient 
strength as an application for eczema. 

The tayuga plant (52) has been recently introduced into Italy 
by the naturalist Signor Luigi Ubicini, of Milan. Its root is used 
by the natives of Brazil as a remedy against s)'philis. Two tinct- 
ures are used, the weaker being given internally in doses of 2- 
20 drops two or three times a day.' 

Van Harlingen (63) revives a method of dispensing oint- 
ments first suggested some years ago by a Parisian apothecary. 
The plan consists in pouring the ointment when melted into soft 
metallic tubes provided at one end with a screw cap similar to those 




INFLAMMATIONS: ACUTE AND CONTAGIOUS. 347 



in common use by painters. \Vhen filled the open end is folded in. 
A iH'c^' objection to the use of many valuable ointments, notably 
Hebra's diachylon ointment, is their liability to become rancid on 
exposure to the air. By means of the above simple device they 
may be preserved indefinitely, while at the same time they are in a 
most convenient form for administration. 



INFL.\MMATIONS; ACUTE AND CONTAGIOUS. 

nUNK p. rOSTKK, M. D. 

I. Poerster. R. — On the modes of diffusion of measles and 
scarlet fever. Einige BemerkuHgtn ub*r dit Vtrbrtihimgntfeist dtr 
Matem unddes Siharlaeks). Jahrb. f. Kinderbeilk., x Bd., N. F., 
Aug. IS, 1876. p. 164. 

a. V. Huettenbrenner, A. — On second attacks of the exan- 
theinatous fevers, p.irticularly scarlet fever. (Utbtr twamaliga 
A-i^'^-'-'n von lUuUn lixiinthemen, inslxsonJert tvn Stharlack). Jahrb. 
• ! hcilk.. X Bd.. N. F., Nov. 30, 1876, p. 334. 

3 Hogg, F. R. — Notes on infantile diseases in India, i. — 
Scarlet (ever. Med. Times and Ga2., Sept. j, 1876, p. 253. 

4. Olshausen, R. — On puerperal scarlet fever. XUtlertutkiu^ 
gen ubtr JU Comfiuatian dts Puerftrium mil Sckarlach umj dit s»ft- 
mannU, " Scarlatina Puerperalis.") Arch. f. Gynakologie, ix. Bd., 
3 Hft., p. 169. 

5. Liebmann, C. — Three rases of puerperal scarlet fever. 
(Diti FilU fon Siharlaek Ui Wd<k>ieriHmtn). Arch. f. Gynakolo- 
gie, X. Bd. 3 Hft., p. 556. 

6. Sutherlanc, D. — Case of puerperal scarlatina. Ed. Med. 
Jour., Nov., 1876, p. 446. 

7. M alone, M. J.— Unusual sequels of scarlet fever. Med. 
Press and Circular, July 12, 1876, p. 25. 

8. Stedman. C. E. — Scarlauna complicated with typhlitis ; 
fatal on the seventh day. Boaton Med. and Surg. Jour., Dec. 28, 
1876, p. 7s6. 

9. Gibney, V. P. — Scarlatinal hematuria. Med. Record, Aug. 
j6, 1876. p. 551. 

la Hall, F. DeH. — Treatment of acute albuminuria. Prac- 
titioncr, .August, 1876, p. loi. 

II. Brakenridge, D.J. — Objections to the use of salicylic 
acid in the treatment of scarlet fever. Med. Tiroes and Gaz., Dec 
2, 1876, p. 621. 

v. HuETTENRRENXER (2) relates a case in which the same pa- 
tient was attacked with scarlet fever twice within the space of two 
months. For the diagnosis of such cases, be thinks it important 
that no symptom should be wanting, particularly the characteristic 
desquamation. 



348 DIGEST OF LITERATURE; 

Olshausen (4) records five cases of scarlet fever occurring dur- 
ing the early days of the lying-in period, and refers to those of 
Clemens, Braxton Hicks, and various other writers. He thinks 
that the puerperal epidemics described during the last century by 
Hamilton, Hecquet, and Ludwig, under the names of febris miliaris, 
fii'vre rouge or pourpre bleu, and miliaria rubra, were genuine scar- 
let fever. The epidemic described by Malfatti as having raged in 
the Vienna Lying-in Institute, during the winter of 1 799-1800, _ 
seems to have given an impetus to the assumption that puerperal ' 
fever may appear under the guise of scarlet fever, since such out- 
breaks occurred in some instances in lying-in hospitals while no sim- 
ilar epidemic prevalence of scarlet fever was observed outside their 
walls ; since the disease, at least in many epidemics, attacked the 
women, like puerperal fever, with great rtfalignancy ; since it was 
often complicated with peritonitis or other such localizations as 
occur in puerperal fever, whereas the angina was almost alwa)'s 
very slight, or seemed altogether wanting ; since, like puerperal 
septicaemia, it nearly always made its appearance during the first 
few days of the lying-in period ; and since infection from scarlet 
fever very frequently could not be made out. 

The author endeavors to show that these facts do not warrant 
the conclusion that a disease allied to, or identical with, septicemia 
can assume, in lying-in women, the appearance of scarlet fever. He 
looks upon Clemens' cases, as well as those of Dance and Gudniot, 
and many of Braxton Hicks', particularly those in which the infec- 
tion was traceable, or which coincided with a prevalence of scarlet 
fever in the neighborhood, as undoubted cases of genuine scarlet 
fever. His own cases were as follows : 

A woman pregnant for the third time, who had already been in 
the Clinic four weeks, was easily delivered on the 3d of January, 
1866. After two days' freedom from fever, there was some tender- 
ness of the uterus and a rise of temperature (101.3° F.) Twelve 
hours later, on the third day, she had a chill, and the temperature 
was 105.8° F. The next day a scarlatinous rash was found extend- 
ing over the whole body. Slight redness of the fauces, without 
pain on swallowing. The uterus remained tender for a short time 
longer, without, however, any exudation being discoverable, and 
without peritonitis. On the seventh day after labor the rash was 
fading, and desquamation began at once. A diarrhcea of several 
days' duration followed a dose of castor oil. By the eighth day the 
temperature had fallen to normal. Brain symptoms had not shown 
themselves, and there was no albuminuria. On her discharge, 
twenty-five days after labor, desquamation was still to be seen. 

From lack of room, a primipara, delivered on the 17th of Jan- 
uary, had to be placed near this woman, and fell ill on the fourth 
day of her lying-in. On the fifth day the temperature had risen to 
104.72° F., with a pulse of 136. On the next morning the rash and 
the angina were present. The case progressed favorably in every 
respect. On the ninth day the rash had nearly disappeared. On 




INFLAMMATIONS: ACUTE AND CONTAGIOUS. 349 



the tunth day desquamation began, with perfect absence of fever. 
No abdominal complications occurred. 

The other atcoiuktes escaped. Among the other inmates of the 
Clinic there were no diseases of any sort, and particularly, for a long 
time before and after this, no septic diseases. Where and when 
the first patient became infecte<l, could not be ascertained. The 
second, of course, was infected from the first. Neither of them 
had - ' ■ ' ' nrlet fever before. 

I i case, which occurred in the Polyclinic, unfortu- 

nate -lanty account is given from memory, as the writ- 

ten dau had been lost. A woman was seized with high fever and 
severe head^symptoms the day after labor. On the second day she 

was ' ' itose, with a scarlatinous rash covering the whole 

boi! abnormal could be discovered about the abdom- 

inal :if died the same day. 

,\ fourth case, likewise fatal, was obser>-ed in January, 1875. Mrs. 
C, a healthy woman, in good circumsUnces, had never had scarlet 
fevef. She was delivered of her third child on the jyth of Januar)', 
at 8 o'clock in the morning, so easily and rapidly that the midwife 
did not reach her until half an hour after the birth of the child, and 
simply removed the placenta bj- external pressure. No phvsician 
was present. On the evening of the next day (January 18) there 
was a moderately severe chill, with a temperature of loj.Sa** F. 
January 29, in the morning, the patient's face was of a deep red ; 
pul»«: 140 and small ; temperature 104' F. ; skin moist ; the uterus 
in its proper position, a little tender, which was not afterwards the 
case. In the evening the temperature was 104.9" ^- The chest 
gnd '»— >«ii..i.. inmk now showed a deep-red, confluent rash ; the 
thr were markedly reddcn«l and slightly swollen ; no 

pam ng ; a good deal of muctu in the throat. On the 

next (lav t<;ini> >rar)- painfulneM of d^lutitioa was conplained of ; 
repeatea vomiting ; diarrhcca ; bleeding froa the nose. Jaotianr 
x\, the temperature was 105.61" F. in the morning, ana ios.8* F. 
in the evening, with the pulse constantly at 140. The tongue had 
shed the white coat which covered it at first, and was now of a 

Curpic-rcd, with enlarged papilbe. She was almost wfaollr sleepless, 
ut with her mind clear, and no delirium. January 31 \tU\ mani- 
fest, but not intense, jaundice was observed. Repntcd vomiting : 
no albuminuria. I'he rash remained almost undiminished until 
death. It had assumed a livid, dusky, blue-red color, only some- 
what tempered by the jaundice. On the limbs the rash was paler 
and in great part macular. On the seventh dajr the sensorium 
was attacked. There was great drowsiness, delirium, and uncon- 
scious excretion. In spite of energetic treatment with cold baths, 
quinine, and wine, death followed a seven days' illness, full eight 
dav- ' 'cry. 

' ! 1 of the abdominal cavity revealed a perfectly 

he.n: n of the genital organs; the uterine lymphatics 

free ; and no peritonitis. The glomeruli of both kidneys were 
highly injected and partly destitute of epithelium ; cortical portion 



350 DIGEST OF LITERATURE ; 

hyperaemic ; interstitial tissue unaffected. Spleen somewhat en- 
larged, anaemic, and soft. Liver not icteric ; its lobules easily rec- 
ognizable. Icteric staining of the skin not present. 

This case is interesting in several respects. For weeks before 
her labor the patient had not been out of doors, and certainly had 
not come in contact with scarlet fever patients. There was no 
epidemic in Halle at the time. Twenty-four hours after labor a 
severe, genuine scarlet fever appeared, which, as in most other 
recorded instances, was characterized by the intensity of the rash 
and the insignificance of the angina. With the pronounced exan- 
them, the absence of any symptoms suggestive of puerperal septi- 
caemia, and the post-mortem aj!)pearances, there can have been no 
confounding of scarlet fever with a septic infection. Indeed, 
almost every possibility of septic infection was wanting, since the 
midwife did not arrive until after the birth, and had no other 
patients with puerperal disease at the time. 

The fifth case is, briefly, as follows : Mrs. G., a primipara, 25 
years old, was delivered with the forceps, by which an extensive 
laceration of the perineeum was produced, which was overlooked. By 
noon of the same day she had vomited several times, and had had 
no sleep. On the second day there was fever, and still no 
sleep. On the third day, in the morning, her temperature was 
102.2° F., and her pulse 120. On my first visit, in the evening, I 
found the patient with a remarkably red face ; temperature 104.54° 
F. ; pulse 150 ; a tolerably well-marked raspberry-tongue ; the 
fauces of an intense cherry-red and a little swollen. Some com- 
plaint was made of pain on swallowing. Almost the whole body 
was covered with a scarlatinous rash, most intens? on the breast 
and abdomen. Her mind was perfectly clear. The perinaeum was 
entirely ruptured, including a portion of the recto-vaginal septum. 
The edges of the wound were covered with a dirty coating, without 
any considerable swelling. This soon cleared off, and the wound 
cicatrized kindly. 

The rash slowly faded away, ending in abundant desquamation. 
After the first day \) of the rash] the temperature fell from 
101.3° to 102.38° F., with a persistent pulse-rate of 120. On the 
seventh day it rose again (to 103.64° F. in the evening). The cause 
appeared in a bilateral parotitis, which, in about eight days, ad- 
vanced to suppuration on either side. The patient then slowly 
recovered. Consecutive albuminuria did not occur. There were no 
symptoms of endometritis or perimetritis. 

Here, too, the source of the disease was obscure. There was 
no scarlet fever or puerperal disease in the village, as the physicians 
of the place assured me. We have here, then, the outbreak of the 
exanthem soon after labor, a moderate angina, and the rapid spread 
of the rash over the whole body. 

The author considers that puerperal scarlet fever, whether in 
sporadic cases or in those occurring during an epidemic, whether 
its genuineness be undoubted or whether there be grounds for sus- 
pecting a dissimilar nature, shows, with very rare exceptions, the 



INFLAMMATIONS: ACUTE AND CONTAGIOUS. 351 

follnwint; peculiarities : That it makes its appearance during the 
first wick of lying-in, and almost always within the firsj three days ; 
th<.' iii>i^ilicance of the throat affection ; and the rapid, almost 
li^htnin;;-like appearance of the rash over the whole i>ody simul- 
taneou>ly, and often its deep, dusky-red coloration. 

1'riniip.ira:, from their including a greater number of individuals 
who h.ive never had scarlet fever, are more prone than multiparc 
to sutler from the disease in chilH^"-' ^>»-'v-rwoof the former, and 
forty-two of the latter, were the > c cases analyzed. The 

course of the disease \s snmetinu - . and sometimes of the 

utmost s< ing fat.il within the first 48 hours. In 

general. ^h, three deaths having occurred among 

seven p-i: .uring pregnancy, and 64 among 134 at- 
tacked during the lying-in period. The mortality shows an inverse 
ratio to the time elapsing between delivery and the outset of the 
disease. 

Diarrhoea is a common symptom, and one of unfavorable im- 
port The lochia, the secretion of milk, and the involution of the 
uterus are wholly unaffected in the great majority of cases. In a 
few cases there is, at the beginning, moderate tenderness of the 
uterus, which soon disappears. Metrorrhagia has never been ob- 
served. In seven cases occurring during pregnancy, premature 
labor look place in four. 

In the treatment, purgatives should be avoided. Stimulants are 
certainly advisable in vrvere cases. Above all, in case of persist- 
<-: ' I baths should not be omitted. 

'hree cases of poerperal scarlet fever, 
^«i :>i^ observation. In the main he agrees 

with 01shauscii':> conclusions, but considers that abdominal inflam- 
matory affections are not so rare as the latter supposes, and that 
they are not fortuitous complications, but directly due to the scar- 
ladnoos poison. He raises the question of whether there is any 
connection between scarlatinous nephritis and such lecoodary local 
afft-cti"n->. [)irfi(i:Iirly those of the peritoneum. 

Srnxiw s. rtl.ites the case of a hospital interne who con- 
tracted scarlet fever for the second time, and who died with typhli- 
tis set up by the presence in the appendix of a concretion, appar^ 
entlynotof recent formation. The scarlet fever was progreaaing 
mo><t f.i%(>r.nhly when the peritonitis arose. 

CiiiNKv 19* records the case of a child, the subject of hip-joint 
disease, in whom the invasion of scarlet fever was accompanied by 
a sudden and abundant hematuria ; and calls attention to the per- 
sistence of the hematuria for a period of four weeks, the absence of 
any marked constitutional disturbance other than an unusual de- 
gree of emaciation, the absence throughout the attack of any gene- 
ral or local (cdema, and the influence of the intercurrent scarlet 
fever on the morbus coxarius. 

Haix (10) gives the treatment which he employed in dispensary 
practice in an epidemic of about three hundred cases of scarlet 
fever. Directly any albumen was detected in the urine, the patient 



3S2 DIGEST OF LITERATURE ; 

was ordered the perchloride of iron, and was allowed no solid food 
except a little bread and milk, and as much water as he liked to 
drink ; this treatment, together with keeping the skin gently acting, 
sufficed in the majority of cases, but in a certain number the urine 
was almost suppressed, and in some there were uraemic symptoms. 
In either case he forbade all food for twelve hours, the child to 
have nothing but water and a drink made of acid tartrate of potash 
(5 j. ad O. j.) in sweetened water with a little lemon-juice. If at 
the end of this time the kidneys were beginning to act, he allowed 
a little milk, but not more than a pint in the twenty-four hours ; if, 
however, the uraemia continued, with little or no urinary secretion, 
he persevered with the water and bitartrate of potash, and in severe 
cases nothing else was given for thirty-six hours. Dry cupping, 
mustard poultices over the loins, and a purgative were the only ad- 
ditional remedies employed. 

Brakenridge (ii) remarks that salicylic acid, judging A priori, 
should prove to be " almost an ideal remedy " against scarlet 
fever, but his experience with it in nine cases leads him to warn 
the profession that it is apt, apparently, to give rise to unpleasant 
results, increasing the frequency and duration of albuminuria, caus- 
ing delirium, etc. 

12. Bell, R. — Small-pox. Brit. Med. Jour., Nov. 25, 1876, 
p. 677. 

13. Svanowsky. N. — Parasitic nodes in the lungs m small- 
pox. {Die parasitdren Knoten in den Lnngen bei Variola.) Centralbl. 
f. d. Med. Wissensch., Nov. 4, 1876, p. 788. 

14. Wilkinson, W. H. W. — The small-pox outbreak in 
Islington. Lancet, Oct. 14, 1876, p. 541. 

15. Hutchinson. C. F. — Modified small-pox and chicken-pox. 
Brit. Med. Jour., Sept. 16, 1876, p. 362. 

16. Irvine, J. P. — Cases illustrating the occasional obscurity 
of the acute specific diseases. II. — Case of varioloid. Med. Times 
& Gaz., Oct. 14, 1876, p. 434. 

17. Orchard, T. N. — On the immunity from small-pox secured 
by revaccination. Lancet, Nov. 25, 1876, p. 746. 

18. Adams, Z. B. — Unfortunate result of vaccination. Boston 
Med. & Surg. Jour., Dec. 21, 1876, p. 722. 

19. Warlomont. — Animal vaccination. Med. Press & Cir- 
cular, July 19 and 26, 1876, pp. 46 and 68. 

20. Mackenzie, S. — Vaccination with glycerined lymph. 
Lancet, Nov. 4, 1876, p. 636. 

21. Shortt, J. — Description of a needle-vaccinator. Lancet, 
Nov. II, 1876, p. 677. 

Adams (18) vaccinated three children twice unsuccessfully with 
animal vaccine. He then vaccinated them a third time with human- 
ized vaccine. In one of these children the vaccination ran its 
regular course up to the 14th day, when marked symptoms of puru- 
lent infection were observed. Deep, black sloughs occupied the 




INFLAMMATIONS; ACUTE AND CONTAGIOUS. 353 



site of the vaccine vesicles ; there was brawnv hardness of the whole 
deltoid region, a huge diffuse abscess reached from the axilla to 
the lower border of the ribs, with hard infiltration extending to the 
sternum in front, and below the scapula behind, showing a waxy 
whiteness with distended veins. A thin ichor flowed from large 
incisions, and no pus. This child died of pyemia on the aist day. 
There was no autopsy. 

Another of the three children went through the disease nor- 
mally, but a second vaccination from its own arm (Bryce's test) on 
the seventh day succeeded. The operation failed on the third child, 
and was repeated with l}'mph from the arm of the second, the re- 
sult being three large, unhealthy, irregular sores, with no clear 
lymph, but some yellow pus, deep induration of the whole deltoid 
region, and tenderness and enlargement of sub-axilUry glands. 
ThiH child had a somewhat scrofulous look, and its mother was 
phthisical. A fourth child, vaccinated from the one which after- 
wards died, developed similar complications. 

aa. Schwimner, E.— Salicylic acid in the treatment of the 
acute exanthemata. {Utber dem Heihttrth dtr Satitylsimrt ka 
akutfn ExamtJUmen.) VVien. Med. Wochenschr., Aug. la, 19 and 
26, :ind Sept. i, 1876, pp. 810, 835, 859, and 883. 

33. Hamilton, A. McL. — Upon certain neuroses following 
the aymotic ferers. Med. Record, Oct. aS, 1876, p. 696. 



INFLAMMATIONS ; ACUTE AND NON-CONTAGIOUS. 

JAMIS C. WHin, M. D. 

1. Hensley, Philip J. — .A case of er)thema nodosum ; with 
diagram of temperature. St. Barthol. Hosp. Rep., Vol. XI., 1875, p. 

350- 

a. Paspelow. — Er)-thema nodosum of the buccal mucous 
membrane. Centralblatt f. d. Med. Wissenschaften, March 17, 1877. 

3. Ory.— Traitement de I'tfrytb^me. La France MMical, Oct. 
as. 1876. 

4. Soltsien. — UfTelmann. — Erythema papulatum and nodo- 
sum. Ccntr.ilb. fUr die Med. Wissensch., Jan. 27, 1877. 

5. Uffelmann. — Ucbcr die ominose Form des Erythema 
nodosum. Dcutsches Archiv. fUr Klin. Med. Bd. xviii., H. a & 3. 

6l Laserre, Jules. — Essay on the etiological conditions and 
pathology of urticarix Paris. Parent., 1877 (I^ Mouvement M^d-, 
p. aoi, March 31, 1877). 

7. Urticaria following the sting of a wasp in the ccso- 

ph.igtis. London Medical Record, Feb. 15, 1877. 

8. Milton J. L. — On giant urticaria. Edinburgh Med. Journal, 
p. 513, Dec.. 1S76. 

9. Nitsche. — Treatment of bums by salicylic acid. Tagblatt 
der Versammlung Deutscher Naturforscher und Aezta in Graz., 1875. 

23 



354 DIGEST OF LITERATURE; 

Dressing for burns. Peninsular Journal of Medicine, 



p. 729, Nov., 1876. 

11. Ponfick. — On death after extensive severe burns. Berlin 
Klin. Woch., No. 17, 1876. (Med.-Chir. Centralbl., 1876 (N. Y. 
Med. Jour., p. 548, May, 1877). 

12. Riddell, S. S. — Chloral hydrate in burns and scalds. Phil. 
Med. & Surg. Reporter, p. 5, Jan. 6, 1877. 

13. Alexander, R. M. — Muriated tincture of iron as an anti- 
septic in erysipelas. Louisville Med. News, p. 207, May 5, 1877. 

14. Bellieu, E. — Experimental researches on traumatic ery- 
sipelas. Journal de Med. de Moscow, No. 13, 1876. Centralb. f. 
Chirurg., No. 21, 1876. (Rev. des Sciences M^d., p. 93, Jan., 1877.) 

15. Behier. — Erysipelas as a sequela of epithelioma. L'Union 
Mdd., et 3 Juin, 1876. 

16. Cavazanni. — Camphorated ether in erj'sipelas. London 
Medical Record, Nov. 15, 1876. 

17. Chase, W. B. — Erysipelas and puerperal fever. Med. 
Record, p. 30, Jan. 13, 1877. 

18. Culbertson, H. — Is diphtheria a form of erysipelas. Ohio 
Med. Reporter, p. 289, Dec, 1876. 

19. Depres, M. A. — Treatment of erysipelas. La France 
M^d., p. 496, Oct. 25, 1876. 

20. Galezowski. — Ocular alterations in erysipelas of the face. 
Recueil d'Opthal. July 1876. (La France M^d., p. 648, Oct. 4, 
1876.) 

21. Hug. — Impfrothlauf in der Stadt Freising. Intelligenzb., 
49, 1875. 

22. Macias, R. — Abortive treatment of erysipelas by quinine 
and opium. (Remarks on F. L. Satterlee's paper.) Anales de la 
Association Larrey, p. 149, Sept. i, 1876. 

23. Matthews. — The muriated tincture of iron a " Specific " 
for erysipelas. The Med. and Surg. Reporter, Feb. 24, 1877. 

24. Ory, E. — Treatment of erysipelas. La France Mdd., p. 680, 
Oct. 18, 1876. 

25. Oswald, J. 'W. J. — Liquor ferri perchloridi fortior as a 
local application in erysipelas. Brit. Med. Jour., Dec. 30, 1876. 

26. Putney. — The treatment of erysipelas and carbuncle. The 
Med. & Surg. Reporter, April 7, 1877. 

27. Sigaud. — Study of albuminuria in erysipelas and lym- 
phangitis. These de Paris, No. 430, 1876. (Gaz. des Hopit., p. 78, 
Jan. 25, 1877). 

28. Tinneane. — Erysipelatous metritis, the mutual relations of 
erysipelas, scarlatina, and the puerperal process. Dublin Journal, 
April, 1877. 

29. White, L. — Liquor ferri perchloride fortior as a local 
application in erysipelas. British Med. Journal, Dec. 9, 1876. 

30. Gibbons, Henry. — An epidemic of boils. Pacific Med. 
& Surg. Jour. (The Med. and Surg. Reporter, March 31, 1877.) 



I 



INFLAMMATION^: ACUTE, ETC. 355 

31. Ory. — Tnitement des furoncles. La France Medicate. 
Dec. 13, 1876. 

32. Roth, J. — Note concerning furuncles and anthrax, their 
abortive treatment. Rev. de Therap. Medico<^hirurg. (L'Union 
MAI. du Canada, p. 55, Dec., 1876.) 

33. Chavanis. — (Lyon Medical, 31 Dec, 1876.) From Load. 
Med. Record, April 6, 1877. 

34. Comin. — Treatment of anthrax. Gaz. des Hdp., p. 131, 
Feb. 10, 1877. 

35. Delon. — Treatment of anthrax by cauterization. These de 
Paris, Dec. 14, 1876. (Gaz. des HAp., Feb. J7, 1877.) 

36. Dibrell.— Treatment of carbuncle. The Med. & Surg. 
Reporter, March 31, 1877. 

37. Guerin.— New method of treating anthrax. Bull, de 
I'Academie de MAiecine, 1876, Nos. 36 & 37. 

38. Jacquey. — Complications of phlegmons in the region of 
the carotid. Thise de Paris, No. 383, 1876. Gaz. des Hdpit., 
p. 78. Jan. »s. 1877. 

39 Raimbert.— Treatment of carbuncle. Practitioner, April 
1877, from (Luettc Ilcbtlom., No. 15, 1876. 

40. Schneider.— Tr.iitcment de I'anthrax. (Journal des Sci- 
ence* MAIicaiis (If I.ouv.iin. Feb., 1877.) 

M. Chavanis i^i), in reference to a caseof anthrax in which be 
employed excision and cauterization with chloride of zinc paste, 
and subsequent injections of carbolic acid, and salydlic acid inter- 
nallv, notes that on the whole carbolic acid does not seem to him to 
fulfil all its therapeutical promise. Three cases of Raimbert's, one 
of Lezart's, and his one are favorable to the use of antiseptics: but it 
is not on so small a number of cases, in which the cure may be due 
to cauterization as much as to antiseptics, that a new treatment can 
be based. Cauterization is necessary. Carboli acid may also be 
emplmred as an adjuvant, in subcutaneous injections, compre s ses on 
the oedema, and also interrtally, without the pretension of being a 
q>edfic against anthrax. In all respects iodine seems preferable. 

Da. Dblon (35) describes four cases of anthrax cured by 
cauterization in the wards of Dr. Deprcs. He made a crucial inci- 
sion down to the bottom of the slough. He then separated the lips 
of the wound and stuffed its bottom with small pellets of tinder 
which had been steeped in a solution of eighteen parts of chloride 
of zinc to fifteen of water. If the slough were too deep to allow the 
caustic to be easily carried to the bottom, he cut out the four frag- 
ments which allowed him greater facility of action. The caustic 
was allowed to remain twenty-four hours, covered with a poultice to 
subdue the inflammation. It was then taken away to allow the 
permanent application of emollients, if the cautery seemed to be 
effectual ; if not, a fresh cauterization is performed. Delors has 
also obser*-pd that the temperature rises in proportion as the affec- 
tion develops, and falls when the disorder is arrested. 

Gi-ERiN (37) applies a large blister to the affected surface with 
a hole in the centre, through which carbolic acid and other disin- 
fectants are introduced to the centre of the carbuncle. 



3s6 DIGEST OF LITER A TURE ; 

Raimbert (39) arrives at the following conclusions : — Cauteri- 
zation of a fresh carbuncle is rational, because it destroys the bacteria, 
which may be supposed to be in the skin, and especially in the 
circumscribed scab. As long as the poison is limited to the skin 
and subcutaneous connective tissue, we may hope to neutralize it by 
the subcutaneous injection of antiseptic solutions, which must be 
made in sufficient numbers in appropriate positions. If the poison 
has been absorbed into the blood, subcutaneous injections are no 
longer capable of destroying it, and M. Raimbert considers intra- 
venous injections as too dangerous a proceeding to be adopted. 

Dr. Schneider (40) makes use of perchloride of iron in pref- 
erence to blisters or cauterizations, and claims for it the following 
advantages : It obliterates the divided vessels and causes contrac- 
tion of the traumatic surface, thus diminishing the chances of septic 
absorption. It plays the part of an antiputrescent and disinfectant. 
It mummifies the slough and renders it inoffensive, decomposes 
deleterious gases, combines with exudations to form a brown 
and imputrescent crust. It does not destroy the healthy tissues, 
nor produce any loss of substance. He incises deeply and widely, 
filling the cavity with lint dipped in perchloride of iron. After 
24 or 48 hours the dressings are readily removed and display healthy 
tissue, which speedily cicatrizes. 

41. Carter, H. Vandyke. — Note on the Delhi boil. Royal 
Med. & Clin. Soc. Rep. Med. Times & Gaz., May 12, 1877. 

42. Fox. — On oriental sore or Delhi boil. Lancet, April 7, 
1877. 

Dr. Fox (42) communicates an abstract of the special report 
of Drs. Lewis and Cunningham, recently made to the government of 
India upon this affection, which has been the subject of such diverse 
expression of opinion lately. They affirm that it is neither a 
parasitic affection, scrofula, nor syphilis, but that it is a peculiar 
phase of lupus, for which they propose the name lupus endemicus. 
From this conclusion Fox dissents. He regards it as an affection 
sui generis, having furunculoid affinities, and running an indolent 
course in consequence of a depraved state of the health. 

43. Grzymala. — Treatment of malignant pustule by vesicants. 
Le Mouvement Medicale, Dec. 9, 1876. 

44. Hamill, J. W. — Malignant pustule. British Med. Jour., 
Feb. 17, 1877. 

45. KlingelhofTer. — Treatment of malignant pustule. L'Union 
Med., p. 175, Feb. i, 1877. 

46. Maffucci, Angela. — Hypodermic injections of phenic acid 
in malignant pustule. Gazetta di Medicina Publica. Nov., 1876. (Lo 
Sperimentale, Aprile, 1877, p. 364.) 

47. Monestier. — Malignant pustule. Thfese de Montpellier, 
No. 52, 1876. (Gaz. des Hop., p. 303, March 31, 1877.) 

48. Ryott. — Case of malignant pustule. Lancet, April 21, 1877. 

49. Treymann, M. — Case of glanders. Dorpater Med. 
Zeitschr. Band VI., 1877, p. 295. 

50. Blenkarne, L. H. — Herpes frontalis treated locally by 



I 



IXFLAMMATIOS^S . ACUTE, ETC. 357 

anodyne amyl colloid. British Med. Jour., Dec. 30, 1876. (The 
Practitioner, p. 130, Feb., 1877.) 

51. Broadbent, W. H. — Partial herpes frontalis, &c. Brit. 
Med. J0urn.1l, Dec. 9, 1876. 

5a. Depes. — Herpes zoster of the tongue, &c. Hospital 
Cochin. Gaz. des H6p., p. 139, Feb. 13, 1877. 

53. Fuchs, Ernst. — Herpes iris conjunctivae. Klin. Monatsb. 
fur .Vugcnhrdc. October, 1876. 

54. Gelle. — Zona of the tongue. Tribune MM., No. 403, p. 219, 
1876. (kcv. des Sciences MM., p. »»7, Jan., 1877.) 

55. Jalaguier. — Neuralgic herpes pudendorum. Gaz. des 
H6pit., 1 1, 20, 1876. 

56. Mercier. — The treatment of zona by the topical applica- 
tion of perchloride of iron. Thkse de Paris, No. 77, 1877. (Les 
Prog. Med., p. Z17, March 17, 1877.) 

57. Perroud. — Note sur le zona du fessier inf^ricur ou petit 
sciatique. Annates de dcrmatologie et de s)'philigraphie. Vol. 
VIM , No. ,. 

58. Tucker. J. I. — A case of herpes zoster frontalis. Journal 
of .M(!nt.il and Nervous Diseases, p. 161, Oct., 1876. 

59. Taylor. — 2^ter followed by peliosis rheumatica. American 
Practitioner, Dec, 1876. 

Ill the case of Zona of Perroud (57X the patient entered Hotel 
Dieu on account of phthisiv for which small doses of arsenic were 
given. The vesicular efflorescence of herpes was developed in 
groups situated upon the left side of the perineum and margin of 
the anus, upon the internal and posterior upper fifth of the thigh, 
anri upon the left surface of the penis and scrotum. The eruption 
w.i^ ] trodcd by acute neuralgic pain in these regions. Dr. Perroud 
(liics not think that the zoster was produced by the arsenic. 

60. Fournier. — Ktude sur la suctte miliare. Thkse de Mont- 
pellier. No. 57, 1876. (Gaz. des H6pit., p. 303, March 31. 1877.) 

61. Bleynis, Id. P. — Kpldemic of pemphigus. Soc. de Med. 
dela Haute Vionnc. Lyon Ni«fd., p. 391, Nov. ij, 1876. 

63. Russell, Jamea. — Histor)- of a case of pemphigus extend- 
ing over seven years, the eruption intermixed with attaclu of erysip- 
elas ; appearance of epilepsy in the later period of the case. Med. 
Times &Gaz., Jan. 6, 1877. 

63. Dohrn. — Pemphigus acutus neonatorum. Arch. f. Gynako- 
logie, X. Btl., 3 Hft., p. 589. 

Dt)HR.v (63) relates the case of a midwife who, during the period 
from March zsth to July 13th, presided at the birth of 65 children. 
Of these, 28 sickened with pemphigus, mostly within the first two 
weeks after birth, and eight died. In accordance with advice, she 
abstained from practice, and left town for a month. From August 
13th to September 3d, nine children were bom under her ministra- 
tions, of whom three contracted pemphigus. These all recovered. 
She again gave up practice, resuming it on the ist of October. Be- 
tween the ist and the nth of October, of six children born, three 
were attacked with pemphigus, one of whom died. She then gave 
up her practice for the thiid time. 



L 



358 DIGEST OF LITERATURE; 

II. 

SYPHILIS AND VENEREAL DISEASES. 

GENERAL QUESTIONS IN SYPHILIS, THERAPEUSIS, 
ETC.* 

R. W. TAYLOR, M. D. 

1. Antonini, E. — Syphilitic fever. (De la Fievre Syphilitique^ 
Thbsede Paris, 1876. 

2. Anonymous. — A syphilitic problem. Correspondence of 
British Med. Journal, Nov. 4, 1876. 

3. Anonymous. — The origin of syphilis. Med. Press and 
Circular, Feb. 23, 1876. 

4. Baumgarten, P. — Giant cells and syphilis. Centralbl. 
fiirdie Med. Wissensch., Nov. 4, 1876. 

5. DeBeauvais. — Syphilitic inoculation from one man to 
another by means of a bite. Soci^td de M^d. de Paris. Lyon 
Med., p. 209, Feb. 6, 1876. 

6. Bettelli, C. — Mercury found in the urine of four syphilitic 
patients. Giornale Ital. delle Mai. Ven. e della Pelle. February, 
1876. 

7. Breda, A. — Clinic of syphilitic and cutaneous diseases. 
(Clinica delle Malattee sifilitiche e cutanee.) Brochure, Padova, 
1876. 

8. Colomiatti. — Contribution to the pathological histology of 
constitutional syphilis, and to the study of the genesis of giant cells. 
Giorn. Ital. delle Mai. Ven. e della Pelle, No. 5, 1876. 

9. Culbertson, H. — Are there one or two syphilitic poisons? 
Cincinnati Lancet and Observer, Jan., 1877. 

10. Dawosky. — Communication from practice, in syphilis. 
Memorabilien 10, 1876. 

11. Deahna, A. — On the influence of erysipelas on syphilis. 
Viertelj. fiir Derm, und Syph., Heft, i, 1876. 

12. Diday, P. — Syphilis of glass blowers. Gazette Hebdom. de 
Me'd. et de Chin, Aug. 18, 1876. 

13. Drysdale, C. R.— On the duality of the syphilitic chancre. 
Med. Press and Circular, Sept. 13 and 27, 1876. 

14. Editorial : Debate on the pathology of syphilis. British 
Med. Journal, 1876. 

15. Editorial : Debate on the pathology of syphilis. Lancet, 
1876. 

16. Editorial : Debate on the pathology of syphilis. N. Y. 
Medical Record, 1876. 

•This bibliography is given in full, to the exclusion of comments thereon, in 
order, as far as possible, to furnish a complete index to the literature of the sub- 
ject up to the close of the current year. — Ed. 



^ 



GENERAL SYPHILIS. 359 

17. Editorial : Debate on the pathology of sj-philis. Medical 
Times and Gazette, April 8, jj, 29, and May 13, 1876. 

18. Editorial : The debate on syphilis at the Pathological 
Societ)- of London. Vierteljahres. fUr Derm, und Syph. Heft. 3, 
1876. 

19. Editorial : Is it our duty to have syphilis ? Med. and 
Surp:- Rfport'T, Sept. 30, 1876. 

' is, E. — On the question of the conta^ottsness of the 
m. nurses. {QmlfHtt rtcktrtka it r^ttt m u eritifuts sur 

/a y tnoeuUi iu lait prtvatamt d» ntkrrita typkUiti^ma^ 

Th^e de i'aris, i877' 

ai. Gaskoin, George. — ^Tbe recent discussion on syphilis. 
Mc<l. Times and Gazette, April 11, 1876. 

■XI. Guntz, J. E. — Report of the first five years of the Public 
Clinic for skin and venereal diseases in Dresden. Deutsche 
Klinik, Nos. 1 and 2, 1875. 

33. Hermann, 1 — On the nature of syphilis and its treatment 
without mcrcur)-. Wiener Med. Zcitung, as., Jahrgang, Nos. 48, 
49 and 52. 

24. kennard, T. — Can syphilis re-occur? St. Louis Med. and 
Suri;. joum., Jan., 1877. 

35. Low, S. — Vehicles and mode of extension of syphilis con- 
tagi )ii. Med. Chir. Rundschau., May, 1876. 

j6. Ory, E. — Ktiology of malignant precocious syphilides. 
lircxhurt, Paris, 1876. 

37. Pick, F. I. — Transmission of syphilis. Prac. Med. Wo- 
chenschrift. Vol. I., No. 9, 1876. 

38. Proksh, J. K. — Scientific protest against the historical 
writing and several other points in Prof. Zeissl's Text-Book on 
Syphilis. Brochure, Vienna, 1875. 

39. Quist, C — The new authentic accounts of the appearance 
of syphilis in the fifteenth century. Virchow's Archiv., Heft 4, 

>875- 

3a Sale. G. — Origin of syphilis. Med. Press and Circular, 
March 8. 1876. 

31. Terry. W. L. — Syphilis of six years' standing cured by 
large doses of iodide of potassium. Medical and Surgical Re- 
porter. Fi-b. 12, 1876. 

3a. Thiry, J. H. — S}-philis lasting 10 years; chloro-anxmia ; 
double syphilitic orchitis ; differential diagnosis between tubercu- 
losis and syphilis. Presse M^ Beige, No. ci, 1876. 

33. Thiry, J. H — Constitutional syphilis ; clinical lectures. 
Presse M(f<l. liclge, Nos. 19 and 23. Apni 9, 1876. 

34. Thiry. — Periods of svphilis ; olMervation of tertiarr syphi- 
lis ; osteitis and necrosis of the frontal bones. Presse Mra. Beige, 
No. 31, 1875. 

35- Thiry. — Address made concerning a new theory of Dr. 
Hermann upon s}-philis and upon the proscription of mercury in 
the treatment of syphilis. Presse Mra. Beige, 29th Jan., 1875, 
No. 37. 



36o DIGEST OF LITERATURE; 

36. Trevisanello, G. — Clinic of venereal diseases of Prof. 
Pellezzari. Giornale Ital. delle Mai. Ven. e della Pelle, No. 5, 
1876. 

37. Vajda, L. — On general syphilis. Bericht. der Klinik fUr 
syphilis. Von v. Sigmund in Wien., 1874. 

38. Wolzendorff. — The present view of the initial manifesla 
tions and prognosis of syphilis compared with that of the eighteenth 
century. Berlin. Klin. Wochenschrift, Nos. 9 and 10, 1875. 

39. Zeller, R. — Notes of syphilitic practice. Memorabilien 
XX., 5, p. 212. 



INITIAL LESION, CHANCROID AND ITS COMPLICATIONS. 

40. Auspitz, H. — Buboes of the inguinal region and their 
treatment. Wiener Klinik, No. 12. (Rundschau, May, 1876.) 

41. Brinton, J. H. — Venereal ulcers. Jan. 15, 1876. 

42. Caspary, J . — On the anatomy of the hard and soft ulcers. 
Viertelj. fiir Derm, und Syph., No. 2, 1876. 

43. Coroze, V. E. — On the initial lesion of syphilis. {Contri- 
bution h r etude de I accident primitif dc la syphilis.') Thbse de Paris, 
1876. 

44. Editorial : The management of condylomata. The Med. 
and Surg. Reporter, Feb. 24, 1877. 

45. Fournier, A. — Syphilitic chancres of the neck. Annates 
de Derm, et de Syph. Tome VIII., No. i, 1877. 

46. Gilruth, G. R. — Condylomatous excrescences of the anus 
treated by escharotics. Edin. Med. Jour., Dec, 1876. 

47. liaibe. — Preputial chancre followed by syphilitic indura- 
tion ; intra-urethral phagedenic chancre. Presse Mdd. Beige, No. 
38, 1876. 

48. Hodgen, J. P. — Induration of the penis. Trans. Missouri 
State Med. Soc. for 1876. (The Med. and Surg. Reporter, Sept. 
16, 1876.) 

49. Hulke, J. W. — Primary soft ulcer of lower lips. Med. 
Times and Gazette, Oct. 21, 1876. 

50. Klink. — Two cases of phagedenic chancre. Medycyn?, 
No. 48, 1875. (Hirsch's Jahresbericht, H. 2, Band 2, 1876. 

51. Lefort. — Suppurating bubo following an ulcer of penis of 
uncertain nature, treated and cured by compression and tincture of 
iodine. La France Medicale, No. 18, 1877. 

52. Mauriac, C. — On the actual rarity of simple chancre. 
Brochure, Paris, 1876. 

53. Mauriac, C. — Diminution of venereal diseases in Paris 
since the war of 1870 and 1871. Brochure, Paris, 1875. 

54. Mauriac, C. — Lecture on balano-posthitis and phymosis 
symptomatic of infecting chancres. Brochure, Paris, 1875. 

55. Mauriac, C. — Balano-posthitis, gangrenous and symptom- 
atic of simple chancres. Progrbs Medical, Aug., 1874. 



I 



SYPHILITIC LESIOiVS OF THE SKIX. 



361 



56. Mauriac, C — On the treatment of balano-posthitis and of 
phymosis, symptomatic of simple chancres. Bull, de Therap. MM. 
et Chirurg., .\ug. 30, 1874, and Brochure, Paris, 1874. 

57. Maury, F. F. — Phagedenic chancre. Phila- Med. Times, 
June 10, 1876. 

58. Mason, F.— Infecting sores in anomalous positions. Medi- 
cal Press and Circular. 

59. Nettleship, E. — Chancre within the nostril, followed by 
constitutional syphilis. British Med. Joum., p. 363, September iS, 

«875. 

Go. Ribble. — Case of soft chancre with secondary symptoms. 
Phil. Med. Times. Dec., 15, 1875. 

61. Schwartz, C — Case of syphilitic chancre of the neck of 
the uterus. .\nn. de Derm, ct de Syph., No. I., Vol. VI., 1875. 

6a. Thiry, J. H. — Phagedenic chancre; clinical lecture. 
Presse MM. Beige, No. 16, March 19, 1876. 

S. Vajda, L. — Contribution to the anatomy of syphilitic 
nof the genital parts. Med. Jahrbttcher der K. K. Gesell- 
•chaft den Aerzte in Wien. Heft 3, p. 309. 



srrHiunc ubions or thb svm« 

64. Barlow, T. — Case of phlegroonoos typhilides. Lancet, 
Nov. 4, 1876. 

65. Brouchtn. — S\-philitic pemphigus and non-syphilitic pem- 
phi,3^ ; a word upon the question of syphilitic conception and its 
consequences. Gaiette dcs Hdpiuuz, Sept. 31, 1876. 

66. Cernatesco, J. N. — On the course and duration of the 
syphilitic chancre and of syphilides of the vulva during gestation. 
Brochure, Paris, 1876. 

67. CresweU, Richard. — Syphilitic copper-colored stains. 
Lancet, Dec. 16 and Dec. 23, i8j|6. 

68. Dullen, C. W. — Syphilitic roseola. Med. and Surg. Re- 
porter, May »o, 1876. 

69. Du-bois-noir, H. DeBnin. — Syphilitic ulceration of the 
glans, pustules of ecthyma, stricture of urethra. Gaz. des HApit., 
103. Sept., 1876. 

70. Gamberini, P. — Ulcerating syphilitic acne. Giom. Ital. 
della Mai. Yen. e della Pelle, Dec., 1876. 

71. Gosselin. — Constitutional syphilis, mucous patches of the 
skin and scrotum, rhagades. Gaz. ws HApit, 78, 1876. 

72. Gosselin. — Syphilis, pustular and tubercular of a form un- 
usually rapid. La France MMicale, Jan. 14, 1877. 

73. Grunfeld. — Condylomata acuminata. Wiener Med. Presse, 
No. 18, 1875. 

74. Hardy, A. — Serpiginous pustulo-crustaceous syphilide. 
Ga7. des Hopit., 93, Aug., 1876. 



362 DIGEST OF LITERATURE; 

75. Hardy. — Malignant precocious syphilides. Gaz. des 
Hopit., No, 56, 1876. 

76. Harris, Vincent. — Secondary syphilis. St. Barthol. 
Repts.jVol. XI. (Am. Jour. Med. Science, Oct., 1876.) 

77. Horteloup. — Malignant syphilis. La France M^d., p. 
693, Oct. 25 and 28 and Nov. i, 1876. 

78. Lorimy. — Syphilitic ulcers of the lower extremities. (^Des 
ulceres et en particuUer des ulclres syphilitiques siegeant aux membres 
in/erieiirs.) Thfese de Paris, 1876. 

79. Moret. — On syphilitic manifestations in pregnant and 
newly-delivered women. Thbse de Paris, 1875. (British and 
Foreign Medico-Chirurg. Rev., p. 482, Oct., 1876.) 

80. Neumann, J. — Diagnosis and treatment of syphilitic af- 
fections of the skin. Wiener Klinik, Feb., 1876. 

81. Octerlony, J. A. — On the diagnosis of syphilitic affections 
of the skin. Peninsular Journal of Medicine, Nov., 1876. 

82. Richard, Albert. — The development of secondary lesions 
of syphilis. {Des conditions dans lequelles se developpetit les accidentes 
secondaires de la syp/iilis.) These de Paris, 1876. 

83. Saccani, G. — Tubercular syphilide of the tongue. Giorn. 
Ital. delle Mai. Ven. e della Pelle, April, 1876. 

84. Stetzer. — Clinical communications : pointed condylomata 
in syphilis. Vierteljahr. fiir Dermat. und Syph., No. 4, 1875. 

85. Taylor, Fredrick. — On phlegmonous syphilides. Lancet, 
Jan. 13, 1877. 

86. Thiry. — Serpiginous ulcers of scalp, ulcers of the palate, 
lips and chin, regarded as syphilitic. Presse Mdd. Beige, 1875, 
27 th year. No. 50. 

87. Visscher. — Observation of severe syphilis ; syphilitic 
ulcerations of the palate and pharynx. Bull, de la Socie't^ de 
M^d. de Gand, January, 1876. 

88. Zeissl, H. — On the diagnostic signification of the annular 
forms of erythematous and desquamative dermatoses, and of the 
so-called serpiginous ulcerative process. AUgemein. Wiener Med. 
Zeitung XX., Jahrgang, No. 15. 



VISCERAL AND TERTIARY SYPHILIS. 

89. Balme. — Syphilitic epididymitis, with considerations as to 
the secondary and tertiary stages. {De Pepidydimite syphililique 
precedee de quelques considerations sur les periods, et cet.) These de 
Paris, 1876. 

90. Barlow, Greenfield, Gowers. — Visceral syphilis. De- 
bate on cases and specimens. Lancet, Jan. 20, 1877. 

91. Beck, F. E. — Case of tertiary syphilis ; with exfoliation of 
the whole anterior surface of the axis. Dublin Journ. of Med. 
Sci., Feb., 1877. 




VISCERAL AND TERTIARY SYFHIUS. 363 

93. Berger, P. — Influence of constitutional diseases (Struma 
Syphilis, ct. cet.) upon the course of traumatic lesions. Th^e 
d'Agr^gation. Section de Chirurgie.) Annales de Denn. ct de 
Sv-ph. Tome VII., No. 3, 1875-76. 

93. Bjomstrom, Fr. — Syphilis of the intestines. Upsala. 
liikareforen Jahrb. cIxLx., p. 14c. 

94. Broca. — Tertiary syphilitic lesions, refractory to iodide 
of potassium, cured by mercury. Gaz. des HApit., No. 149, 1876. 

95. Bhddon, C. K. — Syphilitic necrosis of tibia. Med. and 
Surgical Reporter, Aug. 5, 1876. 

96. Chauvel. — Necrotic caries of the ethmoid. Ga2. des 
Hopit., IJ3, 1876. 

97. Chiarleoni, C. — Distochia of syphilitic origin ; resistance 
of the uterine ami vaginal orifices in consequence of specific scle- 
rosis. .\nn. lie Derm, et de S)-ph., Vol. V., 1874. 

98. Cliquet, E. — Syphilitic hepatitis and its cure. {De la 
AefiatiU syfihilttiifiu et la fossibilUi dt tim guerisom^ Th^ de 
Piu-is, 1876. 

99. Comil. — Inflammation of the lymphatics of the lung in 
visceral syphilis. Ref. in Vierteljahr. fUr Derm, und Syphilis, No. 
3, 1876. 

100. Dowse. T. S. — Syphilitic disease of the rectum. Trans- 
action of the Pathological Society, xxvi. 

loi. Drysdale, C. R. — A review of the debate on visceral 
syphilis at the Pathological Society of London. Doctor, March, 
.\pril, 1877. 

101. Drysdale, C. R.— On syphilitic phthisis. Med. Press 
re., Dec. 17, 1876. 

; Drysdale, C. R — Severe case of tertiary syphilis. Med. 
..... .i:id Circ, May 19, 1875. 

104. Dauzat, Antoine. — Syphilitic arthritis. {Etmdt tmr 
rartAriU syfAilitifut.) Thise de Paris, J876. 

105. bulong. — Subnctitaneous gummata. {CMtrihutwrn d la 
ItuJt dts gommet saus mlanhs.) Tb&e de Paris, 1876. 

106. Editorial : Visceral syphilis. Medical Record, Feb. 
14, 1877. 

107. Ferrari, P. — Entero-peritonitu s}-philitica. Lo Spen- 
mentale, Oct., 1876. 

108. Fournier, A. — ^Tertiary glossitis. La France M^cale, 
Nos. 69, 7 1. 74, 76, 78, 8j, 83, 86, 91, 9J, 94, 96, 97, 99, 103. 1876 ; 
and No. 2, 1877. 

109. Frey. — Infiltration of the left upper lobe of the lung re- 
sulting from syphilis. Allgem. Med. Central. Zeit., June, 1876. 

110. Goldstein.— Syphilis of the liver. Berlin. Klin. Woch- 
ensch.. May 8, 1876. 

111. Gosselin. — Diffuse stricture consecutive to a chronic 
rectitis, caused probably by a chancre of the anus. Gaz. des 
Hopit., 107, Sept. 14, 1876. 

na. Griffith.— Syphilitic phthisis. British Med. Jour. (The 
Med. and Surg. Reporter, Aug. 13, 1876.) 



364 DIGEST OF LITERATURE; 

113. Hedenius, P. — Cases of visceral syphilis. Upsala. 
lakareforen forhandl. X., 7, S. 485. 

114. Hugonneau. — Interstitial syphilitic glossitis. {Etude 
Clintque sur la glossik interstitielle syphilitique?) Brochure, Paris, 
1876. 

115. Kunze, C. F. — Syphiloma of the liver. Deutsch Zeitschrift 
f. Prakt. Medic, 21, 1874 (Rundschau, May, 1875.) 

116. Lannini, V. — History of a case of guniimous glossitis. 
Revista Clinica de Bologna, Aug., 1875. 

117. Lorenzo, G. — Benign fungus of the testicle and its rela- 
tion to syphilis. Giorn. Ital. delle Mai. Ven. e dell a Pelle, No. 2, 
1876. 

118. MacSwiney. Syphilitic phthisis. British Med. Journ., 
Dec. g, 1876. 

119. Martineau, L. — Acute hypertrophic cirrhosis in a syphi- 
litic woman. L'Union M^d., No. 108, Sept., 1875. 

120. Mauriac, C. — Syphilitic myopathies. Ann. de Derm, et 
de Syph. Tome VIL, No. 4, 5, 6 ; Tome VIII., No. i. 

121. Mauriac, C. — A case of gummous precocious syphilis, 
unaffected by iodide of potassium. Brochure, Paris, 1874. 

122. Mulreany, J. — Gonorrhoeal and syphilitic affections of 
the testicles. Med. and Surg. Reporter, April 15, 1876. 

123. Orth. — Large syphilitic ulcer in the rectum. Berliner 
Klin. Wochenschrift, No. 5, 1875. 

124. Porter, F. T. — Syphilitic osteitis. British Med. Journ., 
Dec. 30, 1876. 

125. Purves, L. — Syphilitic deafness. British Med. Jour., 
Dec. 9, 1876. 

126. Sabail, Paul. — Syphilitic tumors of tendons and aponeu- 
roses. {Contribution a i' etude des tumeurs des tendons et des aponeu- 
roses.') These de Paris, 1876. 

127. Tibbits, E. T. — On the probable relationship of syphilis, 
scrofula, tubercle, cancer, and other allied morbid conditions. 
Lancet, Dec. 23 and 30, 1876. 

128. Thompson, H. — Lecture on syphilitic disease of the 
liver, with peculiar physical signs in the abdomen. Lancet, Aug. 
28, 1875. 

129. Verneuil, M. — Note on the tertiary ulcus elevatum. Gaz, 
Hebdom. de Med. and Chirur., No. 3, 1877. 

130. Woodbury, F. — Acute and chronic syphilitic orchitis. 
Med. and Surg. Reporter, Feb. 12, 1876. 

131. Zannini, V. — Case of gummous glossitis. Rev. Clin., 2. 
S. V. 8, p. 238. 

132. Zeissl, H. — Syphilitic orchitis. Wiener Med. Presse, 
41, 42., 1876. 



I 



PROPHYLAXIS OF SYPHIUS. 365 

PROPHYLAXIS or SYPHILIS AND PROSTmmON. 



133. Black, J. R. — Pre^-enting the estensioi) of s}'philU. Cin- 
cinnati Lancet and Observer, Dec, 1876. 

134. Bouchard. — Hygiene and prophylaxis of venereal dis- 
eases. Lectures. Gaxette Hebdom. de Med. et de Chirxir., Nos. 

*9. 30- 34> 36. 37. 39 a"d 40- 

135. Democtritus. — Prostitution and medico-legal disserta- 
tion. New Orleans Med. and Surg. Journal, Nov., 1875. 

136. Drysdale, C. R. — \ small contribution to the statistics 
of viiicreal diseases in London and Paris. Medical Press and 
C'icul.ir, May lo, 1876. 

137. Drysdale, C. R. — On the prevention of s}-philis. Med. 
Press and Circul.ir, Oct. 18, 1876. 

138. Durand, Faudel, M. — Prostitution and the condition 
of women in China. Union MMicale, Noa. 60, 64, 67, 73, 75. 
1876. » 

r clsted, S. — Mcisures to prevent the propagation of 
\ ^es in Denmark. Transactions of International 

M .,:eM. Phihadelphia, 1877. 

140. Fcrssmann, D. — Prostitution in Helsingfors. Finska 
lik. Sillsk. Handl., xvi., p. 173, 1875, (Hirsch's Jahresbericbt, 

No. a. p. ^39. '«;'■'•) 

141. Gamberini. P. — Report on prostitution m Bologna. 
Giom. Ital. dillc Mai. Ven. e della Pelle. Na a, 1876. 

X43. Jeannel.J. — Prostitution in large cities in the 19th cen- 
tury and the extinction of venereal diseases. Paris, 1874. 

143. Jeannel,J. — Prostitution in England. Annales d' Hygiene. 
April, 1875. 

144. Lowndes. Fred. W. — The working of the Contagious 
DiMises Acts at .'Mdcrshot, Chatham, Windsor, Plj-mouth, Devon- 
port, .ind Stonehouse. Med. Times and Gaz., Jan. «, 18^6. 

145. Lowndes, F. W. — The extension of the Contagious Dis- 
eases Acts to Liverpool and other seaports practically oonsidered. 
Brochure, Liverpool, 1876. 

146. Lecour, C. J. — The actual state of prostitution in Paris. 
Brochure, Paris. 1874. 

147. Mireur, H. — S)-phili$ and prostitution in their relation to 
hygicni', nior.ils and law, I'.iris, 1875. 

148. Nevins, J. B. — Inquiry into the condition of prostitution 
and alleged influence of the Contagious Diseases Acts. Liverpool, 
1876. 

X49. Nevins, J. B. — Statement of the grounds upon which 
the Contagious Diseases Acts are opposed. Brochure, London, 

«87S- 

150. Pini, G. — Laws upon prostitution. Giom. Ital. delle 
Mai. Ven. e della Pelle, No. j, 1876. 

151. Poray, Koschitz. — Instance of the spread of syphilis in 
a workshop. Sitzunghr. der Med. Gesellsch. zer Charchow., 1875. 
Centralbl. f. Chirurg. (Rundschau, May, 1876, p. 412.) 



\ 



366 DIGEST OF LITER A TURE ; 

152. Sigmund, C. — Prophylaxis of syphilis. Wiener Med. 
Wochenschrift, No. 10-12, 1876. 

153. Sims, J. M. — Prevention of syphilis. Address before 
Am. Med. Association. Trans. Amer. Med. Association, 1876. 
(Med. and Surg. Reporter, July 15, 1876.) 

154. Strohl, E. — The question of prostitution. Viertelj. f. 
Gerichtl. Med. N. F., xxiv., Jan., 1876. 

155. Schpeck, E. — Statistical researches in syphilis in the 
female population of St. Petersburgh. Translated by Poray Kos- 
chitz and Ch. Schwartz. Annales d'Hygiene Publique et M^d. 
Legale, 2 Series, Tome XLIV., 1875. 

156. Schpeck, E. — Statistics in reference to the bodily state of 
prostitutes. St. Petersburgh Med Zeitschrift, 1875. 

157. Valle, E. — Prostitution and syphilis. (La prostitutione 
e la sifilide) Brochure, 1876. 

158. Anonymous. — The limitations of syphilitis. The Med. 
and Surg. Reporter, Jan. 6, 1877. 

159. Anonymous. — Compulsory medication of prostitutes by 
the State. Westminster Review, July, 1876. 

160. Tables relative to the working of the Contagious Diseases 
Acts as regards the army, comparing the results obtained from the 
returns of twenty-eight stations in the United Kingdom. Govern- 
ment Document, 1875. 

161. English and Continental laws and regulations concerning 
prostitution. (Pamphlet without name, date, etc.) 

162. Army Medical Department report for the year 1874, Vol. 
XVI., 1876. 



CONGENITAL AND INFANTILE SYPHILIS. 

JAMES NEVINS HYDE, M.D. 

1. Appai, C. — ^The transmission of syphilis between nurses 
and nurslings, and its medico-legal aspects. Giorn. Ital. d. Mai. 
Ven. e. della Pelle, Aug, 1876, p. 237. (Rundschau, Feb. 1877, 

P- "7") 

2. Cory, Rob't. — Origin of infantile syphilis. London Lancet, 
June 17, 1876. 

3. Diday, M. P. — Syphilis by conception. Annales de Dermat 
et de Syphilig. Tome VIII., No. 3, p. 161. 

4. Dowling, Francis O. — What influence does a syphilitic 
father exert upon his offspring ? Cincinnati Lan. and Obs., V. 38, 
May 1877, p. 453. 

5. Ercolani. — Syphilitic disease of the placenta. Annales de 
Tocologie, July 1876. (Monthly Abstract of Med. Sci., Dec, 1876, 
P- S72-) 




CONGENITAL AND INFANTILE SYPHILIS. 367 

6. Gallois. — Examination of the question respecting the 
innocuity of the milk of syphilitic nurses. Paris, Deiahaye et 
Cie, 1877. 

7. Hutchinson, J. — On Colles' law, and on the communica- 
tion of syphilis from the foetus to the mother. Med. Tiroes and 
Gazette, Dec. 9, 1876. 

8. Hutchinson, J. — Illustrations of Ginical Surgery. Vacci- 
nation sx-philis. Phila. Lindsay and Blakiston, 1877. 

9. Kassowitz, M. — The hereditary transmission of syphilis. 
(Translation of Ur. M. A. Wilson,) N. Y. Med. Jour, Feb. (et 
scq.) 1877, p. 163. 

la On Colles' Law of immunity from syphilis. Editor of the 
Med. and Surg. Reporter, Jan. 20, 1877, whole No. lojS, p. 64. 

II. Senseney, B. R. — Vaccino s)'philis. Paper read before 
the Surglc.1l Section of the American Medical Association, in 
Chicago, ill., June 7, 1877. Trans. Am. Med. Assn. for 1877. 

la. Voss, R. — Inoculation of syphilisby the milk. St. Peters- 
burgh Med. Wochenschr., No. aj, 1876 ; Centralbl., No. 44, 1876 ; 
(Dublin Jour, of Med. ScL, Jan., 1877 ; Lyon M^dic, Feb. 18, 
1877, p. 247) 

Appai (i) verv properly insists that the sole basis for the solu- 
tion of medico-legal questions arising in consequence of the 
transmission of syphilis between nurses and nurslings, is to be 
found in the careful study of all the pathological facts. Beginning 
th< rofore with a brief historical sketch of the investigations upon 
tin: Mibjcct of hereditary syphilis, the author fully describes the 
principal manifestations of the disease, classifjring the cutaneous 
lesions under the eight varieties given by Foumier, and proceeding 
to a dcIlDcition of the mammaiv ulcer. The site of the latter is, 
n. y, in the order of decreasing frequency ; the base of 

tl nipple itself, the areola and the mammary globe. 

Muiiipiicity of lesions means numerous, simultaneous or successive 
inoculations, from repeated applications of an infected child to the 
breast. The lesion is cither erosive or postulo-crustaceous ; the 
former, of those still suckling infants, the latter, of those who have 
ceased to give the breast. 

In a medico-legal investigation, the duty of the physician is, 
first, to gather the facts relating to the history of the child, the 
symptoms exhibited before death, or if the child is living, the 
sequels of such symptoms. No h)-pothesis can be substituted 
for the possession of such facts, and if the latter are contradictory, 
or not established, such circumstance should be noted. Next 
comes the objective examination of the child, if it be living, 
with a view to the discovery of disease-relics in the event of a 
previous cure or successful treatment ; in the case of a child still 
affected, the truth can be attained much more readily and certainly. 
Last in order is the examination of the nurse, which should be as 
complete as possible, not merely to discover the nature of the disease, 
but also, if possible, its origin. The author is disposed to attribute 



363 DIGEST OF LITERATURE; 

much importance to the site of any existing adenopathy, especially 
if the glands of the axillae are found to be involved, vifhere often the 
medical jurist will find " a page which is eloquent in its tale of 
truth." 

Dr. Cory (2), believing that the immunity from syphilis of a 
mother bearing an infected child, is as yet unproven, presents an 
ingenious hypothesis to explain the transmission of the disease from 
the mother to the child, when the latter is apparently healthy at 
birth and is subsequently attacked. He supposes that, at the 
moment of the separation of the placenta, and before the cessation 
of the foetal circulation, some of the maternal blood is swept into 
the umbilical vein and blood infection results. Hence early grave 
hepatic involvement. How is the mother infected if not then by 
the foetus ? He supposes that in prior pregnancy she has been 
infected by an ovum impregnated with a diseased spermatazoon, 
with the result of early abortion, so early perhaps as only to induce 
"retarded menstruation." Ultimately, the combination of two 
healthy elements may produce a sound foetus. It seems to him 
incredible that a child, the offspring of a diseased first element, 
should be born apparently well, and yet should have previously 
transmitted to its parent a disease of which it displays no 
symptoms. 

He calls attention to this difference between hereditary syphilis 
and other hereditary diseases, viz. : that in the former the disease 
is fostered and built up in the growing embryo, is present, inevi- 
table and strictly inherited ; while in the latter, there is merely a 
greater liability to the influence of external noxious agencies. One 
is a disease in esse ; the other, in posse. 

We have heretofore (Archives of Dermatology, Vol. III., No. II., 
p. 180) briefly noticed the paper which Diday (3) here presents 
in full. It is written in the well-known characteristic style of the 
author, and attempts to establish clinically and logically the theory 
that the product of conception, infected by the father, may trans- 
mit the disease to the previously healthy mother during intra-uterine 
life. This is the theory of " Choc-en-reionr " — a theory conspicu- 
ously at variance with the proposition of Kassowitz, that intra-uter- 
ine infection is impossible so long as syphilis demands a virus-bear- 
ing element for its common carrier. It may be remarked that Diday 
brings his best powers to bear upon the task. Twenty-six cases are 
tabulated — the greater part of them from his personal observation, 
and in connection with each is given, (a) the duration of cohabita- 
tion preceding the pregnancy ; (b) the condition of the husband at 
the moment of conception ; (c) the period of pregnancy at which 
maternal syphilis developed, with (d) the nature of her symptoms ; 
and (e) the issue of the product of conception. Two other cases 
are added, in which the maternal syphilis developed only after preg- 
nancy had been completed. His objections to accepting, in expla- 
nation of these latter phenomena, the occurrence of ordinary infec- 
tion (wife directly from husband) are : (i), such a supposition would 
require sexual congress to have been effected at, or near, the date 




CONGENITAL AND INFANTILE SYPHILIS. 369 

of accouchement, when the husband would be naturally disinclined 
to the act ; (2), the accoucheur would have detected the chancre. 
These reasons will simply pass for what they are worth. He urges 
for the former cases, (1) the absence of initiail chancre, (2) the simul- 
taiMous development, at several points on the body of the mother. 
of a non-ulcerative syphilide, type of the first eruption of the sec- 
ondary stage of syphilis ; (3) the average interval preceding this 
explosion (between the 6sth and 70th day after conception) ; (4) 
the non-con ta^ious character of the lesions of the infected father 
j,j ,1. 1 .. ^ _ _ . f„ ^^^^ » ^j ji^g head, palmar syphilide, 
&c. nmunitv of the wife after cohabitation 

with r a vanable period of time. 

He c.ill» attcntiuii 10 the precocity of the maternal sjinptoms in 
the cases where the children only exhibited the disease from 15 to 
30 days after birth. 

Not content, however, with his somewhat enforced deductions 
from these premises, th>' Author i)ii-.hfi hi<ic<>nclusions still further, 
holding that the ovulr r igion «^ tfr(fM<, and 

explains with Cory th luhers, by supposing 

a previous prejjn^ or less, and making 

itself known ni ncwhat more painfiH 

than othrr^, 1: ' ,,( a few blood clots. 

\ iihiluatiun " d'emblt'c," DiDAr 

sa;. ,t is not the manner in which 

sypl , , ,, ,„.; rather, why do so many mothers 

enjoy an apparent immunity .> Here he adduces the law of Colics, 
and would have it believed that the fcetus may exercise a varying 
deforce of influence upon the mother ; in one instance infecting her 
with its <li<tcase, in another endowing her with a mysterious gift 
of irnniiiTufv. \m,! tii,- . ii!«<k| of this Variability the author pro- 
IH>- ;:ure. 

1 • ■. forth briefly the ronf!tctin;» views of 

authors upon tin- sul)ji-<t of the ' ■ 'm 

parent to child, the chief imperfcr it 

the opinions of the latcft and bcsi ., .. . ^ ,. are 

ignored. He believes that when the father is affected with cither 
prim.-iry or secondary syphilis, mother and child will almost certainly 
ooatract the disease— the mother through the medium of hrr offspring 
-^uxl that in cases whcte the syphilis of the f.tthcr wanes, cither 
from lapse of time or treatment, the child will be affected and 
the wife escape. On the other hand, in tertiary disease of the 
father, " the infection of either wife or offspring need not be 
feared," the male parent transmitting a constitutional diathesis 
which renders the child peculi.irly susceptible to the influence of 
other diseases, notably scrofuloid affections, which are distinguish- 
able from scrofula. It is to be remarked that in discussing proposi- 
tions of the character of those stated, the weight of authority will 
often be found opposed to their acceptance ; and much more rigor- 
ous (Ifduction is nccessar)- for their establishment than that offered 
bvthe author. 



370 DIGEST OF LITERATURE; 

The cases presented by Mr. Hutchinson (8) in this fasciculus 
(twenty-four in number) have appeared in part in the Transactions of 
the Royal Medical and Chirurgical Society. The plates are very well 
executed, and will serve a good purpose in enforcing the two les- 
sons inculcated in the forcible language of the text : first, the 
danger of vaccination from the arm of a syphilitic infant ; and, 
second, the means to be employed to avoid that danger. The clini- 
cal results of vaccination-syphilis here portrayed are in agreement 
with what has been already accepted. It is well understood by 
syphilographers id) that the syphilitic infant as a vaccinifer may 
be in a condition of apparent good health ; (J)) that the vaccine 
vesicle in cases where syphilis has been also communicated, may 
progress normally to its final phase ; (c) that after the typical in- 
cubative period, the primary syphilis lesion may appear as an in- 
durated, red, glossy tubercle, which will probably degenerate to an 
ulcer with scanty secretion and hard base and edges ; and (</) that 
tissue or blood elements are essential carriers of the syphilis from 
arm to arm, and not the vaccine lymph. 

The excellent translation of Kassowitz' monograph (g) places 
the observations of the author before the English reading members 
of the profession, in admirable form. A brief summary of the 
original has heretofore been incorporated with this digest of litera- 
ture. 

The Editor of the Medical and Surgical Reporter (io) 
enunciates the law of Colles, and quotes Mr. Hutchinson's recent 
remarks, laying before the profession in America the inquiries 
formulated in the late address before the Hunterian Society of 
London. He suggests that the deductions from Colles' law, point 
to the possibility of discovering a method of inoculation by which 
the virus of syphilis may be neutralized, and complete protection 
be afforded against it. 

Sensenev (n) enlarges upon the circumstance that the wise 
forethought of Jenner led him to anticipate the fact that the act of 
vaccination might, under certain circumstances, lead to the intro- 
duction of another morbid product than that intended, into the sys- 
tem. Taking this as his text, the author proceeds to give a hasty 
review of the subject of vaccino-syphilis, and the epidemics thus occa- 
sioned, giving to Dr. Joseph Jones, of Nashville, Dr. James Bolton, 
of Richmond, and Dr. Thos. F. Wood, of Wilmington, the credit of 
fully presenting the subject to the American public. There are no 
original observations of the author, the chief part of the paper al- 
lotted to the subject proper, being merely an exposition of the cases 
illustrated in Mr. Hutchinson's plates of vaccination syphilis re- 
cently issued. 

Voss (12) inoculated three prostitutes with the milk of a woman 
affected with papular syphilis, who suffered also from moist mucous 
papules of the anal and genital regions, the mammary glands 
being free from disease. A syringeful of milk expressed from one 
breast was injected into the tissues of each prostitute by means of a 
Pravaz syringe. One who had been previously syphilitic suffered 




CONGENITAL AND INFANTILE SYPHILIS. 371 

no incon\'enience. The second had urethritis, and was not affected. 
Tl>e third was a young girl sixteen years old, free from syphilis, 
who was injected on the eleventh day after her admission to the 
hospital. The inflammation and local suppuration excited, subsided 
in one week, but forty dap after the inoculation, papules were de- 
veloped around the site of the inoculation, and in Are days 
maculo-papular syphilides appeared over the body with concomitant 
adenopathy, these symptoms disappearing under the influence of 
mercurial inunction. 

13. Barlow, T. — Gummata in cranial nerres and changes in 
vessels in congenital s}-philis. Path. Soc. London Lancet, p. 645, 
May 5, 1877. 

14. Barlow, T. — Phlegmonous syphilides. lancet, Jan^ 1877, 
p. 16 (.\m. reprint). 

15. Barradough, O. — On hereditary syphilis and the contagi- 
ouH diseases act. Med. Times and Gazette, Sept aj, 1876, p. 

34<)- 

101 Berger. — Coi^^enital syphilis. Report to the SociA^ 
M^ic. du VI'. Arrondissenent. Gazette Obst^, Jan. 5, 1877, 
An. 6., No. t, p. 13. 

17. Carre. — On the keratitis of Hutchinson. La France 
M^dic, Nos. 13, 14, and 15, Feb. 14, 17, and ai ; 1877, pp. 98, 
\(ii<, and 115. 

18. Drysdale, Chas. R. — Observations on hereditary syph- 
ilis. The Doctor, Feb. 1, 1877, p. 39. 

19. Faure. — Syphilis of new-bom children. Gazette des 
Hfipit., P- 33*. April la, 1877. 

30. Foamier, A. — Syphilitic nurses and nurslings. L'Union 
M^dic, Xos. s> and 58, May 5 and 19, 1877, pp. 733 and 805. (i 

ai. Gaerin, A. — Suspected vaccinal syphilis. LITnion MMic, 
No. 158. .Nov. 23. 1S76, p. 793. 

aa. Guntz, J. E. — Six cases in which fathers affected with so- 
callod Litent syphilis, produced children who were and remained 
healthy, the f.xthtTs afterwards exhibiting fresh symptoms of syphi- 
lis, without reinfection. Vjcrteljahrschft. f. Derm. u. Syph., 1876, 
Hft. 10, p. 526. 

33. Howard, Warrington. — Epiphyseal disease from a case 
of inherited sj-philis. Path. Soc. of London, Lancet, May 5, 1877, 
p. 646. 

34. Hutchinson, J. — Ginical remarks on a case of deafness 
in connection with heredito-syphilis. Med. Times and Gazette, 
Jan. 16, 1S75. 

35. Hutchinson, J. — The types of syphilitic teeth. Half 
Yearly Compend. of Med. Sci., Jan., 1877. 

36. Infantile Syphilis. — Case. Reports from Bellevue Hos- 
pital, N. Y. N. Y. Mea. Record, No. 337, April 21, 1877, p. 
146. 

37. Jacob, E. H. — Hemiplegia from inherited syphilis. Case 



372 DIGEST OF LITER A TURE ; 

treated in the Leeds General Infirmary. Med. Times and Ga- 
zette, No. 1399, ^o'- !•' i^77> P- 4'8- 

28. Mason, Osgood. — Cases bearing on some doubtful points 
in the history of syphilis. N. Y. Med. Record, No. 316, Nov. 25 
1876, p. 761. Southern Med. Record, Mar. 20, 1877, Vol. VIL, 
No. 3, p. 60. 

29. Monti, Alois. — Clinical lecture on hereditary and congeni- 
tal syphilis. Report Phil. Med. Times, No. 246, Vol. VII., p. 337 

30. Parrot. — Clinical lecture on Diseases of Children. He 
reditary syphilis. Le Progres Medic, No. 19, May 12, 1877, p. 365 

31. Review of The Debate on Visceral Syphilis at the 
Pathological Society of London. The Doctor, April i, 1877. Vol 
IV., No. 7, p. 82. 

32. Taylor, Frederick. — On phlegmonous syphilides. Lon- 
don Lancet, April, 1877, p. 176. (Am. reprint.) 

33. Visceral Syphilis. — Editor of the N. Y. Med. Record, 
Feb. 24, 1877, No. 329, p. 121. 

34. Zeissl. — Late hereditary syphilis. Centralbl. f. d. Med. 
Wissen., April 21, 1877. 

Barlow (14) reports the case of a boy, ten weeks old, who 
had snuffles, desquamation, mouth lesions and maculae of the trunk. 
On the temporal regions, upper lip, front and back of the belly and 
thorax, thighs and dorsal surface of the right big toe, were numer- 
ous marble-sized, subcutaneous furuncles, without red areola;, con- 
taining laudable pus and having no " core." On the nates were 
fluctuating tumors as large as a chestnut ; clean cut ulcerations had 
been the sequelae in two places. There was also adenopathy, with 
hepatic and splenic enlargement, and great debility. A cure was 
eflfected under the administration of mercury internally, and cod- 
liver oil locally. These were more acute lesions than the " Scrofu- 
lides phlegmoneuses " of Hardy ; also no nodular masses could be 
discerned as in gummata, though (as stated) ulceration occurred 
in ten places. Hence the name prefixed to the article. 

Berger (16) reported the case of an infant, two months old, 
presenting two small fluctuating tumors in the sheaths of the exten- 
sor tendons on the dorsal aspect of the right hand, at the metacar- 
po-phalangeal articulation and the wrist. These were succeeded 
by mucous patches of the throat, tonsils and fauces, which yielded 
to mercurial treatment, and were followed by a general eruption of 
pemphigus. Finally, papular syphilides appeared on the verge of 
the anus. The reporter called attention to the peculiar sequence 
of symptoms of the different stages of syphilis — a sequence occa- 
sionally noted in acquired syphilis. 

Carre (17), after enumerating the symptoms of interstitial 
keratitis described by Hutchinson as occasioned by hereditary 
syphilis, including lesions of the choroid, teeth, tympanum (David- 
son), lips, laryngeal and nasal passages, proceeds to describe the 
reaction apparent in the writings of such Continental authors as 
Mooren, Panas, Dolbeau, Perrin and Beau, who pronounce either 




I 



CONGENITAL AND INFANTILE SYPHILIS. 373 

against the connection between the ocular and dental lesions or 
against their syphilitic origin. He names GiraudTcuion and Dd- 
ma.'qu.iv, as accepting the views of the English school. 

Carre announces the interesting fact, that 24 of Hutchinson's 
64 observations had lesions of the iris ; and legitimately concludes 
that in iii.tiiv of the others iritic symptoms may have been obscured 

by ' ■ ;■.... -f '■'■•cyri, the well ' •■;ude of the iris 

for idealization^. to a suspicion 

of t; at in syphilii and it is sug- 

ge>.;nl ;h.i: i;..a nuiy form an important element in deciding ques- 
tions as to the etiology in certain cases. Carr^, however, is 

in -•■'■•• "' ••• .....,>,■■>,-...: .K., ti... I'v^^iish author does not claim 

th :■ iilis by the teeth alone ; for 

Hu I'V sqmc teeth he "would 

swc ir." lis the case of a child 

13) ears iiid exhibiting lesions 

of the c ^ ^>; •'-" i'-ris, which 

went on t ^ide, for 

which iri<! tseof the 

eye rity of unu^ual degree. 

iS) observations are founded upon two ones 
of ! which he reports. In the first, there was a 

»< : s}-philis in a woman aged 36 years, where 

k< - . vene till the age of 30. A mother had disease 

I't ti: ' ' at 16, and a sister at 20. The father possibly died from 
sy[il lll^ rif the brain, and the mother lost eight of eleven children. 
In tli^' src'ond case, an infant aged four months had syphilodermata, 
snutii.'^ and anal mucous tubercles. The mother, aged 30, was 
^ucl>;Iln^ this her third child, the two former having died a week or 
so atter birth. She had not a symptom of syphilis, and had always 
enjoyed excellent health. The husband was dissipated, and had 
had, as reported, disease of the bones. 

This leads the author to adroit that he had for some rears been 
a convert to the theory of Cullerier, believing, as he did, that if it 
were at all common for the male parent to contaminate his off- 
spring withoot the mother becominf affected, hereditary syphilis 
would become much more frequent than it actually is. 

But he is reminded bv the writings of Kassowitz, of Vienna, and 
R. W. Taylor, of New York, that he has certainly seen not a few 
cases in which there was really no \ n e tp<4tfiSnv/- obtaina- 
ble, that the mother of the heredit c infant had in any 
wajr suffered from the disease. (I ire his.) 

Still he finds difficulty in accepting the views of the writers 
named, and thinks in practice it is well to remember that Cullerier's 
law is a very near approximation to the truth, maternal s}-philis 
being often an insignincant disease and one readily overlooked. 

He concludes by admitting that it seems quite possi ;le that 
fathers may transmit s}-philis to their offspring without affecting 
the mother, but that numerous fallacies have to be taken into ac< 
count in statistics like those of Kassowitz, drawn from public char- 
ities and not controlled by the most careful observations. 



374 DIGEST OF LITERATURE ; 

Faure (19) happened to inspect an infant brought to a nurse 
in order to relieve her distended breasts. The child was found to 
be manifestly syphilitic, and due precautions having been taken, in- 
fection did not result. But the author takes occasion to point out 
the possible consequences to others from the single application to 
the breast of an infant thus affected. 

FouRNiER (20) admirably delineates the line of conduct to be 
pursued by the conscientious practitioner, confronted with a syphilitic 
child at the breast of a nurse, who (a) as yet has not contracted 
the disease from it ; or (b) has already become infected. The prob- 
lems are studied both from their bearing on the present and future, 
not only in cases where the nurse refuses to discharge her duty 
further, and demands pecuniary indemnification for damage, but also 
when she persists, in her ignorance, to suckle the child. We have 
heretofore presented a full abstract of this lecture from a clinical 
report. 

GuERiN (21) presented to the Academy of Medicine a little 
patient who had been vaccinated nine days after birth — seven 
weeks prior to date. The immediate results of the vaccination had 
been quite normal, the vesico-pustules becoming well developed. 
On the eighth day, the virus from the latter had been employed in 
the vaccination of an elder brother, in whose case the evolution of 
the disease had been entirely regular. 

In the case of the first child, however, deep ulceration had oc- 
curred, at the three sites of inoculation, with indurated edges, quite 
suggestive of indurated chancre ; but the corresponding lymphatic 
ganglia were not engorged. On the same arm, however, was a per- 
fectly cicatrized periostosis. The difficulty was shown of establish- 
ing the influence of syphilis in a case which exhibited tertiary 
symptoms after a few weeks, without the occurrence of symptoms 
intermediate between these and the primary lesion. The reporter 
consequently assumed the phenomena to be manifestations of the 
strumous diathesis in a infant vaccinated very early after birth. 
Gubler added that he had seen many such cases in the Maison 
Municipale des Nourrices, and in the Maternitd, resulting from 
vaccination at an early age (one day after birth). The absence of 
the color of raw ham was also noted in this instance. 

GuNTZ (22) admits the fact that men formerly syphilitic may 
become fathers of children who are infected with the parental 
disease, and afterwards of those who are apparently healthy. 
This fact seems to support the view that the syphilis of the father was 
either cured or existed merely in the encapsulated centres of some 
authors, the results of specific treatment pointing in the same direc- 
tion. But the author considers the theory of latent syphilis an 
" arbitrary hypothesis," without foundation in fact. The pathologi- 
cal anatomy of glands, with ducts whose lumen is unobstructed 
(when not actually inflamed and therefore plugged with disease 
products), is opposed to the theory of glandular encapsulation, as 
it points to an uninterrupted career in the process of disease. 
Symptoms occurring after so-called latency, indicate that there was 




CONGENITAL AND INFANTILE SYPHILIS. 375 

no cure, but merely interruption in the chain of external manifesta- 
tions. The function of glands is continuous — and not occasional 
in its results. Syphilb may exist without externa! manifestations, 
and even without (glandular complication, in such a condition of 
activity .!-• - ■ ' '•' ' '" v ' . '-■''• ..illy 

the soif > of 

paternal lose 

cases where the ireatiiiciit ut tiit: Ullier only en»urc:> fuvixublc re- 
sults, while the untreated mother may beget healthy children by 

an- ■' ' ';''•• products given up •- ■'■ ' •■ ■ '■; of 

til ised organs are \\\ ■■ to 

th .. htitiK swept mccli - uJs, 

c ^-n. It is therefore nut lu be concluded 

t)i iscd, less diseased and finally healthy 

cliuui^ii 1^ < 1^. 1 •>! latent" disease on the part of the male 
parent. Thoui^li in general this succession may be deemed of 
fa\or,i!.!f irui" :'. ^-'i!! t tic sword of Damocles rem.uns suspended 
v. -her and child. ' "gcd and 

c:; iren, with such at. d report- 

ti; ...111 ut iegarded as conrhi, '■■-trent 

.1; o is no safe criterion of c'l'. >■ !: ■ es, 

til '. to uninterrupted disease (>::.'' pT.; .isc 

iti mptoms may be wanting, save that t off- 

^i ricnce has demonstrated that even t of 

til' L.. ...uy co-exist with the procreation of ■>«....... c...,.Ucn. 

< >r.,- Ills not niacroscopially disordered, nuy be foci of disea.se for 
lilt interchange of nutritious and waste matters, an interchange 
which is necessarily continuous and simultaneous in all organs of 
the body. There is no fixed limit between health and disease. 

'fK.. oMfi.of'j cases are urged in illustration of the foregoing 
s: id he concludes with the suggestion that many sus- 

lik' .iiate disorders of the skin in infants and older chil- 

dren, iiity be made to yield to appropriate anti-syphilitic treatment. 
&fR. HirrcHiNSoN's (14) clinical remarks were suggested by a 
young w'>">>" ■■• i-»ars of age, having •►"• '-••'»» mfl i»yiv>t,,..i>omy 
of here'' >, absolutely deaf : nal 

feaftirp ' ,-rce of surdity. 1 i^es, 

i^ i: tended by ii lin, 

(ii ons. As r > "ws 

b); > I :hout pain or l.,.- - . ....lam- 

mation, so the aural symptoms may dcfwnd upon obscure changes 
in the auditory nen'e. No postmortem examinatioits have ever 
br inherited syphilis sur\ivlng the period of 

t). icious of life. In syphilitic deafness the 

niL i.f no decided value. In a minority of 

ca.ses, |< v and permanently deaf ; in others, 

the fun. , d ; in a third group of cases, al- 

-ult^. Tliough it is not clear that treat- 

ii the relation of cause and effect, it is 

, . caution, never pushing it to such an extent 

as to produce depression. 



376 DIGEST OF LITERATURE ; 

The third of the Bellevue Hospital cafes (26) was that of a child 
aged two years, exhibiting a tubercular syphiloderm, double perios- 
titis of the tibiffi, and cachexia, first affected at the 3d month, and, 
subsequently, well illustrating the efficiency of sound treatment. It 
served as a text for the visiting physician (who was evidently a 
disciple of the Ecole du Midi), inasmuch as, although the mother 
had never exhibited the slightest evidence of constitutional syphilis, 
yet because she had given birth to a syphilitic child, she was ad- 
judged to be infected. He therefore dwelt upon the question of 
unrecognized syphilis in mothers (" imperceptible syphilis " of 
Diday), but did not explain why the behavior of the disease was, 
in such cases, so exceptionally different from that universally rec- 
ognized as classical. 

The case reported by Jacob (27) was that of a sixteen-year-old 
girl, ailing for six months, and having an obscure previous history. 
There had been cervical adenopathy, and one month before admis- 
sion to hospital, she had suddenly lost power in the left side. Two 
months before, sudden deafness supervened. 

On admission, she was found greatly emaciated, forehead low, 
occiput raised, nose flattened, teeth specifically altered. Intersti- 
tial keratitis had completely destroyed vision on the right side, and 
partially on the left. Hearing was gone. The voice was harsh 
and low — she moaned as if in pain. There was partial impairment 
of sensibility of the left arm and leg, with complete loss of power, 
slight wasting of muscles, no facial paralysis, tenderness on percus- 
sion over lower dorsal spines (but no perceptible prominence in 
that region), cough without expectoration, deficient resonance and 
flattening of left apex, with moist rales universally, enuresis and 
mental hebetude. One month afterward, left hemiplegia also oc- 
curred, and she lay in bed completely unable to stir a limb. Treat- 
ment by the iodides, from May 22d to Oct. 4, resulted in such im- 
provement that she could stand and even walk with the help of an 
arm. 

Mason (28), d propos of Diday's Paper on " Syphilis by con- 
ception," reports the case of an apparently cured syphilitic man, 
the father of healthy children, who married a second time. The 
second wife first miscarried with suspicious symptoms, then had a 
syphilitic child, and, finally, in the second month of the next preg- 
nancy, showed symptoms of syphilis, the father, at the same time, 
suffering from a fresh explosion of that disease. A case is also re- 
ported, from details furnished by Dr. Loomis, of New York, in 
which a syphilitic father married a healthy wife, and had two 
healthy children. Then the wife miscarried with an infected foe- 
tus, the husband suffering from a relapse and the wife from symp- 
toms of constitutional disease. Then followed pregnancy and mis- 
carriage, with periosteal disease, pachymeningitis and paralysis 
of the mother. The argument is that, as the maternal syphilis did 
not occur till after the inception of pregnancy, therefore it resulted 
from the latter. We remark of such cases, that they serve mere- 
ly to establish the possibility of infection within certain periods of 



I 



CONGENITAL AND INFANTILE SYPHILIS. 377 

time, and that the explosions of paternal disease might be effect- 
ively used as an argument on both sides of the vexed question. 

Monti (29) sketches the macules, papules, pustules, coryza, 
condylomata and ulcers of hereditary syphilis. He adds that 

sp' ' at birth is a constant phase of the disease, a state- 

ni certainly incorrect It is probably true of one half 

ot a ' cl cases. (For exception, cf. post-mortem lesions in 

case examined by Parrot, Lyon Midual, Feb. 6, 1876, p. 313.) 
Monti is also at variance with other obser\'ers in recognizing 
rat hitis and scmftilosis as sequclx of hereditary s)'pbilis. In the 
«.i\ "I :h : ;;i . he recommends calomel, ferric lactate, ferric 
i'xii'I'j, l>i'.h^ "t ' >rrosive sublimate, and, as local applications 
io'ikI.I 'III i;.i. .\ red precipitate and lime-water, with mercuric 
l)i(lilMn'!( . Ill tic rules are also given which, in particular, 
fiii.iiii the avuiiiaiice of the stirr'-— ••■' •'— •■-- of soups at the 
thiri! .\iid fourth month — the b^.■^• i the lecture. 

I'akrut (30) finds the study ' 1 lis of special in- 
terest, because it may be conducted fruiu tiic inception of the 
dbeaae, and declares that tlie latter is neither congenital nor in- 
fantile ^yphi!!-;. '•■• -• •••••1 - ■■' the newly-bom, but is strictly 

iiihtriti ! !i i:ii He gives a brief risume 

of !hr rrs'- ir . iding the authors upon the 

■-111,'.-, t in: .;.■.■.- ^ , 14 til'- n lines of Gaspard, 

■| '^r.i':, I ,ri ! M i-iii ■:.;.;■■.■:. T :; : '■ .,' I I'i v . ;>, Aitgier Ferricf, 
K. ;h1' ■' :. Ami )ru>c I'ari.', R^>.vcii, Malioii aiui iJcilin. 

Ilk 1 1 1 , I > ale's Kniew 0/ the Dtbate at the Palh^gUat Soeidy 
of /..■'!. i."i. I ; I ) contains a note of his own report of the case of a 
girl, aged 16 years, the subject of inherited syphilis. She had 
tracheal stenosis, destniction of the soft palate, and a large 
phagedenic ulcer on the lower extremity. This girl had cavernous 
breathing, cavernous riles and bronchophony in the supraspinous 
fossa of the left side. All these symptoms yielded to the potassic 
i(xli<lc. He also refers to Lancereauz's case of a woman, aged 
f'irty. with peculiar teeth and other symptoms of berediury svphuis, 
in whose right lung there was a large cavity oocupyine all three 
lobes. The apex was found crepitant, and no trace of tubercle was 
discovered, many parts of the lung being indurated. All this was 
adduced to show that true syphilitic phthisis did occur in heredi- 
tary syphilis. 

Dr. Greenfield also reported a case of recognized syphilitic 
pneumonia in a newly-bom child. 

Taylor (33) supplements Barlow's observations, given above, 
by describing similar lesions in two cases of congenital s)-philis 
treated by him in the Evelina Hospital. Inflammatory- globular swel- 
lings, in these cases, discharged a thick, green, ropy pus and healed 
with small cicatrices, strikingly different from boils or gummata. 
From a few, " black blood " escaped, others were resolved. He 
quotes Bouchut (Gaz. dcs Hopitaux, Aug. 1, 1876), who describes 
sm.ill, hard, subcutaneous nodules, softening but not bursting for 
months, and then giving exit for a long time to a scanty yellowish 



378 DIGEST OF LITERATURE; 

sanious pus, through a livid and fistulous opening. Taj'lor's cases 
were evidently affected with congenital syphilis, but the phlegmon- 
ous syphilides, after exit was given to the pus, healed more readily 
than those described above. 

The article published as an editorial in the New York Medical 
Record (33), is evidently from the pen of an expert. On the ques- 
tions relating to the pathology of visceral syphilis in the hereditary 
form, reference is made to the enlargement of the spleen exhibited 
by Dr. Barlow, traceable as low as the crest of the ilium. The 
child had been observed since its fourth month, when the splenic 
disorder became evident with the usual symptoms of the disease. 
A systolic murmur was audible at the cardiac apex and as far as the 
axilla. According to Gee, the splenic involvement occurs in one 
half of the cases, one fourth of which terminate fatally. Little is 
known of the lesion. Capsular thickening has been noted, without 
lardaceous or gummatous changes. Reference is also made to the 
specimens exhibited by Gowers, from a twelve-year-old child affect- 
ed with hereditary syphilis. These were two coalesced nodules, 
springing from the dura-mater, composed of rounded, nucleated 
cells, ^000 to Yiooo of an inch in diameter, with fusiform cells 
and delicate fibrillary stroma. 

A description is also given of Barlow's specimens from a female 
infant seen by him, having snuffles, but no rash, though the father 
was known to be syphilitic. He learned three months later that 
the child had had convulsions, and he noted wasting and serpigin- 
ous symmetrical syphiloderraata. Later it had laryngitis and con- 
tractions of the feet. In the fundus of each eye, were specks of 
brownish exudation in the choroid. Post-mortem, the thoracic and 
abdominal viscera were found normal, but in the skull were adhesions 
of arachnoid and dura-mater, with some greenish lymph. The pia- 
mater was thick and fibrous, and in some places, its vessels were 
thickened and appeared like white threads. There were no granu- 
lations and but few superficial spots of softening. Examination of 
the choroid membrane by Mr. Nettleship, showed collections of 
corpuscles in the chorio-capillaris, not arranged around the vessels. 

" These growths in the choroid differ from tubercle, in not being, 
like it, of peri-vascular origin, and in not showing a tendency to 
caseation, as the latter does. In the pia-mater there was a great 
excess of fibrous tissue, and a diffuse infiltration of nucleated 
lymphoid cells, while the vessels showed a growth in their inner 
and middle coats of such extent as to nearly occlude them. When 
they become thus occluded, new vessels develop in their structures." 

35. Ambrosoli, C. — On the use of tincture of tayuga of the 
Ubicini brothers. Case of infantile syphilis. Gazz. Med. Ital. 
Lombard., Ser. VII., T. III., No. 49, p. 481. 

36. Daniel. — On the influence of anti-syphilitic treatment on 
the mother, and on the product of gestation. Thbse de Montpellier, 
No. 74, 1876. (Gazette des Hopit., p. 359, April 19, 1877.) 

37. Faraoni, M. L. — Tayuga in syphilis and scrofula. Re- 



I 



SYPHILIS OF THE MOUTH, THROAT, ETC. 379 

port to the Medical Congress in Turin, Sept. 18-33, 1876- S. 
Aluggiani & Co., Milan, 1876. 

38. Gallassi, R. — The tincture of tayuga of the Ubicini bro- 
thers. Giorn. Ital. d. Malat. Vener. e. d. Pel. Oct., 1876. (Gazz. 
Med. Ital. Lombard., S. VII.. T. IV.. p. 481.) 

39. Ilanor, Carl Sigmund von. — On new methods of treat- 
ment in syphilis. 4to. Urban und Schwarzenberg. V'icnna, 1876. 

40. Johnson, G. K. — Preventive treatment of congenital 
syphilis. Detroit Med. Journal., p. 344, May, 1877. 

41. Longhi, G. — The tincture of tayuga of the Ubicini bro- 
thers. Oazz. .Med. Ital. Lombard., S. VIU T. IIU No. 48, p. 471. 

AMnRosoLi (45) treated a child, two years of age, who had been 
inftctcd with syphilis while at the breast It had syphilodermata 
Miiii iti;4uinal .iiul corvic.il adenopathy. A gramme of the tincture 
of t.ivuga wa.s injected hypoderroically. No reaction ensued, and 
the therapy was successful. 

Faraoni (37) has collected the records of those Italian physi- 
ciiiis who have treated syphilis and scrof ' the tayuga 

tiiKturc. As regards hereditary syphilis, he os report- 

c< ; [.onuhi aiM Ambrosoli, and adds two < loned in a 

1' I'rof. Belluzzi of Bolognx On« dtild lud purulent 

c .ind vesicular syphilodermata ; the other suffered from 

UKci.i::\ < : sions of thc mouth and external genitals. The results, 
in each c.ise, were quite doubtful so far as regards the value of the 
medication. 

JuHNSuN (40) reports two cases, in each of wh: it of 

the pregnant wife was followed bv the birth of h ^rcn, 

though ' •■•' -'n were diseased. The remcdio iiniJimeu were 

blue til i liichloride and the potassic iodide — the two last 

wi.-rc ^;i'. :k. 

I.oNGiii ^41^ treated a child, three months old, infected from 
the hreast of a nurse, having papular syphiliilcs of the mouth and 

K' ' >ic hundred an(f futv drops of dilute tincture of tayuga 

\^ > 800 grammes of water, and three teaspoonfuls of 

ti. en daily, the solution being also applied locally to tb« 

Icsioiu. A rapid cure is said to have resulted. 



SYPHILIS OF THE MOUTH, THROAT AND LARY.N.X. 

CEORCK M. LXrrUtTS, 11. D. 

I. Chauval. — Syphilitic caries o( the ethmoid bone, purulent 
infiltration of the anterior lobes of the brain. Bull, de la Soc. de 
Chir. Paris, p. 714, 1876. 

a. Cripps. — A case of fcetid discharge from the ikmc (s}-phi- 
litic ozcena), treated by a new operation. London Lancet, May 5, 
1877. 



38o DIGEST OF LITERATURE; 

3. Fournier. — On tertiary syphilitic glossitis. La France 
Mdd., Aug. 26 ; Oct. 7-14 ; Nov. 15-22-29 ; Dec, 2-9, 1876. 

4. Hausen. — .4 case of paralysis of the abductor muscles of 
the vocal cords, of syphilitic nature — cure. St. Petersburgh Med. 
Wochensch. No. 6, 1876. 

5. Hugonneau. — A clinical study of interstitial syphilitic 
glossitis. Gaz. Hebdom., p. 173, March 16, 1877. 

6. Martel. — On laryngeal syphilis. Thfese de Paris, No. 59, 
i8j7. Le Progres Mdd., p. 216, March 17, 1877. 

7. Mauriac. — On naso-pharyngeal syphilis. L'Union Med., 
March 22-29 '> -April 26. Continuation of Feb. 24. March 1-13, 
1877. 

8. McDowell. — Tracheotomy and its advisability in certain 
forms of syphilitic disease. Med. Press and Circular, p. 243, March 
28, 1877. 

9. Symian. — .A. contribution to the study of tertiary s)^hilis of 
the larynx. Thfese de Paris, No. 17, 1876. 

10. Tauber. — Ozcena syphilitica. Cincinnati Lancet and 
Observer, Dec, 1876. 

11. Von Vajda. — Sarcoma of the nose in a syphilitic subject. 
Wiener M^d. Presse, March 18, 1877. 

12. Verneuil. — A case of adhesion of the free border and the 
postero-superior aspect of the velum to the posterior pharyngeal 
wall, the result of syphilitic ulceration. Operation, improvement. 
Bull, de la Soc. de Chir. de Paris, Tome IL, p. 308, 1876. 

13. 'Wagner. — On syphilis of the nose and larynx. Ohio Med. 
Surg. Journal, June, 1876. 

Cripps' case of syphilitic ozcena is as follows : A. B., aged 30, 
struck the bridge of her nose five years ago in falling. The nose re- 
mained tender and swollen for two or three months, and the Jiasal 
passages became so much obstructed that she was scarcely able to 
breathe through them. Six months after the injury a fcetid dis- 
charge commenced. At the time of examination the nose was 
flattened, and both nostrils reduced to little more than pinhole 
apertures. The soft parts between the nose and upper lip were 
deeply ulcerated, and the foetor arising from the discharge was be- 
yond all description. The probe, introduced with difficulty, detected 
no dead bone. Ordered to take full doses of iodide of potash and 
wash out the nasal cavities with Condy's fluid. Two and one half 
months later, as dead bone could be felt with the probe and the pa- 
tient was anxious that something should be done to relieve her, she 
was operated upon by drawing up the upper lip and nose together with 
the soft parts forming the anterior portions of the face, after liberating 
the former by an incision between it and the upper alveolar process 
of the jaw. The nasal fossa were thereby thoroughly exposed, and a 
large quantity of dead bone, which could both be seen and felt, 
was easily removed by the finger and forceps. The operation was 
completed by replacing the lip in its natural position. The wound 
healed by first intention. All discharge ceased, the ulcerations heal- 
ed, and the fcetor entirely disappeared. 



I 



SYPHILIS OF THE MOUTH, THROAT, ETC. 381 



The doctor remarks that this method of operating is of the 
greatest importance and value, and would seem justifiable in cases 
of ozxna which, according to recent observations, are dependent in 
a large majority of instances on a sequestrum or carious portion of 

bo!- - " ' imination fails to detect it. 

his interesting paper, states that the question as 
t> t performing tracheotomy in syphilitic disease 

of the loxynx often becomes one of life or death, and that no class 
of cases arc calculated to cause more anxiety to the surgeon, and 
in cerTnin instances to require more vigilant treatment. He has 
inr: u,:!i •■.v.. :--i;ces of death as the result of laryngeal spasm 
< u -< il l.y li. ^ini. tivc syphilitic ulceration extending down to the 
I ir; n\'. and in the face of such experiences does not doubt but that 
( .^^!•■, .irc met with in which tracheotomy becomes a positive ne- 
cr.- ■ I., ^'ipport of hi!i position he quotes Bryant as saj-ing, that 
N« : '■ has commenced and seems to be unaffected by 

Ct nt. the subject of tracheotomy claims serious con- 

si ^^ the organ of voice and respiration can be kept 

(|: t go on. As long as progressive ulcerative 

div._ .. .Jen spasm of the larynx i« >mm;n..nr. and also 

the death of the patient. The operation should. !y be un- 

dertaken when the disease is steadily progress of treat- 

ment, and it is clear (hat the larynx will be destroyed .is a vocal as 
well as a respiratory organ, unless some steps be taken to stop its 
progress, and of these steps there are none equal to tracheotoror ; 
for .ill surgeons are familiar with the fact that even under the 
nio^t extreme conditions of disease repair goes on in the larvnx 
dinxtly the tube has been introduced and physiological rest is given 
to the organ. Hilton, speaking upon the same subject, expresses 
himself as follows : In chronic laryngitis cured by tracheotomy, the 
cure is not effected by opening the larynx but by giving the larynx 
rest. The operation is performed in reference to these two circum- 
stances, in reference, first, no doubt, to securing the continuance 
of life by allowing the patient to breathe through the tracheal tube ; 
secondly and ulteriorly, the object is to give rest to the diseased 
part. In the performance of tracheotomy for disease of the larynx, 
the surgeon never touches the disease at all, he merely enables 
the patient to breathe through the tracheotomy tube and diverts the 
stream of air away from the larynx, thus giving the latter an opportu- 
nity of recovering itself. 

In conclusion, McDowell states that the two forms of s}-philitic 
ulceration of the larynx in which tracheotomy is called for, are 
either of the phagadenic or serpiginous t}'pe, and that a distinction 
must be drawn between them. The former is much the most common, 
and will be found to pronounce itself generally in naturally weak 
and broken-down subjects. It is rapid and destructive in its pro- 
gress, after eroding the cartilages of the lar}-nx. It requires active 
local as well a% general treatment. The margin of this form of 
ulceration is sharply cut, and there is no surrounding thickening 
of the tissues. The serpiginous form, on the other hand, most com- 



382 DIGEST OF LITERATURE; 

monly occurs, when it does present itself (which is rarely), in 
strong, healthy individuals, and is much slower in its progress, and 
carries before it an effusion of specific lymph, its edges thickened, 
irregular, and of lupoid character. It is in the phagadenic that 
large doses of iodide of potassium and iron, combined with opium 
and liberal diet, will prove most serviceable. In the serpignious 
form of ulceration, the best results are to be obtained, he believes, 
from the judicious administration of a carefully sustained course of 
mercury. 

In regard to the pathology of laryngeal spasm, he regards it as 
being caused, in the phagadenic variety of ulceration, by exposure 
of the recurrent laryngeal nerve ; whereas in the serpiginous it is 
probably the result of pressure upon that nerve, or of pressure and 
ulceration combined, as sometimes happens in cases of malignant 
disease. 

Dr. Von Vajda showed at a recent meeting of the medi- 
cal society of Vienna (11), a man, aged 24, who had had syphilis 
three times. Seven months ago he had a tumor as large as 
a pigeon's egg on the septum nasi. It was supposed to be a syph- 
ilitic gumma, especially as there were nodes on the tibiae and other 
indications of syphilis. About two months since (after an absence 
of two months) the patient returned. The swelling was somewhat 
smaller, but was covered with numerous fungoid excrescences as 
large as hempseeds, which bled readily. Careful rhinoscopic examin- 
ation showed that the tumor could not be defined sharply posterior- 
ly; and the microscope showed that its substance consisted of 
small and large round cells, along with some spindle and giant 
cells, with numerous nuclei. Some of these cells had undergone 
mucous degeneration like that observed by Wagner and Virchow 
in gumma. The doctor diagnosed the tumor as a sarcoma, atid Doctor 
Heschl confirmed the diagnosis. He pointed out the difficulty of 
diagnosis in such cases, and remarked that in gumma the connect- 
ive tissue elements rarely showed signs of proliferation, also that in 
malignant growths the cells, and in gumma the inter-cellular sub- 
stance, were the chief seats of mucous degeneration. 

Verneuil reports the following interesting case (12) : The 
patient was a young woman, married, 22 years of age, who had 
contracted syphilis since her marriage, and about a year afterwards 
had suffered great loss of substance of the soft palate, which 
resulted in a nasal tone of voice and painful and imperfect degluti- 
tion ; after a while the projection of the velum posteriorly became 
evident, and there were all the signs of closure of the posterior 
cavity of the nasal fossae : the patient could not blow her nose or 
breathe unless the mouth were open. She had intermittent deafness, 
and examination showed that the velum was completely fastened 
to the pharyngeal wall. Verneuil decided to operate, and pro- 
ceeded as follows : The patient was anesthetized, and the channel 
which remained between the pharynx and the rfasal fosste was 
enlarged by the knife. A pair of polypus forceps was then intro- 
duced and their blades strongly opened, while the lateral adhesions 



i 



SYPHILIS OF THE MOUTH, THROAT, ETC. 383 



were broken down by means of the fingers. He then placed 
between the velum and the pharynx an india-rubber apparatus 
consisting of two lateral tubes, and of a series of transverse smaller 
ones, the anterior openings of the larger tubes passing out through 
the nostrils and the posterior through the mouth, opposite the 
labial commissures ; but it was found necessary to remove the 
instrument, as after some days specific ulceration showed itself 
wlicrcvcr it was in contact. Vemeuil had then recourse to pro- 
gro-^ive dilatation by means of a sound ending in a rubber bag, 
which was introduced by the nostrils and inflated. By repeating 
this process daily, it was hoped to prevent adhesions forming ; but 
the negligence of the patient frustrated the perfection of the idea ; 
ne\ erthe^ss a sufficient aperature was fonned, by means of which 
the (i.itient could breath and blow her nose, the sense of smell 
V ' - '. the nasal character of the voice was noticeable only 

(i Iterances and in a loud tone. 

- subsequent discussion of the case, Championni^re 
rctn^kcd that on a similar occasion he endeavored to introduce a 
hollow sound from behind forwards, but after a two hours' attempt, 
being unable to do so, he made lateral incisions to effect his object, 
but notwithstanding the employment of india-rubber laminc, 
adhcMon still took place. At a second operation he cut down with 
a sin};lo stroke into the nasal fossae behind the velum, the wound 
hciKil. but the patient had been forced to wear a silver tube 
t!r '• •'— "isal fosse. 

-i>eaking of secondarjr syfkUis of th* mou (13), says, 
t!i r symptoms of syphilis existing, or a denr history of 

tli<' i.!.>c.i:>c in the individual, the diagnosis is e,i )iut 

wiihiiut these, there is nothing that will enable ii~ ice 

upon the true character of any given case. To expl ., he 

remarks that the discharge, thickened raucous membrane, super- 
ficial ulceration, pain, etc., are precisely what you find in ordinary 
catarrh or struma, and in such cases if proper local treatment had 
been previously tried for a reasonable length of time, without good 
result, he would then put the patient under specific treatment. He 
has done this in a large number of cases in which the history of 
syphilis was extremely doubtful, and the good results therefrom 
convinced him that he had not erred ; he therefore asserts that very 
many of the obstinate cases of so-called nasal and naso pharyngeal 
catarrh are of specific origin. 

Sttondary syphilis of tkt larynx generally appears within a few 
weeks or months after the primary symptoms, simultaneously with 
the early skin and mouth affections, or later, but never precedes 
them. The subjective symptoms do not differ from those of an 
ordinary laryngeal catarrh ; among the objective symptoms, is the 
raucous patch, which the author in one paragraph says are <;<v<fx*M- 
olly obser\'ed, while in another remarks that the mucous patch will 
be found, in the largt majority of cases, to co-exist with others in 
the phar)nx or on the tonsils, tongue or soft palate. This latter 
statement is interesting in a view of the wide difference of opinion 



384 DIGEST OF LITER A TURE ; 

regarding their occurrence and frequency in the larynx, at present 
prevailing among observers. 

Tertiary syphilis of the larynx is characterized, according to our 
author, by extensive and deep ulcerations, appearing usually in the 
following order, ist. Upon the free edge and posterior surface of 
the epiglottis. 2d. Upon the vocal cords, and ventricular bands. 
3d. The arytenoid cartilages and inter-arytenoid fold. 

Finally, after summarizing the opinions of several writers upon 
the points in differential diagnosis between laryngeal syphilis and 
cancer and tuberculosis of that organ, and giving the results of his 
own observation, he concludes with the following statistics, regard- 
ing the frequency of the affections, considered in his paper. At 
the London Throat Hospital, 40-50 per cent of all cases treated, 
were syphilitic. At Guy's Hospital 40 per cent were syphilitic ; 
the laryngoscopic clinic at Vienna treated in 3 years 3,700 cases of 
throat disease, of these 120 were laryngeal syphilis. At Charity 
Hospital, Blackwell's Island, of 55 cases of constitutional syphilis, 
32 had tertiary symptoms and 23 secondary ; of the 32 cases of 
tertiary, 20 had laryngeal syphilis, and in the 23 cases of second- 
ary, 19. At the Metropolitan Throat Hospital, out of 1,000 
cases, 74 were syphilitic; of these 27 laryngeal, 21 nasal, and 26 
pharyngeal. 



DISEASES OF THE PENIS, URETHRA AND TESTICLES. 

E. L. KEYES, M.D. 

I Bourgade. — Diabetes as a cause of phymosis. Le Prog. 
M^d.*, Sept. 2, 1876. (New York Med. Record, p. 728, Nov. 11 

2. Demarquay, J. N. — Surgical maladies of the penis. Paris. 

A. Delahaye, 1877. 

3 Dittel.— Treatment of hypertrophy of the prostate. Central- 

blatt f. Chirurgie, Nov. 27, 1876. (Phil. Med. Times, Oct. 14, 

^4' Foot A. W.— Papilloma of the bladder with protracted 
hematuria. ' Brit. Med. Journ., Sept. 30, 1876. (Phil. Med. Times, 
p. 65, Oct. 28, 1876.) 

5 Griffith, G. De G.— New treatment for phymosis (by grad- 
ual dilatation, pushing the glans penis through the contracted pre- 
putial orifice). Brit. Med. Journ., Oct., 1876. (Half Yearly Comp. 
Med. Sci., p. 550, Jan., 1877.) , , ^ r ■ 

6. Johnson, J. T.— New (?) method of performmg circumcis- 
ion (slitting prepuce on dorsum and cutting off sides). Atlanta 
Med. and Surg. Journ., July, 1876. 

7. Lucas, R. C— Thrombosis penis. The Practitioner, p. 22, 

Jan., 1877. . , . . ,. , T „ 

8. Ory, E.— Treatment of preputial (genital) herpes. La 
France M^d., p. 21, Jan. 10, 1877. 



DISEASES OF THE PENIS, URETHRA, ETC. 385 

9. Ranke. H. Posterior catheterism. Deutsche Med. Wochen- 
schrft. No. 29, 1876 (Monthly Abstract Med- Sci., p. 567, Dec. 
1876). 

10. Roberts, J. B. — Exstrophy of the bladder ; new method of 
operating, etc. Phil. Med. Times, April i, 1876, p. jjj. 

11. StukowenkofT, N. — Case of urethrad calculus. Central- 
bkitt f. Chirurgie, No. 43, 1875. 

la. Taylor, Melville. — Fibroid tumor of prostate success- 
fully treated by injection of iodine. Virg. Med. Monthly, June, 1876. 

13. Walker, M. M. — Case of persistent priapism. Virg. 
Me<l. Moifhlv. p. 784. Feb., 1877. 

■'.■■■ rson, T. B. — Case of hypospadias cured by opera- 
til) .Monthly, p. 795, Feb., 1877. 

. I ) refers to the irritation produced by saccharine 
flui(is ii)Mm portions of integument with which they come into con- 
tact ivc-icular and papular eruptions seen upon workmen in sugar 
factories). He recounts four cases of pbymosis due to inflamma- 
tioa produced by the irritating action of saccharine urine upon the 
prapnce and glans penis. Vemeuil had seen two similar cases, and 
a surceon is alluded to who lost two cases upon which he operated. 
The deduction is, do not operate on phvmosis in any case of possi- 
ble doubt without examining the urine for sugar. 

DKMARQt'AV's posthumous work (i) is published by Voelker 
and Cry. It contains manv curious cases and much interesting 
matter, out is not quite so full in some particulars as it would have 
been had its author lived to finish it. It deals with 1, Physical 
l^siiins of the Penis ; », Inflammatory Lesions ; 3, Tumors and 
Ur;i.iii:i I.csions ; 4, Anomalies (including stricture of the urethra). 

l>irrr.L (3) has produced acute prostatitis and suppuration l^ 
the use of parenchymatous injections of iodine as advised by Heine 
for NostaiJc hypertrophy. 

KAT^iCE (9) brings the experience of another case of posterior 
catheterism to add to one previooslj published (from Volkmann's 
clinic I in So. 6, Deutsche Medictniache Wochenschrift. In the 
new case no guide would pass bv the urethra. The stricture had 
long been clMed and a catheter had been permanently established 
in the bladder through the hypogastrium. By this opening a firm 
flexible catheter was easily p.isscd through the prostate into the 
urethra and up to the posterior face of the stricture, rendering very 
simple the operation of dividing the stricture from without, an oper- 
ation which mighf otherwise have been attended by all the diffi- 
culties so well appreciated by those who have attempted external 
perineal urethrotomy without a guide. 

Robert (10) reports a case of exstrophy of the bladder from the 
service of Dr. Levis. The novelty of the operation consisted in an 
attempt first to establish drainage downwards by an artificial ure- 
thra leading from the base of the bladder into the perineum ; 
secondly, to shut in the bladder entirely in front. The patient died, 
there being considerable suppuration around the flaps and ante- 
mortem clots in the heart cavities. 
as 



386 DIGEST OF LITERATURE ; 

URETHRAL INFLAMMATION, ETC. 

15. Chiene, John. — Note on the treatment of gleet. Med. 
Times and Gaz., June 24, 1876, p. 686. 

16. Dauphin. — Gonorrhoea! ophthalmia. La Presse Mdd. 
Beige, Sept. 24, 1876, p. 337. 

17. De Vos. — Anti-blennorrhagic injection. L'Union M^d,. p. 
24, Jan. 6, 1877. 

18. Dixon. J. N. — Urethro-ragia ; ergot as a styptic. Cincin- 
nati Medical News, Nov., 1876. (Half-yearly Compendium of Med. 
Sci., p. 550, Jan., 1877.) 

19. Guillaud. — Manifestations of rheumatism in the urethra 
and bladder. Lyon Med. (La Presse M^d. Beige, Nov. 5, 1876.) 

20. Marty. — Gonorrhoeal endocarditis. Archives G^n de M^d., 
Dec. 1876, p. 660. (Med. Times and Gaz., Dec. 23, 1876, p. 710.) 

21. Merkel, S. B. — Oil of sandal wood in the treatment of 
gonorrhcea. Phil. Med. Times, April 29, 1876, p. 367. 

22. Rucker. — Bromide of potassium in gonorrhoea. Western 
Lancet, June, 1876. (Half-yearly Comp. of Med. Sci., Jan. 1877.) 

23. See. — Digitalis in the treatment of urethritis ; digitalis an 
aphrodisiac, etc. Tribune M^d. de Paris. (La Presse M^d. Beige, 
Sept. 10, 1876, p. 323.) 

24. Taylor, Chs. Bell. — Remarks on gonorrhoeal ophthalmia. 
Med. Times and Gaz., April i, 1876, p. 360. 

25. Van Holsbeck. — Anti-blennorrhagic injections. L'Union 
Med., p. 271, Feb. 15, 1877. 

26. Will, J. C. Ogilvie. — Note on the treatment of gleet by 
isolation. Med. Times and Gaz., Oct. 14, 1876, p. 435. 

Dixon (18) claims that injections of fluid extract of ergot into 
the urethra will arrest severe haemorrhage from that canal without 
forming a clot. His conclusions are drawn from one case. 

Guillaud (19) recognizes a gonorrhoeal rheumatism and a 
rheumatic gonorrhoea as well. To support the latter he adduces 
five cases of urethral discharge which he thinks he proves to be due 
to an existing rheumatic attack. In a similar manner he endeavors 
to create a rheumatismal cystitis — but with poor success. 

Marty (20) bases his paper on gonorrhoeal endocarditis upon a 
case under the care of Prof. Poncet. He gives a good r^sumd of 
the several cases already reported in different periodicals. The new 
case is a young man of 22, with no rheumatic antecedents, who had 
an attack of gonorrhoea running a moderate course from Aug. 15 to 
Sept. 22. At this date chills and headache came on, the urethral 
discharge moderated, and a systolic murmur appeared upon the 
fourth day. Among his conclusions Marty maintains that endocar- 
ditis occurs as a result of gonorrhcea as frequently as pericarditis, 
ifjODt more often. 
/^ See (23) recommends with confidence a combination of digi- 
f talis and iodide of potassium in the treatment of cases of great 
( sexual excitability with tendency to hypochondria, etc. ; where, for 




DISEASES OF THE PEXIS, URETHRA, ETC. 387 

instance, erection and ejaculation are produced by the sight, touch A 
or thought about one of the opposite sex. He relates a striking J 
case. _Zy 



STRicnnti or nn unEnniA, nc 

ay. Adelina, Ch. — Strictures of the urethra and internal nre- 
throtomy. La France MAI., p. 813, Dec. 16, 1876. 

a8. Bos, A. — Rapid dilatation of strictures of the urethra. 
Thise de Paris, 1876. fLa France M^. p. 8oj, Dec. 9, 1876.) 

ag. Browne, J. W. — Case of retention of urine depending 
upon organic stricture of the urethra, necessitating puncture of the 
bladder above the pubes and per rectum. The Dublin Joum. of 
Med. Sci.. Feb., 1877. 

30. Bush, J. F. — ^Two cases of stricture of the urethra. Bost. 
Med. and Surg. Journ., Nov. 30, 1876, p. 637. 

31. Byrd, W. A. — Sloughing of scrotum and perineum : re- 
covery. Iloit. Med. and Surg. Joum., Nov. 9, 1876. 

3a. Caswell. — Fifteen cases of stricture. Bost Med. and 
Surg. Journ., Nov. 30, 1876. 

33. Cras. — Traumatic lesions of the urethra. Gaz. Hebd., p. 
810, Dec. 2J, 1876. 

34. Croly. — On urethral stricture with enlarged prostate and 
cystitis. The Dublin Joum. of Med. Sci., Jan. 1, 1877. 

35 Curtis, T. B. — Recent progress in genito-urinary surgery. 
V. " ' ' >urg. Joum., Nov. 30, 1876, p. 640. 

; { — The subcutaneous and other methods of divid- 
ing ;he urethra. Med. Press and Circular, p. 39, Jan. 
17, 1877. 

37. Harrison, R. — Stricture of the urethra. Lancet, p. 947, 
Aug. 19, 1876. 

38. Le Fort, L. — New method of treating strictures of the 
urcthr.i, immediate progressive dilatation. L'Union M^d. and La 
France .VKd., p. 745, Nov. 15, 1876. (Lyon MM., p. 503, Dec. 3, 
1876.) 

39. Monette, G. N. — Traumatic strltture of the urethra. Am. 
rractitinruT, p. ;i4,Oct., 1876. 

40. Ormsby, L. H. — Recto-vesical fistula, lacerated urethra. 
Medical Press and Circular, March 29, 1876, p. 158. 

41. Otis, F.N. — Spasmodic stricture of seventeen years' dura- 
tion, cured by over-distension of the membranous urethra, combined 
with division of a contracted meatus. Archives of Clinical Sur- 
gery, p. J 21, Dec., 1876. 

4a. Stricture of the urethra ; progressive dilatation ; rare acci- 
dent ; recovery. La Presse MAI. Beige, Nov. j, 1876. (Moskaner 
Med. Zeitung., Nos. 14 and 16, 1876. Centralblatt f. Chirurgie, 

P- S76) 

43. Teevan. Internal urethrotomy and its advantages. Lancet, 
1876. (Half-yearly Comp. of Med. ScL, p. 549, Jan., 1877.) 



388 DIGEST OF LITERATURE ; 

44. Teevan. — Traumatic stricture of the urethra and numer- 
ous penile fistulae, cured by internal urethrotomy. Lond. Clin. Soc. 
Rep., Med. Times and Gaz., Oct. 28, 1876. 

45. Teevan. — Choice of an operation for stricture of the ure- 
thra., Med. Times and Gaz., p. 357, April i, 1876. 

Byrd (31) details a case of extensive sloughing of the scrotum 
and perineum, unusual in being spontaneous, without obvious effi- 
cient cause. There was no injury and no infiltration of urine. The 
patient recovered. 

Cras (33). Discussions in the Soci^td de Chirurgie (the high- 
est exponent of the surgical views of France), of Dec. 13th, 1876, 
and May 19th, 1875, on contusion of the perineum, crushings of the 
urethra, &c., disclose the painful fact that not one member of the 
society on either occasion raised his voice against the advisability 
of leaving a " sonde ^ demeure " in the urethra after the operation 
of external perineal urethrotomy. In favor of this proceeding the 
following names are found ; Cras, Notta, Guyon, Rochard, Le 
Fort ; while Duplay, Trelat, Verneuil, and Voillemier had nothing to 
say to the contrary. 

Le Fort's (38) new method of treating strictures may, perhaps, 
be new in France, but it has no essential feature of novelty in it. A 
small conducting soft instrument, with metal cap, is passed through 
a tight stricture and allowed to remain there twenty-four hours. At 
the end of that time it lies loosely in the canal, a conical instru- 
ment of metal is screwed upon the conducting guide, forced in, 
and withdrawn, to be followed by another of larger size.- 

Ormsbv's (40) cases are interesting. In the first a vesico-rectal 
(small) fistula got well spontaneously after Ormsby had dilated a 
stricture of the urethra, and thus allowed the bladder to empty 
itself without violent contraction. The second case was one of lacer- 
ated urethra treated by a rubber catheter k demeure. The patient 
made a prompt recovery. 

Otis's case (41) is one of those rare examples of prolonged 
spasmodic stricture which are so apt to pass for some other and 
more serious lesion. The prompt effect of over distension in this 
case is gratifying. Dr. Otis considers that the condition is analogous 
to vaginismus, in which latter malady the beneficial effect of over 
distension is notorious. 

Teevan (45) comes out strongly in favor of cutting as against 
divulsion in urethral stricture. 



DISEASES OF THE TESTICLES, ETC. 

46. Coombs, C. p. — Case of severe orchitis following paracen- 
tesis. Med. Press and Circular, Feb. 23, 1876, p. 156. 

47. Depaul. — Cancer of the testicle in an infant of ten months. 
Soc. de Chirurg, May 19, 1876, p. 316. Phil. Med. Times, July 8, 
1876, p. 470. 



I 



DISEASES OF THE TESTICLES, ETC. 3S9 

48. Knaggs. — ^Treatment of orchitis with amica. Gazette M^d. 
de Rome. (La Presse Mrfd Beige, Aug. 13, 1876.) 

49. Leale. — Tubercular diseases of testicles. N. Y. Path. Soc. 
The Med. and Surg. Reporter, July i, 1876. 

50 Leclaire. — Practical considerations with regard to acute 
orchitis, and the advantages of compression in its treatment. La 
Presse Mrfd. Beige, Nov. j, 1876, p. 385. 

51. Thiry.— Compression in acute orchitis. Presse MW. 
Beige, No. c, 1876., Med. Times and Gaz., Nov. 18, 1876, p. 579. 

51 Thiry. — Blennorrhagic orchitis; its causes, varieties, le- 
sions, consequences and tre.ttment. La Presse M^ Beige, Nov. 
j6 ; Dec. 3, 17. 1876 ; and Jan. 14, 1877. 

53. Trelat — Diagnosis of tumors of the testicle. Le Prog. 
M«fd., Jan. 10, p. 41 ; and Feb. 10, 1877, p. 103. 

54. Volkmann. — Treatment of hydrocele of the testicle by in- 
cision with antiseptic dressings. Berl. Klin. Wochenschrft, Jan. 17, 
1876, p. 29. 

55. Waterman, L. D. — Treatment of orchitis. Practitioner, 
Nov. 1876, p. 334. 

56. Puncturing the testicle in orchitis. The Med. and Surg. 
ReixTttT, P'eb. 17, 1877. 

Kna'.os (48) cures (?) epididymitis with amica by keeping the 
patient in bed fifteen days. 

Le Cij^irf. (50) and Thikv (ci) praise the application of 
evenly adjusted pressure to the testicle from the very onset of an 
acute att.ick nf cpiiiidymitis. 

V. HKMANN- (541 makes an exceedingly good showing with his 
seventeen cases of hydrocele treated by incision antiseptically. He 
says that no febrile reaction followed, that the Cases got well on an 

'i)-s, and that many of the later patients were dis- 

days, generallv leaving the bea on the fifth or 
V a most excellent resalt. All the cases rccov- 
crctl, and in iixtccn out of the seventeen the cavity of the tunica 
vaj^inalis was found to be obliterated on the first changing of the 
I. .,,,1 ■„.. ^ot one drop of secretion having formed. Jn the one ex- 
ise a small portion of the ca\'itv remained, and serum 
I it. A drainage tube was therefore introduced and re- 
i few days, whereupon the little cavity immediately dosed. 
I :>erative procedure is as follows : The genitals and groins 
ly and frequently washed with carbolic acid solution, the 
I off. Under carbolic acid spray the hydrocele is in- 
top to bottom, and its cavity syringed out with a 3-pcr- 
•' . r" !icacid. Bleeding vessels are tied with cat- 
u . The serous membrane is stitched to the 

.skiu .\..'. -iu .-:;■-: u.:i; many points of fine suture. A portion of the 
front wall of the tunica vaginalis may be cut away if it be thick- 
ened. Antiseptic gauze is firmly applied, a hole being left for the 
penis. All defects in the dressing are stopped up with salicylized 
wool. 



39° 



Ueoietne anb Sook iDl^otices. 



At/as of Skin Diseases. Part II. Acne rosacea, Ichthyosis, 
Tinea versicolor, Sycosis non-parasitica. By Louis A. Duhring, 
M.D., Professor of Skin Diseases in the Hospital of the University 
of Pennsylvania ; Physician to the Dispensary for Skin Diseases, 
Philadelphia, etc. Philadelphia, J. B. Lippincott & Co., 1877. 

In the July issue of last year vi^e noticed the first part of this 
admirable work ; the present fasciculus has been published several 
months, although behind the time expected : future portions are 
promised more regularly. The second part fulfils completely the 
expectations raised by the first one, and the plates are models of 
artistic worth, guided by intelligent and experienced medical judg- 
ment ; they are thoroughly true to nature. 

Plate I., of Acne rosacea, represents the disease in a far more 
aggravated form than is commonly met with but, with the descrip- 
tive text no mistake in diagnosis could be made. We agree wholly 
with the author in applying the term acne rosacea to such a state 
as here exhibited ; the congestive element of the disease is well 
represented, as also the enlarged capillaries : it is rare, we think, in 
such cases to find so many comedones as appear here. Some of 
the larger masses, we think, pertain more to the variety acne 
indurata, as do also the scars, which are rare in uncomplicated acne 
rosacea ; it is not uncommon to find these two varieties combined, 
acne rosacea and indurata. 

Plate 11. of Ichthyosis is a most admirable presentation of the 
disease, and no one could fail to diagnose a case after having once 
studied this picture. 

Plate III. represents the very common eruption, Tinea versicolor, 
named also pityriasis versicolor, sometimes wrongly called chloasma 
or liver spots. The general delineation of the disease is perfect, 
and the plate is one which should be carefully observed by all, for 
the eruption is constantly mistaken and treated for syphilis. The 
color of the diseased spots is a trifle yellow, — a shade more of brown 
would have imitated the disease more closely. 

Plate IV., of Sycosis non-parasitica, is especially to be commended: 
these cases are constantly treated as " barber's itch " (and to their 
great detriment) by the most irritating parasiticides. A careful 
study of this portrait and the letter press will assist almost any 
one to arrive at the correct diagnosis. 



i 



REVIEWS AND BOOK NOTICES. 391 



Again we must compliment and thank Dr. Duhring for this 
American Atlas ; we have nothing but praises for it. and only hope 
that it will find its way into the hands of every ph)-sician in this 
country. 

Nc^ra OH Dittases of the Skin. (Lehrbuch der Hautkrankheiten. 
Band II. Lief III.) Stuttgart: Ferdinand Enke, 1876. 

It is with sincere pleasure that we announce the completion of 
Hcbra's great and classical work on Diseases of the Skin ; begun 
in i860, the concluding Lieferung bears the date of 1876. The hrst 
volume was revised in 1874, and the two earlier portions of this 
second volume appeared in 1873 and 1874 respectively ; and in the 
two vohnnes before us, of 733 and 735 pa^ respectively, we have 
a total of 1468 pages of the best descriptions of skin diseases ex- 
tant, and a monument of literary work of which Dermatology may 
well be proud. The latter portions of this work have emanated 
from Kaposi, who has long been associated with Hebra, and repre- 
sent \i.ry well the present stand-point in regard to the actual 
kii)»Udge of skin diseases: latterly microscopic drawings have 
bc-in introduced The earlier portions being familiar to our readers 
ML- will notice now but the doaiog section which appeared a few 

ni ■ •' ■ . 

uling part embraces the diseases included in the last 
tilt' ■ ^ of Hebra's classification : X., Cutaneous ulcers; XI., 
Cutaneous neuroses, and XII., Cutaneous parasites and their 
diseases. "Cutaneous ulcers " refer principally to the hard and 

»"f* •"'■ ■" :ind here, as might be expected, we have expressed 

tl vs of Kaposi (ofcourse io accordance with those of 

)>'^ : '>ra), indeed the larger part of this section devoted 

to the ,1. ., . : i^ .1 verbal transcription from the illustrated work of 
KjpoM t Ihf .Si/>/i;;/* iUr Haul uitJ der AHgrtmttUn SMtimkaiUt), 
pages 27 tu 6j uf this latter, corresponding almost exactly to pages 
506 to 526 of Hcbra, with some onainions. 

The section on " Neuroses catanec " is short, occupying but 
twenty pages in the 258 of this Liefemng, but is quite full in refer- 
ences to the literature of the subject. We are sorry not to see the 
matter of the eruptions following injuries and disease of nerves 
worked up, but very slight allusion is made to it, and herpes zoster, 
the neurosis /<ir exaUtHtt, having been treated of in the earlier part 
of the work, does not enter this class. 

More than one half of this Lieferung is occupied with the para- 
sitic diseases, and is a thorough and masterly study of them. The 
substance of quite a portion of the general considerations in reference 
to the present stand-point in regard to the vegetable parasitic dis- 
eases has been given to our readers in full in the April issue, pages 
329-244. The microscopic drawings of the vegetable parasites 
are very good, although the delineations are, we think, far more 
clear than can be generally recognized clinically, and thus might 
mislead those unaccustomed to microscopic study. 



392 REVIEWS AND BOOK I^OTICES. 

It is a satisfaction to the dermatological world to have this great 
work of Hebra's finished, and it must and will long stand as an 
authority in this branch ; its clinical descriptions will ever remain 
true because they are from nature, but its therapeutics must become 
old, and, for this country at least, will be altered with the advances 
of the science of Dermatology. As a work of reference, especially 
in regard to bibliography, it will probably never be excelled. 

The Tonic Treatment of Syphilis. By E. L. Keyes, A.M., M.D., 
Adjunct Professor of Surgery and Professor of Dermatology 
in the Bellevue Hospital Medical College, etc. New York : 
D. Appleton & Co., 1877. 

This little work of Dr. Keyes' is valuable in its way, and if the 
knowledge contained in it were possessed by the profession at large 
there would be far fewer cases of severe and rebellious syphilis, 
and still fewer cases if practitioners knew better how to recognize 
syphilis in its protean forms. 

We regret that this brochure bears evidence of having been 
hastily written ; for the subject is one that demands very careful 
consideration, and we believe that many of the statements might 
mislead in regard to the purely tonic effect of mercury, and the 
readiness with which syphilis yields to treatment ; still the influence 
of the work is most excellent, for to those unacquainted with the 
subject it gives good suggestions of practical benefit, while to those 
who have abused mercury it acts more or less as a check. 

One very correct opinion, which we are glad to see in print, is 
as follows : " The Hot Springs of Arkansas are vaunted for their 
power to eradicate syphilis. This claim is utterly unfounded in 
fact," and the author in a few words gives the reasons for the asser- 
tion. The italics are ours, and are inserted to emphasize a matter 
about which frequent inquiry is made, and about which our clinical 
experience has long ago decided in the same manner. 

On the Pathology and Treatment of Gonorrhcea. By J. L. Milton, 
Surgeon to St. John's Hospital for Diseases of the Skin. Lon- 
don: 1876. 

Like all the writings of Mr. Milton this book is of a practical 
character, and although it is rather diffuse contains very much of 
good. The opinions of others are introduced very freely, and 
would be confusing were they not criticised and at the end of each 
section the author's opinion clearly stated. The rules for treat- 
ment are judicious, and in the main such as are of well recognized 
value by writers on the subject. 



393 



INDEX 



AMOffpCiOB of 1 

CUmital C m mml itm 

AcBc, tmtMmt o( 
Acne nplnUlka . 
AtJdiwMiSdiMaw 



b^lbeiUa . «4S 



«3« 



Adeaia iblkntMl hj vaalmg inam- 

Ikm aad death 60 

Albaaiiaaie of nercunr .... 371 
Atuinr, T. C. On intcnul »kia 



Aliipada areau 160 

AhiMcia areata or pelade .... 167 

"Amhelaama" 234 

Alpfiea oaHrcnalb 252 

Aaiericaa Denaalaiogical AMod» 

tios jt 

Anatomy a< ctTtkcmaloiH lapoa 

51, aoB 
Anatoair of haid aad toft cbaocre . 49 
Aaaloaiy of akia. Digeat . .-49^ S45 
AnfioaM o( the lip, caTcnwoa . . 254 

Angiwila cavereoaa 354 

AaUdratica S51 

Aaoa aad ractam. aTpUIia of tka . 171 
Apiwotttiiac. difttalii aa aa . . . jjM 
Anaaic ia dkaaaaa of Ike aUa . . 146 

Ancidc !■ ickthraaia 158 

Antmit ktlmmlf ybr tkt tmrt tf 

wmtt. Qimiiml CmntrtaHtm . . jS 
Ait>w|>atllkia,«TpMitk .... 167 
Aiiiwa, arpMBtk coMenital . . 188 
Aqthjraia m anUUlic larTngitia . 191 
Aapiraliaa of the bladder . ... 94 
AnuMaoM. J. E. Sjrphflta inher- 
ited throoah two feaeralione . 106 
Atreaia of tne pharTnx, complete 

•jrphUitic 191 

Atrophica and hypertrophica. Di- 
geat ijS 

Atroi^ and paraplegia in malig- 

aaat ajrphilia 385 

BalaiMMoathitia, treatment of . . }6o 
SstfM iwM«, mm tf. L. A. 

Dui ting 191 

Bile giviH arphilitic iaocalatioB . 358 



Bladder aad wethra, rhcvmatiam 

in the 386 

Bladder, a tioiple aMthod of aapira- 

iion ofdM 94 

Bladder, eatrophy of the . . . .385 
Bone aflectioiM, ayphilitic treat- 
ment of *8| 

Bones, typhilb of the. Dipeat . . 164 
Hooka and pamphlets received . . 90 
Book Notices aad Revtewa 9^ 187, 300 
Brain, syphilitic diMaae of the . . J85 
BaoNsu.H, EtiWAXO B. Case of li- 
chen plaaaa 130 

BaoNtoM, E. B. Case of sospected 

gaamwaa <fii«aae of the penia . ui 
BauNsoN, E. B. Heat cniptions .lit 
BaowN, Thos. R. Hare-lip and 

cleft palal* ia syphilitic children 307 
Buccal paoriasia, caae of. Disco*- 

sion 334 

Bl-LKUY, L. D. Clinical coaver- 

sations i&, 131, 317 

BiTUCUnr. U D. Local treatment 

of skin diseases . . ■. 30^111,310 
Btruujnr, L. D. Nomenclature 

«fnl claaalAcatioQ of skin diseases JOO 
BcuCLBY, U DvNCAM. Two cases 

of hydroa 317 

BouucT, I. D. Two cases of 

BnUmu trtMitu, am tmumal firm 

tf. Ct». N. Aiur 35 

Bona; syphOiaef the. Dixcst. 164. itio 
Campbux, RoBMtT. The rela- 
tiona ewlstliig between e cicm a 

aad paoriasia 311 

CaaocMella, derclopmenl of . . 347 
Cancer in lelaticn to syphilis, scrof- 

ola and tubercle 50 

Cancer of the skin, or epithelioma, 

histologyof 59 

Cancer . 358 

Carbolic add ia the treatment of 

weri js 

Carbon, sulphide of ... . 172, 383 
Caries of toe ethmoid bone, syph- 
ilitic 379 



394 



INDEX. 



PAGE. 

Cassia lata leaves in the treatment 

of ringworm 266, 267 

Catlieterism, posterior 385 

Cerebral hemorrhage, purpura re- 
sulting in death from .... 61 

Cerebral syphilis 286 

Cerebrum, gummy exudation of the 286 
Chai.crc, anatomy of hard and soft 49 
Chancre, and chancroid . . 82, 360 
Chancre, duality of syphilitic . . 358 

Chancre of the neck 360 

Chancre, phagedenic 360 

Cheiro-pompkolyx of Hutchitison, A. 

K. Robinson 289 

China, prostitution in 365 

Chloasma^ local treatment of, L. D. 

Bulkley 20 

Circumcision 384 

Classification and nometielatiire of 

skin diseases. L. D. Bulkley . . 200 
Clavus, local treatment of. L. D. 

Bulkley 20 

Clinical Conversations. L. D. Bulk- 
ley 26, 131, 327 

Clinical Reports . . 23,128,217, 325 
Cochlea, syphilis of the .... 286 
CoUes' law of the transmission of 

syphilis 367 

Conception, syphilis by .... 366 
Condylomata acuminata .... 361 
Condylomata, treatment of syphili- 
tic 283 

Condylomatous syphiloderm, Sfc, 
cured by the hypodermic injection 
of corrosive sublimate .... 39 
Congenital and infantile syphilis. 

Digest 199, 366 

Congenital ichthyosis 253 

Congenital syphilis 366 

Congenital syphilis following pater- 
nal infection 180, 369 

Congenital syphilis, on healthy 

mothers of children who have. . iSo 
Congenital syphilitic ascites . . . 188 
Congenital syphilitic parapism . . 187 
Congress, International Medical . 32 

Contagious impetigo 65 

Contagiousness of hereditary syphi- 
lis 185 

Contagiousness of leprosy ... 57 
Contagiousness of milk in syphilitic 

nurses 367, 370 

Contagiousness of venereal laarts. y. 

E. Giintz 14 

Conversations^ Clinical. L. D. Bulk- 

I'y 26, 131, 327 

Corneitis, diffuse 85 

Corpora cavernosa, cases of inflam- 
mation of the. Discussion . . 335 
Corrosive sublimate in the treat- 
ment of urethritis 89 



VAGB. 

Corymbiform arrangement of erup- 
tions. &c 142 

Cranial nerves in congenital syphi- 
lis, gummata in 371 

Crysophanic acid in psoriasis . . 252 
Crys ophanic acid in ringworm . . 265 

Curette, dermal 148, 345 

Cutaneous nerves in pemphigus . . 62 

Dactylitis syphilitica 165 

Damon, H. F. Analysis of ten 

thousand skin cases 10 

Deafness, syphilitic 364 

Deafness with heredito-syphilis . .371 
De.\micis, To.masso. Framboe- 

sioid condylomatous syphiloderm 39 
Dermatitis, local treatment of. L. 

D. Bulkley 21 

Dermatological Association, Amer- 
ican 31 

Dermatological Society. New 

York 136, 223, 332 

Diabetes as a cause of phymosis . 384 
Diabetes and Skin Diseases . . . 337 
Different countries, variations of 
Diseases of the Skin in. J. C. 

White 32 

Digitalis in urethritis and as an 

aphrodisiac 386 

Dilatation of the urethra for stric- 
ture, mediate 91 

Diseases of the skin depending upon 

nerve lesions, f. S. fewell . . 303 
Duality of syphilitic chancre . . 358 
DunRiNG, L. A. Case of a beard- 
ed woman 193 

Dysidrosis of Fox. A. R. Robinson 289 
Eczema and psoriasis, are they local 

diseases. L. D. Bulkley ... 34 
Eczema and psoriasis, the relations 

existing betiucen. Rob. Campbell . 311 
Eczema, local treatment of. L. D. 

Bulkley 22, 122 

Eczema marginatum of Hebra . . 267 
Eczema treated by galvanism and nerve 

tonics. W. H. Fitch 325 

Electrolytic treatment of tumors 52, 53 
Elephantiasis of the nose . . . .159 
Elephantiasis, treatment of . . . 160 
Endocarditis, gonorrhoeal . . . 386 
England, prostitution in ... . 365 
Epidermis histology and devel- 
opment of human 52 

Epidermis, nerves of the .... 246 
Epidermis of mammalia, termina- 
tion of the nerves in 51 

Epididymis, extension of inflamma- 
tion from the epididymis to the 

urethra 92, 220 

Epididymitis, gonorrheal, preceding 
discharge from urethra, f. T. 
Stansbury 220 



I 



INDEX. 



395 



KpSdidymitM, «7plulitic .... 361 
Kpidkiymitii, trcataienl of . . . j8S 
EpipkTMsl diacaM frooi iakerited 

•jrplSlM 371 

EpnaciiaBa, hfatirf-gHr l changes 

i" 58. »S7 

BfUktHmmm, Utat trtmtmtat ^. L. 

Dumtam BmUIn ij6 

Epithclkma of tkt face . . . . 1J7 
> pithcliooM of tka tcrataa ... 157 
Epiihelima, coara* d the BCtrca 

ondcr pavcatsl 147 

Ergol aa a ■t7J>lk in nrethro-ragia 
Eifot fai porpanL BolUcy . . . 7A1 
Emoi, raacmar Mmon treated bjr 

fii ) ac t to» with JJ4 

£91f^tttt$f tut $Uttttt$0i JipfWt 09 Mw* 

bm, Gn. H. Ft* 15 

I nijpdaa . •••••• "54. 3$4 

Ejjmtiaa fai typhflia j jS 

erfAtlaM, knl Intlmtmt if. L. 

OmmtamBtdkby 117 

Erjilpclaa «acda«l . . . . 149^ 3J4 

Erythf i gradathr— 151 

£rjtk t wta, Utal tnHaitml tf. L. D. 

Bmltbjr jjo 

Erytheau anltifonBC and typhOis . 16a 

EnrOawalaBiacaaiMcir techMdj '^ 

f>iaenMia«iacaaao( ij6 

Eiythaaaaloaa faipaa, acate ... 156 
l^vytnasHMflva nipaai amtosBT 01 ci 
Efythcatalaaa lapaa, caaaa of. Dia- 

obbJob 33J. 333 

MrylAtw tal mu /«/•# tf tkt ftuit. 

Mamy C PiftrJ aaS 

EfTtkoMt labcrcolaiom. D bc aa 

mm Ml a caaa tt 140 

E t iology and hialDiocy of Icpcoay . aci6 
Et fatap of hwadteiyayp hflto iSi. jU 
EtMiagy Km bcipca aaalcf .... 1^ 
H Mil in y ot I cmu ^ .••••. j7 
EtialMnrofakkdttaaacs Dinat 14]. 337 
EiMqpky of tka Madder. . . .St 
Ey% ayyiaMc dliiMM of tha. Di- 

V* 83 

Rxirmttt amd TVanilttitHt . . 39^ tX9 

ExadatiTc errthcmi 151 

Face, epiihalMna of the .... 157 

Facial heariabopky ite 

Favaa, harpaa toaaaraat in pcnoas 

ondar t i aa ia an i tot 64 

nvmt, Ittal ImtmttH if. L. D- 

BtdkUr 321 

Famw in the peaia, aa ota a a and 

kfi,caseo{ i-g 

F ew, qrp fcfliric 3? 

FtfaraaHin of the akia 53 

FBwnaaaiiaaata of the acrrca of 

tlwanaa 259 



FUtaria ^imatttaiaa, Icaiea pro- 
duced by 66 

fStntres, lital tnatmunl if. L. D. 

BtUkUy 3x2 

FiatuU, recto-orethial 9a 

FiMola, nctOTa a i ci l 3X7 

FrrcM, W. H. Eczema treated by 

aerr* loaica and cIcctridtT . . 315 
F l lmei t m p tm jM g mi . S. Siirwta 97 
Fox. Gbo. Hbmbt. Aa nanaaal 

(ana of ballooa craMioa . . . *5 
Fox, Gmo. Ukmkv. Caae of lidien 

plaana 119 

Framhniaia arisiag from syphilis . 144 
Fnatkmitid ttmnitatati^s npJkii^ 
dirm, Air., nmdtyf tkt k v f m krmk 
u^ttttut if ctwmaM Mitnatali . 39 

IK H. FUck 3»s 

Giant^clls, contribotion to the slady 

of «4S 

GUnda, diitaiaa of ih*. Difcat . aio 
Gket iraafiat of ... >« 3Po 
36i3l»o 

OK 

. i<6 

Gooorrtea SS. 3S6 

Gaoorrhaa. ftc, aorrooa di a otdtr 

caaied by tt 

Gonatihtaa, pathology and treat* 

awa( of. J. L. Miltoa. Review 301 
GooorrhoBal eadocarditia . . > . 3II6 
vMMWjMa/ ifimiufwutti fnttautf 

djikmfi fnm jmntkra. J. T. 

ajo 



Gloaaida. sypkUac . 
Go»pa«dar ia the 



GoaoffhflMU ophdutlaMa 
Giiadlioa MM* aad 

caa ca Mf acfofala . 
GaaMBata ia ciaaial aer 



ita Mgain* 




386 

MS 

S' 
363 

86 



aypUMc 

aaMT of lobe_ of brain, 
biaocalaff heaiiopla 
EOMVNIk Contagioaa- 
ra a a nal warta .... 14 
Hcauiaria, scarlatinal .... 347 
lUiaialiiiahy, p t uMea ai»e (adal 160 

HcaMpWHa, tporaAc >6l 

HaaMmagea and aearoacs. V>V 

gasi 61,260 

llaaMrrhagic porpora 61 

Hnaorrhagic variola 149 

Hart Nf amd cUfl falalt tm lyfkililte 

tkitJrtn. T. X. Bnttn . . . yyj 
Htat Emftitms. E. B. Bmum . Ill 
HeUa OB diseases <A the skin. 

Review 391 

Heauopia from gnmiay tnaior of 

lobeafbraia 86 

Hepatitis, syphilitic 363 



396- 



INDEX, 



PAGE. 

Hereditary syphilis 366 

Hereditary syphilis and rickets, 

osseous lesions o£ 187 

Hereditary syphilis, case of. Bulk- 
ley 225 

Hereditary syphilis, contagiousness 

of 185 

Hereditary syphilis, etiology of 181, 360 
Hereditary syphilis, late 184, 186, 372 
Hereditary syphilis treated with 

saccharated iodide of iron . . . 186 
Hereditary syphilitic teeth, debate 

on 184 

Hereditary syphilis, deafness with . 37 1 
Herpes, local treatment of. L. D. 

Bulkley 322 

Herpes tonsurans and favus ... 64 
Herpes zoster, clinical study of . 155 
Herpes zoster, etiology of. . . .157 
Herpes zoster, patholo^ of. Geo. H. 

Kohi 318 

Herpes zoster, pathology of . . .157 
Histological changes in epithelioma 257 
Histology and development of 

human epidermis, &c .... 52 
Histology and etiology of leprosy . 256 
Histology of cancer of the skin, or 

epithelioma 59 

" Hydroa." Discussion on . . . 226 
Hydroa, two cases of. L. D. Bulk- 
ley 217 

Hydrocele, treatment of ... . 389 
Hyperidrosis, local treatment of. L. 

D. Bulkley 322 

Hypertrophies and atrophies. Di- 
gest 158 

Hypertrophy of the lymphatic 

glands, &c 60 

Hypodermic use of mercury . . 269 
Hypospadias cured by operation . 385 
Ichthyosis. Clinical Conversation , 135 

Ichthyosis, congenital 253 

Ichthyosis, local treatment of. L. £>. 

Bulkley 322 

Ichthyosis, successfully treated by 

arsenic 1 58 

Impetigo contagiosa (case of). Dis- 
cussion on 224 

Impetigo contagiosa 65 

Impetigo, local treatment of. L. D. 

Bulkley 323 

Infantile and congenital syphilis. 

Digest 179, 366 

Infantile syphilis 185 

Infantile syphilis, liver from a case 

of 183 

India, skin diseases of. Fox and 

Farquhar . . 253 

Inflammations. Digest, 

149. 151.347. 353 



PAGB. 

Inflammation of the corpora cav- 
ernosa, case of. Discussion . . 335 
Inherited syphilis. J. E. Atkinson . 106 
Inoculation of pemphigus .... 157 
Insanity due to syphilis .... 286 
Instrument for treating " port wine 

marks," Exhibition of . . . 225 
Internal skin diseases. T. C. Allbutt . I 
International Medical Congress . 32 
Intertrigo, local treatment of L. D. 

Bulkley 323 

Intestinal syphilis 362 

Inunction and cold-water treatment 

combined in syphilis .... 279 
Inunction-cure, mercury in the milk 

of women under the .... l6l 
Iodide of potassium, medicinal 

mode of action of 275 

Iodine by the skin, absorption of . 248 
Iodoform, therapeutic effect of . 174 

Iritis, syphilitic 85 

Jaundice, xanthelasma planum as- 
sociated with 54 

Jewell, J. S. Diseases of the skin 

dependmg on nerve lesions. . . 303 
Kaposi, Moriz. Vegetable para- 
sites of the skin 229 

Keloid, sarcoma of the skin resem- 
bling 259 

Keratitis, syphilitic, at an unusually 

early age 85 

Keratitis of Hutchinson . . . .371 
Keyes, Edward L. Case of li- 
chen planus 129 

Kinnicutt, F. p. Case of zoster 
frontalis traumaticus . . . .128 

Laryngeal syphilis 380 

Laryngitis and its treatment, causes 

of asphyxia in syphilitic . . . 192 
Larynx, secondary syphilis of . . 190 
Larynx syphilis of the. Digest 189, 3S0 

Leprosy 56 

Leprosy, etiology and histology of 

57. 256 
Leprosy in the Sandwich Islands. 

Enders 36 

Leprosy, tubercular. Tilbury Fox 256 
Leucodermatous spots following ro- 
seola syphilitica. X. IV. Taylor . 118 
Leucodermic spots left after psori- 
asis, narration of a case of . . 137 
Lichen, local treatment of. L. D. 

Bulkley 323 

Lichen planus, case of Edward B. 

Bronson 130 

Lichen planus, case of. Edward L. 

Kcyes 129 

Lichen planus, case of. Geo. Henry 

Fox 129 

Lipoma 1 59 



d 



INDEX. 



397 



r*ea. 
Liver froo a caM tA iaf astilc iTphi- 

li* 183 

Liver, iTpluUa erf the 363 

Local applicatioM in arpUlie . . 380 
LooooKMor ataxia of «7pluUtic origin 185 
Lu^i, tjrpiulia of the. DigeM 168.363 

L»P«» 56. »5S 

iMpati acatc cfTtkenatoo* . . . 256 
LnpM, aart ce ay of cfTtbctnaloa* . 51 
LnpM eiytlnwiitw. caae of. I>i*- 

n— inn 33>> 333 

iMfmt tf tkt ftmit, nytttwiatmi. 

nittry C iS^tn^ Mo 

Lupnt of the v«lv»«aal rc|Jo« . 155 
Luna T«%aHa, caae* of. Diacn*- 

Mon. 334 

LupM Talnria, tieatad bjr a Bodifi- 

aitiwi of Volkwui'a metkod . t c6 

Lmartnw of the peaia, irliiiilf 

a<a»<alled S7 

M aHnal ajrphOia frooi c w Kept kai 
^ i<ak3tt 

JlCMlM SBQ SCSfKt iBVCVt QlBMMMI 

ol 347 

If edieal CoiWiwa. latciaatiaiial . 33 
Meicfial f— ilgatkm !■ eyphilia . 175 
Mctciirial prepantioiM in the blood, 

lof 177 



Mcfcoric peptone in fvphUia . . a6b 
MtTony tai •jroUUn. Kcfca . . 17! 
McicwTla arpuUi^ aobcaiaaaoaa 

injecdon of biqraaide of ... 176 
McfcwT Id the mBk of ■o w i w ■■»• 

der the imwctian cv*. KUak . 161 
Milk in tvpUUtic nnw . . . . 3^ 
Mni<.UivpmhtraaMalMiblethfo«^ 

thr Voaa 164 

M«lluu:im fbraaH» 53 

»49 

"'""• • TofiUJ 
ihrfikta. L. Dmmtam BmUlty . . 100 

Ifoiphsa S7 

Mouth, tvphilia of the. Digeat 189^ 379 
MiMclcB. ■Tphili* of the. Digcat . 164 

MjFCoaia of the akte 6$ 

Myap«ttiM.npkittk 3(4 

MMaMa,a]rphiUtic 16s 

Abm, faOwiy »f. S. SMmmO . 214 
Nkvim, multiple pigmented . .158 
Ncraa. tfcaled oy injectioiia of 

caibaiie add 55 

Natrna, treatment of 55 

Maial dephaatiaaia, treated bjr de- 



Naao-pharmceal irphilis .... 380 
Neck, ajrp^tic cKancre of the . .360 
Ntrvt Unnu, diuoHt »/tJU sUm Jt- 

ftmdmft^tm. f.S.JtwM . .303 
Ncrrca m ooogcaital ayphilia . . 371 



Nerrca in pemplii|ua cntaneua 
Nenrca in the epw ton n i a of ma 

malia, terminattoii af . . . 
Nerrea of the aia^ 

ofthe 

Nerrea of the epidermia 

Nerrea ader pavement epitbclioo^ 

COOTMCf 

^VFW WNKrtfMvflBniaMfm m o'wiJi 

W.H.Fittk. .... 
Nervooa (tttcaaaa, ajrphilitic 
Nervosa dmoraar caoaad by gooor^ 

rhoea, cc 



Ncrvtma ayitua m pemphigua • 
Nervooa ayaiem, ayphaia of the 



Digeat 
Neuromala, picsiform 
Neuropathy, mcikral .... 
Navoaaa nd hamorrhagaa. Di' 



12 



SI 

88 

«S7 



ite 
*6« 



'» 



307 
»4 



N a i ir oaaa of the aUn . . 
Mm * ^1i» t.D. Smlilty 

OttTcUft WCMIQM IBndft • • • 

Ophthalmia. goMThoal . . . 
Orchitia falMriag pmacenlaaia 

Orchitia, qrphOkic 

Orchitia, treatment of .... 
Oaaeoaa leaiona of haictftary aypht 

Uaandrickcta 

Oamna, treatment of trphilitic 
~tUltiMt, mmi kart-'jif m tyfA- 

aUk tkiUrtn. T. X. Brvmm . . 
Pancrea* in ncw-boni childicn, ayph-' 

ilitic alterationa of the ... . 
rapilloina and apithaBci of the 

•oie of the foot 158 

ftfaptoAtaad atrophy hi malignant 

f^miHu^lte titmi^iptMi. M. 

Xtptti •■• ••• sa9 

Paraailic diacaaca. Digeat . 64. a6s 
Parla. Proatitniioa In ... • 3^5 
rmhtUty tf ktrftt —lir. C^ H. 

KttT 318 

Pathology of herpea Meter . . . 157 
Pathology of akin. Digcat . 49. a4j 
Pathology of aypUlia ... 8. 3<8 
Pelade or akijircia areata . . . any 
Pellagra, diaical atndyof . . . tci 
Penpiugaa, catancoaa nervca fai . M 
Pcmphigoa foUaceoa, d iac uaa i on on 

acaae of 224 

PfmfkifMt filmtaa. S. SitrmtU . 97 
Pemphigua, inocoiatioo of . . . 10 
Pcmphjgaa, ayphilitic . . .361 

Pcmphlgaa^ na^vova ayatcui in . * 1 57 
Pcnia, gummou a diaeaae of the . . 223 

Ptnia. paoriaaia of the 335 

Ainr, our tf imtft€ttJrummotu dit- 

mjttflAe. E.B.Bmum. . . 22* 



398 



INDEX. 



PAGE. 

Penis, disease of the. Digest . 86, 384 
Penis, erythematous lupus of the. 

Nenry G. Piffard 208 

Penis, induration of the .... 360 
Penis, laminar tumor of the. R. W. 

Taylor 335 

Penis, mechanism of the so-called 

luxation of the. Bush .... 87 
Penis, surgical maladies of the. De- 

marquay 384 

Phagedenic chancre 360 

Pharynx, complete syphilitic atresia 

of the 191 

Pharynx, tertiary syphilis of the soft 

palate and 190 

Phosphorus in psoriasis .... 25 

Phthisis, syphilitic 168 

Phymosis caused by diabetes . . 384 
Physiology of skin. Digest . . 49, 245 
PiFFARD, Hf.nry G. Erythema- 
tous lupus of the penis .... 208 
Pigmented nsevus multiple . . .158 
Pilocarpine in unilateral sweating . 251 
Pityriasis versicolor, treatment of . 267 

Podelcoma 65 

Pompholyx. A. R. Robinson . . . 289 
Post-mortem appearance of pur- 
pura 263 

Potassium iodide in syphilis . . . 359 
Potassium, medicinal mode of action 

of iodide of 275 

Placenta, fatty degeneration of, as a 
cause of death in the foetus . . 181 

Placental syphilis 

Plexiform neuromata 259 

Pregnancy, syphilitic manifestations 

in 362 

Priapism, congenital syphilitic . . 187 

Priapism, persistent 385 

Prophylaxis of syphilis 365 

Prostate, hypertrophy of the . . 384 

Prostitution 365 

Prurigo (of Hebra) discussion on a 

case of 139 

Prurigo, winter 63 

Pruritus hiemalis, treatment of . . 63 

Pruritus pudendi 62 

Pruritus, treatment of 63 

Pruritus vulvae treated by nitrate of 

alumina 63 

Psoriasis, administration of tar inter- 
nally in 252 

Psoriasis and eczema, are they local 

diseases, &c ? Bulkley .... 34 
Psoriasis and eczema, the relatione ex- 
isting between. Robt. Campbell . 311 
Psoriasis buccalis, case of. Discus- 
sion .... 334 

Psoriasis, crysophanic acid in . . 252 
Psoriasis leaving leucodermic 
spots, narration of a case of . -137 



PACK. 

Psoriasis of the penis, case of. Dis- 
cussion 335 

Psoriasis of the tongue 253 

Psoriasis, phosphorus in ... . 252 
Psoriasis punctata. Clinical Conver- 
sation. L. D. Bulkley .... 26 

Pudendal pruritus 62 

Puerperal scarlet fever 347 

Purpura 262 

Purpura, cured by ergot and lemon- 
juice. Clinical Conversation , . .133 
Purpura, death from cerebral hem- 
orrhage 16 

Purpura, ergot in. Bulkley . . . 261 
Purpura hemorrhagica .... 61 

Purpura rheumatica 61 

Purpura, post-mortem appearances 

in 263 

Rectal syphilis. Digest . . 170, 363 

Recto-urethral fistula 92 

Recto-vesical fistula, &c 387 

Rectum, syphilis of the anus and . 170 
Rectum, syphilitic stricture of . . 171 
Rectum, treatment of syphilitic 

strictures of the 174 

Reports, clinical . . 25, 128, 217, 325 
Reviews and Book Notices 95, 287, 390 

Rheumatic purpura 61 

Rheumatism of the urethra and . 

bladder 386 

Rheumatism, syphilitic 166 

Ringworm, treatment of, by goa-pow- 

dcr 266 

Ringworm, treatment of, by leaves 

of cassia lata 266, 267 

Ringworm in an infant six hours 

old 64 

RoiiiNSON, Andrew R. Pom- 
pholyx 289 

RoiiF., Geo. H. Pathology of her- 
pes zoster 318 

Rosaceous acne, treatment of . . 250 

Roseola syphilitica 361 

Roseola syphilitica followed by leuco- 
dermatous spots. R. W. Taylor . 1 18 

Rbtheln ico 

Rupture of the urethra 87 

Salicylic acid in scarlatina . . . 347 
Salicylic acid in sweating of the feet 251 
Sand in the treatment of acne . . 249 

Sarcocele, syphilitic 171 

Sarcoma 59, 258 

Sarcoma of the skin resembling 

keloid 259 

Scabies, dijffiailt of recognition. Clini- 
cal Conversation. L. D. Bulkley. 29. 

Scarlatina 150, 347 

Scarlatina complicated with typhli- 
tis 347 

Scarlatina, salicylic acid in . . . 347 
Scarlatinal hxmaturia 347 



i 



INDEX. 



399 



Scarlet fever and meailes, diffuaion 

o< 347 

Scarlet fever, poerperal .... 347 
Sckrodenna, ai«CTWiin« on a caae 
«< «» 



Sdvodcma in a naniag child . . 158 

Sdnodcnaa of adalta 159 

Sckraderma. oa Ike action o< hot 

wai«r ia. Diac— ion .... 137 
oi(waBDir^0f^^tmt» twnutjt tfrgtt mm 

limtm j m t*. C lim i aU Ct) m < nt t t t t m 133 
Scraftaf ia tka tfcataent of *ca- 

•fcal aflactioM* aSj 

Soolala, granabtiMiliMW and its 

ripiicaaoefor *4S 

Scmab, ajrpUUa aad tabnck ia 

rdaiian to ouKcr 50 

ScivMa. ajiphiiia, raberdc. Ac, rcl» 

Ikaaal 159 

Scrotaok cpiihelioaa of tlM . . .157 
Scbocrtiiaa. traatawai of .... 36 
Sacnndary n'lptcwM foUowiagaoft 

chancre • • ^i 

^ ' ttioa of tactile . . S47 

rcnphina foUaecaa ^ 

^ Tattooing at aai*i ai4 

-jfptioa of iodine bjr the . 148 

0»m*m 10 

sk i 1.C*. Analyaiaof terea htm- 
<!ir-l And tcTcnty-fow. L. D. 

i'"'i«i«y 337 

Jittm, dtmun ff, dtftrndjng am mtrnt 

Inimi y. S. JtwM ... . . .303 

Skin JJataaei. hand-book of. Neo- 

■aa. Retriew 95 

SMa dfaiairi Hcbea. Review . 391 
SlUm 4umut$, imttrmml. T. C. AlUmtt 1 
Stm U tat n , Itml Irm l wt t n t »f. L. 

thmtam BmltUy. . . . 10, l>2, 330 
Sim dimia, mtm um himrt ltd tUui- 
JiMtim ^. L.D. BmlUn ... aw 
Sua JhtMM of ladia. rox aad 

Faroahar aS3 

SUa d Jaa m a treated by aneaic 

Bdkiey 146 

Skin, ibraauta of the $3 

SMn diataaai in different coontrice 

J r White 31 

Sk ,1 >. ijrpkilia 361 

Skui :rritanta, oa the accrctioa of 

luinc 5* 

SUiS practical treatiie on d i a eaiea 

of the. Dnhrii^. Review. . . 287 
Skim, im«iWi fmrasUtt tf tk*. if. 

Kafmi 129 

Sim, 9 tmm u JtUtitm tfUt. Ctimkmi 

C mm mml im 30 

Small-pox 352 

Suciciy Transactiona .. 31, 136^ i>3> 333 



Soft dbaacre with aecondary iymp- 

tonM 361 

Staining new method of double . 247 
STAHtaVRY, J. T. Case in which 
gonotrhoeal epididymitis preceded 
the diackarge from the urcihra . 210 
Strictare of the rectum, t^-philiiic 

«7^ «74. 363 
Strictnica of the urethra . . . 3S4 
Stricture, urethral, treated bjr medi- 
ate dilatation 91 

Sweating of the feet 251 

Sweating. Pilocarpine in unilat- 
eral S51 

SjrpbiliaaflectiMikebarac Keyea 166 
Sjrphffia aad ciytlMaa mulittf orme . 16a 

SyphOia aad fkketa 1S7 

SypUlia aad vtacreal diieaaca. Di- 
geat ..... C6k i6a 26S, 3c8 

SvpkiUaby! caaeeptian 366 

SypHia by TiBciwarina 367 

SypWlla,cMao(heraditary . . .125 
Syphilh ci iiag yawa, fratnboesia. 

or fnageU giowtk 144 

SyphlUa. oenXeal 386 

Syphilia, fonj»aital aad infantile. 01 

1 I79b 306 

coacnhal, following pa- 
lalaoina . . ... .180 

Syi*aia.«yal||elaain . . . . . 358 

Syphilia. hercditafy, coat^iouancta 

of iSc 

SypUHa, bcietfitary, etiology of . . 181 
SrpklHi, aalanHl, fra« cooceptiaa 180 
SyphB kkfratih^. .^ • "* •"•• ^ 

i^Jt^Mttlt MMCThMb JBVMi|p9 AW^VIWV^ 

MbML J.M.4lkmtm .... 106 
SypkOk hMMky dae to .... 286 
Sypkflk lM» ba w d ilaiy . 184. 186^371 
SypWNa. aHMcalw airopinr aad par- 

wkSiiaaMlignaat. . . . aSs 
SypHW of baaia, ieadana, araadea. 

andbataa. Dignt 164 

Syphilia of the anna and rectum . 171 

Syphilia of the cochlea a86 

Syphilia of the eye 83 

.Syphilia of the longa. Diseat . iM, 363 
Syphilia of the nioatb. throat and 

brvns. Digest .... 189^09 
Syphilia of the nervoaa ayiteai . . Aa 
Syphilia of the placenta .... 366 

Syphilia of the »kin 361 

Svphilii. patho logy of. . . . 0. 3^ 

tkt mHitl Uam tf. R. ff. 

SypUBa, acrofnla, and tubercle, in 

rebtioa to caaoer 50 

SyphiHa, layngm in . . . . 27a 378 
Syphilia, the tonic treatment of. £. 
L Keyes. Review 39a 



400 



INDEX. 



Syphilis, transmission of ... . 182 
Syphilis, treatment of. E. L. Keyes 37 
Syphilis untreated. Clinical Conver- 
sation. L. D. Bulkley .... 27 

Syphilis, iron in 183 

Syphilis, visceral 362 

Syphilitic bone affections, treatment 

of 364 

Syphilitic chancre, duality of . . . 358 
Syphilitic chancre of the neck . . 360 
Syphilitic children, harelip and cleft 
palate in. T. R. Brown. . . . 307 

Syphilitic dactylitis 165 

Syphilitic epididymitis 3O2 

Syphilitic fever and tissue metamor- 
phosis in syphilis .... 162, 358 

Syphilitic glossitis 

Syphilitic inoculation caused by a 

bite 358 

Syphilitic insanity 268 

Syphilitic iritis 85 

Syphilitic keratitis at an unusually 

early age 85 

Syphilitic laryngitis 192 

Syphilitic lesions of the rectum. Di- 
gest . . • . : .... 170, 363 

Syphilitic myositis 165 

Syphilitic nervous diseases . . . 286 
Syphilitic nurses, milk in ... . 366 

Syphilitic ozoena 380 

Syphilitic pemphigus 361 

Syphilitic phthisis .... 168, 363 

Syphilitic re-infectiqn 161 

Syphilitic re-infection. R. W. Taylor 1 19 

Syphilitic rheumatism 166 

Syphilitic roseolafollowed by leucoder- 
matous spots. R. W. Taylor . .118 

Syphilitic sarcocele 171 

Syphilitic stricture of the rec- 
tum 170, 174 

Syphilitic teeth, hereditary . . . 1S4 
Syphiloderm, vegetating, tubercular, 

in an infant. A. Van Harlingen. 211 
Syphilography, is'c. clinical. R. W. 

Taylor 118 

Syphilography in Bologna . . . 276 
Syphiloma of the tubercula quadri- 

gemina 285 

Tactile sensation, duration of. . . 247 
Tar internally in psoriasis . . . 252 
Taylor. R. W. Clinical syphilog- 
raphy, &c n8 

Taylor, R. W. Rare appearance 
presented by the initial lesion of 

syphilis J 

Tayuga in syphilis . . .76, 279, 37S 
Teeth, hereditary syphilitic . . . 184 
Tendons, syphilis of the. Digest . 164 
Testicle, diseases of the. Digest 86, 384 
Testicle, gonorrhoeal and syphilitic 
disease of the 3S4 



PACK. 

Testicle, tuberculous granulations 

of the 93, 3S9 

Testicle, treatment of hydrocele of 

the 389 

Therapeutics of skin diseases. Di- 
gest 142, 337 

Throat, syphilis of the. Digest 189, 379 
Tinea tonsurans, treatment of . . 64 
Tongue, psoriasis of the . . 253, 334 
Tongue, tubercular syphilide of tiie 363 
Tracheotomy in syphilitic disease 380 
Transactions, society 31, 136, 223, 382 
Translations and Extracts . . 39, 222 
Transmission of syphilis . . . 189 
Transpiration, unilateral .... 250 
Treatment of skin diseases, local. L. D. 

Bulkley 20, 122, 320 

Treatment of syphilis, E. L. Keyes. 37 
Tricophyton, treatment of ... 64 
Tubercle and syphilis, relations of 359 

Tubercular leprosy 256 

Tubercular syphiloderm in an infant, 

vegetating. A. Van Harlingen .211 
Tumors, electrolytic treatment of. 52, 53 
Tumors, vascular, treated by injec- 
tion with ergot 254 

Typhlitis, scarlatina complicated 

with . . 347 

Ulcers, non-malignant, chronic . . 148 
Ulcers, varicose, treated by tartrate 

of iron and potash 148 

Ulcus, induratum of the edges of 

the lids 86 

Unilateral transpiration .... 250 
Urethra and bladder, rheumatism of 

the 386 

Urethra, diseases of the. Digest 86, 384 
Urethra, extension of inflammation 

from the epididymis to the . . 92 
Urethra, gonorrha:al epididymitis pre- 
cedingdischargefrom. jf. T. Stans- 

bury 220 

Urethra, rupture of the .... 87 

Urethral neuropathy 88 

Urethral strictures 387 

Urethral stricture treated by medi- 
ate dilatation 91 

Urethritis, digitalis in .... 386 
Urethritis, treated writh corrosive 

sublimate 89 

Urethro-rhagia ergot as a styptic . 386 
Urethrotomy, internal .... 387 

Urine in syphilis 67, 358 

Urine, skin irritants on the secretion 

of 52 

Urticaria 152, 353 

Vaccinal erysipelas 149 

Vaccinal variola 149 

Vaccination 149 

Vaccination syphilis 371 

Van Harlingen, A. Vegetating 



INDEX. 



rAca. 
HberciiUr (yphOadena iaia io- 

(mC Ill 

VaiicoM uken treated bjr tannic 

a< iroa and poosk 148 

Variola tHnMiThafic 149 

Variola, tracdaal 149 

Vaacotar toners treated by injec- 

liwi with ergot 154 

KijfrtrtiiMi tmbtrtnlar tyfJkHtdfrm im 

am mfiml. A. Vam Harlingtn . in 
Venereal aflectioaa Heated bjr ten- 

pine ^l 

Venereal dJieam and wplJlia. Di- 

tt* «k i6m6B, 358 

Veoeml diaeaae* in Denmark, ftc 

^,365 
VcnetMlMCW ; lite nnity or dnality, 

thoviraaai Bnmrtead ... it 

VeartMl Matiatka 3K 

V imr m l w m tt, ttrntngmummi tf. J. 

SJmmmi Matt 14 

Ktmw MuHm tf lAt ihm. CUmitat 

y> 

Pigaa, 
Kaul 



Vims of venereal 10m ; its unity or 

diuliiy. BumMcad 35 

Viiceral lyphUi* 

Vulvo-iiuil repioa, lopat d the. . aK 

Vulval (jrphilia 361 

Ifartt, nmtigm un est tf vtmrtoL y. 

EJm$wiJ CimU 14 

H\irH, amd tjr Artnic imkmaUj. 

Oiiiital C w wuaft iw . . . . aB 
Water tteitment hi ayphilia, coot- 

bined with iaoactioa .... J79 
I V t mau , tast if m kmrJtd. L. A, 

lhiAri»e «93 

Xaatbelatma o< iIm Uda, heredity of 

certain foma e< yj 

Xaathelaama plaaam aaaociated 

with chronic jamdice .... 54 
XaathclaHMplHHHB of the cyelida. 

caM of «a4 

Vawa ari*in( tram •TPhilia ... 144 
Zoatcr, diaical ftndy of . . • • 15s 
Zoater. etioloj yof ■ . . • . • 157 

F. p. KinmitwK laS 

Zmbr, fatktltp if. G*». tf. Rtkk 31S 

Zoater, patboloBr cf. 10 

I have delayed th« jrca c n t Imm madi 



(A nawher of 
beyond itaregolar tiiM of appearaaot ; it ia hofied tint inch Belaya may be 
ceaMry In tiM fntnra. Eo.) 




AECHIVES 



DERMATOLOGY: 



A QUARTERLY JOURNAL 



KIN AND Venereal Diseases. 




BomD rr 
L. DUNCAN BULKLEY, A.M., M.D., 

amd Vntr—I IH —f M lit Ot^-Tliml D f m < it <<«*> f/tm YmtHt^itml ; tte. 



COtXAM»ATOH : 

DRS. B. B- KRONSON, ROBT. CAMPBELU RICHARD H. DERBY, P. P. POBTSI, 

CKO. H. FOX.B. L. KKYES. GEORGE M. LEPPERTS. HENRY a PIPPAROb 

A. R. ROBINSON, EDWARD C SECUIN MS R. W. TAYLOR, or New You; 

DRS. JAMES C.WHtTB.JUiD EDW. WIGGLESWORTH, o» Bonw: 

DRS. L. A. DUHRING *«d A. VAN HARUNCEN. or I 

41ID DR. JAMES NEVINS HYDE, or CacMO. 



THIRD VOLUME. 



NEW YORK: 

O. p. PUTNAM'S SONS, 

iSa FiPTH Atimvx. 

1877. 



Copyright. 
DUNCAN BULKLEY. 
1877. 



EDITORIAL 



A special Journal, devoted to a branch of medicine which has 
been so much neglected as Dermatology by the profession at large, 
inust create for itself a |x>sition, and command its own audience, 
which it must in a measure educate up to its standard ; this of 
course refers only to the general practitioners, who have not devoted 
»ny special thought or study to the branch. 

The aim of the Archives or Dermatoixxjv has been to meet 
the wants of the General Practitioner, and to serve as a means of 
commanication between the specialist, whose whole time and 
thoogfat are devoted to Skin or Venereal Diseases, and those in gen- 
cral practice, that the daily-gained experience of the latter may 
reach the former. To this end the Editor and staff have endeavored 
to include within its pages reference to everything which has been 
reported elsewhere in these departments during the year, in addi- 
tion to the large amount of original matter which has filled more 
than one half of the Journal. Many of the original articles have 
undoubtedly been very special in their character, and considerable 
of the matter digested from other Journals has been purely scien- 
tific, but it must be borne in mind that it is impossible to render 
the entire subject of Dermatology clear and interesting to those 
unacquainted with more than hs rudiments, and that the .\rchivcs 
is designed to serve as a compendium of knowledge in this branch 
for those engaged exclusively in it, as well as an assistant to the 
general practitioner in managing these diseases. 

Attention is especially called to the very large number of refer- 
ences to Dermatological literature contained in the Review and 
Digest departments. Vol. I. contained six hundred and thirteen 
references ; Vol. II. seven hundred and sixty-eight, and in Volume 
III. the number reaches eleven huiulred and forty-five. It is be- 
lieved that this record is unique, and that no branch of medicine 
has ever been thus thoroughly presented to the medical public, 
and that the indices of these volumes are unequalled for fulness 
of reference. 

The Editor has continued the serial articles entitled " Clinical 



EDITORIAL. 

Conversations on Diseases of the Skin," and the " Notes on the Local 
Treatment of Certain Diseases of the Skin," with a view of furnishing 
in each issue practical matter of immediate service to those little 
versed in Dermalotogy ; they will be continued as long as they con- 
tinue to meet with the favorable reception which has been accorded 
to them in the past. 

With the beginning of "Volume II. it was found necessary to 
enlarge the capacity of the Journal, and accordingly it was printed 
much more closely — entirely without leads ; the gain thereby made 
was equivalent to sixteen pages in each issue, or sixty-four pages of 
solid reading matter during the year. In Volume III. the press of 
matter has been still greater, and in addition to the gain from close 
printing, the present number contains twenty-two additional closely 
printed pages, or one hundred and eighteen pages in all. It is hoped 
that the pecuniary support of the Archives will warrant the continu- 
ance of an increase in the actual size of the Journal. Space will also 
be gained in future issues by a new arrangement of the matter in 
the Digest Department, whereby the titles of articles which are not 
abstracted will be printed in smaller type and so condensed as to 
occupy but a small portion of the space heretofore required for 
them. Certain changes will also be made in the conducting of the 
Journal, aiming to furnish more accurately an account of the pro- 
gress of Dermatology, and therapeutical and other hints of general 
service. 

For these and other reasons the first issue of Volume IV. may 
be delayed much beyond the usual interval of time, and it may be 
deemed advisable to make the new volume begin with the coming 
year ; should this occur, the indulgence of our readers is asked. 



AMERICAN DERMATOLOGICAL ASSOCIATION. 

We look forward with interest to the coming First Regular 
Annua! Meeting of this newly formed Association, which is to meet 
at Niagara Falls on September 4th. There is every indication that 
the attendance will be large for such an organization, and that 
much of interest will be there presented. 

By a provision of the By-Laws titles of papers to be read must be 
forwarded to the Secretary not later than one month before the 
time of meeting. 




ilte attention of the profession is hereby called to the rery great 
raloe of C Mm ohme in tbe treatment of 

MUemaem mf the 9Sktm. 

COSMOLINE is a moderately dense, oleaginous substance, made 

from p.!r.'. li'ii. which has absolutely no affinity for oxygen or 
inoi.iiU'-. itui .'. ; ,. h will mottr d tc n ^ott ^firmtiit or ttmm* ramculin 

:iny dim i-- > r t- riipcraturc. It forms 

A perfectly bland application to the skin, 

«ven iti its mr«t sensitive condition'* and may be used alone or mixed 
with medicinal substances in the treatment of Cutaiuims affeciioms. 
1 1 Jots m0t tomtiiu with praof tpiritt. Ammonia or Ikt ca»stk aikmUts. 

n C0imktmea MemdUi/. 

with white wax or ointments and cerates ; with sulphur, iodine, 

: with camphor, c" - and 

etc. ; as also with de of 

ith, etc^ commonly ^jic»<.iiL>tii ni un- i.jun ni •>iMiincnt»; 

rnay be kept in a perfect condition for years when pre- 

' oanoline. 

'^inoline is also highly recommended as a lubricant for 

-^ : !s, bougies, etc, in tlM treatntent of 

Strietmrt of ike Urttkrm, 

f its perfectly bland, unirritating qualities, and because 
s rancid. It is likewise very valuable for protecting 
^«.j..v.,, .......uments from rust. 

Mnally, Cosmoline oflfers 

J FerTeei 9mktt4tmte 

for the fatty substances used eztemally, and possesses uas. ^.-.^s 
TAGEs over most of them. 

Prepared expressly for the Medical profession by 

E. F. HOUGHTON, & Co. 

»I5 South Front St. Phuj^delphia Pcim. 

For Saw tiy Itruntata tai mm, flve aii4 ten 
S t-'i ox. bo(U««. 



HEALTH FOOD COMPANY, 

13*7 EIO-HCTH ST., 

Between Broadway and Fourth Ave., NEW YORK, 

WOULD CALL THE ATTENTION OP THE PROFESSION TO THEIR 

WHOLE WHEAT FLOUR, 

AS A REMEDY FOR 

INDIGESTION, CONSTIPATION, AND MAL-NUTRITION. 

This Flour represents all the Food Elements of the Wheat, 
the indigestible silex coat being first taken off, and the entire 
kernel, including the phosphates, etc., being ground to fine 
flour by a new process, in which both the admixture of 
detritus from mill-stones and the injurious effects of heating 
the flour during preparation, is entirely avoided. 

IT IS CHEAPER THAN WHITE FLOUR, 

Because it contains nearly four times the amount of the Mineral 
Substances required for 

NOURISHING THE NERVES, BONES, HAIR, AND TEETH. 



ATTENTION IS ALSO DIRECTED TO OUR 

WHITE WHEAT GLUTEN, 

for diabetes, and for those requiring the Nitrogenous and Mineral 
portions of the Wheat, 7vithout starch. — This, like the Whole Wheat 
Flour, can be made into Bread and Crackers, or may be taken 
in various ways, and often proves a very valuable remedy for 
the Constipation and Dyspepsia, associated with many 



Circula'^s, descriptive of these and other Health Foods, mailed to all ap- 

p'icants. 



(Lats Mrrmooar • Haas), 



Chemist & Druggist, 

No. 268 FOURTH AVENUE. Cor. 21ST ST., 

NEW YORK. 



cotnTAim, roM MAsiK ron tmma ntjurr or domasms or thm sruf, 

HEBRA'S UNGUENTUM DIACHYLI, 

SAPO VIRIDIS. (GtKUAN Gkccn Soap), 
' OLEUM CADINI, OLEUM RUSCI, 

D«, BULKLEVS "LIQUOR PICIS ALKALINUS,** 

(raa»*>a» mtraoMxr roa ■ad. 

OLEATE OK MERCURV, 

OLEATE OF MERCURY and MORPHINE, Etc 



nUMORtPXIONS A. SPKOIJk.r.TT'. 



MO-^ir Ks^D-v. 



Tin: 



f-BOOK 



(>.••... , . . -.. 

By mioaAxo J. DUHouaoir. mj». 

la mMm i>«m « »»t t »«»< » n hm ii . «^»««i»wn. !■ « »— i 

|>il*CiihK»tiiiMl»«»>liMi» kSrL%*M«»M<»M •• M.Vai#ri* »n«M >i* Mi •■« 
l5»i»MM»>w»iiMinit.i ■irf»»>«*M»Sa*wiw«w«*»ii>TT;iJi >iil iiry»«»- 

■M«>w«M« » n i»M lil n l >» »l» ««»l—» ■«. It li f i l l . MM—y WM^«i<lf —m4^ TW 

IM aa^ mMto ■■■»■<■ •( MM (arfkai^. !•«■••• Mb !• MiWaa «■ Wf> UM ■ wtmt taw 
ii in iiii l li I i n iilM«»« ln» l i i>fc»li» i in — t m l n . 

■•■•4 ■■ clotk, •€••««. M«* !»,}& aaM few, by aaa. afaa w d pl tifikm. 



THE SEBnS OF AMEBICAH OLIHICiL LEOTTIBES. 

Volume III., kor 1877. 
No. I. TRANsrvsioN or Blood and m Practical Applica- 
tion. By ProC TIhm. C. Morton. >vo, paper. 35 p^ge*. 30 ctt. 
No. II. HvDROCtLL By Rrof. D. Hayes Agnew. 14 pages. 30 cts. 
No. III. Thr Philosophy or Mknstruation, Concrption, and 

Strrilitv. By ProC Mootrose H. Palleo. 2$ pages. 3$ cts. 
Na IV. CONVRRCRMT STRABISMUS. By Prof. Thos. C. Porley. 

G. P. PUTNAM'S SONS, i8j Fifth Ave , Nbw York. 



F. A. STOHLMANN. EDWARD PFARRE 

ESTABLISHED 1826. 

GEORGE TIEMANN & CO., 

MANUFACTURERS OF 

SURGICAL INSTHUMENTS, 

No. 67 CHATHAM STREET, 
^or. iVew Chambers St., NEW YORK. 

BRA.T^CH STORE : 

STOHLMANN, PEARRE & CO., 

No. 127 EAST 28TH STREET, 

Near Fourtli -A-venue, NEW YORK. 

81, 83, 85 BOEEUM ST., BROOKLYN, E. D., and Rear 
67 CHATHAM ST., N. Y. 



INTERN-A-TION-^L EXHIIBIXIOlsrS : 
PAHIS, 1867. JfHILAnELrHJA, 1876. SANTIAGO (aiiU), 187& 

2 Silver Medals. 2 Awards. 2 First-Class Medals. 

1 Bronze Medal. 1 Honorable Mentiox, 




Cosmoline is a heavy paraffinous oleaginous hydro-carbon, constituting the emollient and healing 
principle from Petroleum, highly purified, concentrated and separated from all the offensive and irri- 
tating properties contained in the natural or crude oil. No acids, alkalies, or any chemicals are used 
in its manufacture. It has no affinity whatever for oxygen or moisture ; and will never decompose* 
lerment or become rancid* in any climate or temperature. Cosmoline possesses, in a remarkable de- 
gree, the natural combination of certain demulcent, refrigerant, antizymotic, protective, and other 
valuable healing nroperties. While its softer or oily properties lubricate and penetrate the parts 
affected, it is sufficiently rich in paraffine, to afford a perfect protection to inflamed surfaces from 
atmospheric action, and other malinc influence. It is therefore not simply an oil but an unguent ; and 
will permit of a bi,q;h degree of trituration, either atone or in combination with other medicaments. 
IT IS -A- FER.FEOX -A^I>3PLia-A.TI03>a-. 
Cosmoline 18 extremely bland, soothing and cooling to the most sensitive conditions, and can be 
applied even to the eye, without causing the slightest irritation. Its i>ermanent character ensures 
great uniformity of action in given conditions. It combines readily with White Wax or Ointments 
and Cerates; with Sulphur, Iodine, Bromine, etc., with Camphor, Gums* Resins, etc., with Carbolic 
and Tannic acids, etc. It Jofs not combine with Proof Spirits, Ammonia, or Caustic Alkalies. Com- 
ing from the same primitive source as Carbolic Acid ; it has a peculiar affinity for that valuable remedy 
?jid forms a superior vehicle for it. On account of its simple and positive character it is vastly 
superior to Olive Qil^ Lard, etc., as a menstruum. As ai| emollient, it is superior to Glycerine, 
especially the Rose-Perfumed. Its non-affinity for oxygen or moisture renders it a perfect protection 
against rust when applied to surgical instruments, and p>reveut5 hard rubber instruments from cracking. 
The odor and taste peculiar to Cosmoline, could easily be removed, but not without lessening its 
therapeutical value. It is absolutely free from moisture, and therefore will not in time have the odoi 
of decomposition. Its degree of odor is permanent, purposely retained, and indicates the presence o/ 
valuable antiseptic and other medical properties, which have not been destroyed to please the fancy. 

Prepared expresMly for medical purposes by E. F. HOtJGIITOIV Sc €0., 
S15 South. Front St., I^hilaclelphia, TJ. S. jV. 

FOB SALE BT SBUGQISTS IN 1 lb., 5 lb.. 10 lb. CANS AND 3H oz. BOTTLES. 



Recent Medical Publications. 



Ferriar (Pmor. David. M. f). K. R. S.) Th« Functions of the 
Bkain. OcUto. Cloth with numcioai illaMration*. $3 50, 
Of thii work the Lomlon '.Valtirt ' tajn ; — 

" Faa of MifgiMinm, wmI hck in farU wUcb no-coaslcr bets emu Mt uMs. Il 
win laa( r—Mln • M ot ifc oii M 10 wkick all wiliMi ■■■ go lor ■iniitl " 

"TWdkicf ob(Kl of tha ratkor. IwliiforaMa*, wa* to hhmK to tW Mtdonl of 
f^ytUhfy or pajrcboloor ■ » ) miuo tlc cxhlbiiioa ol tk* kwirim ol kim ovm np«rta«al« 
«■ Um kacikaa cl Iba braa. In <Wa( lu ii wa* Mcaaary 10 corn lk« wkota gnmDd 
«t mm ftlttloii."— ^il. Mtdkal amJ SmrfitMl ytmrm^. 

S J>— M (MaBV Pt*TNAM. M. r>.) ThK QtTKSTln> OF RMT FOk WoMCN 

IHVklxo MrxsTtfATlON. Bring the Uojrbton Priie Emsjt of liar- 
' vanl Univcr>ii]r for 1876. With Fifty SphjrgBMipaphic Trace*. Umwing varia- 
1ioa« in anrrial teiuion, ukI table* (iviac wJti of ajo orca aaalytct of 
arinc. OcUvo. Clollt, 9} 00. 

"Tkartcaa k*aede«b( Ikat tb« anlkor ka* porfanaad a vary KrataAil larric* l« 
aMdkal adoaca, aMi ■• kar own ica. In ika prodvctioa of iMa laaiaad aatf laauwthr* 
<l— mliia."— Ct<f<^ Tritmmt. 

" Il l« (ood 10 w« a book abou woaian kjr a woaMa. Our antkor. am—a. wkh 
aU kar eapartenca •< w mn a«. i i r niw aaa to iiaio tka iacia aa aha k>« aaparto nt aJ tk— and 
•aantkaaa. Sheteaauclaartjrandcnadidljr, and tka work Is wcO worlk raadlat, and 
>battUbaanaMkartaronlk«aabiact."-.V. V.StltMe Mt^Mfytmrmtt. 

gagwla (E. C. M. D., Clinical rrofcMor of DtMaacs of the Mind and 
NervoB* Sjralctn. ia the Cotlej^ of I'hjnticiaiu aiMi Suijcanst. New Yuri ) 
UvuUTl* or THB AxmtlOR llokNt: or Spiaal Parmiyiua of the Advlt and 
the Child. Octa«o. Chi(h ntn. $1 50w 

~ Thia e«ar hy Dr. Safwin h aaMkar *alwkbla caaulbatioa in ikl* dajiarUBaal of 
nlwdr. and can ka rnaiiMa Ud. nut aal)r lur it* c lf i na iola i a l awi n l. and fai Ika rahta 
o( Ika iacia praMMad. bvt lor lu mccm in raadanng iKira easy Iha difaramlal dla^no- 
•la o( rkangr> In tba aManor comna at tka arc froa olhar iaras at avuial aflcctlon* " — 
.Vfw Ytrk MtJifl Krrirm. 

F»rqah»rM>a (fKor. Koiilrt) A Gaidc to Thcrapculio 
Cloth. J 3 i«. 



HUl (BKftKBt.SV) aad O o> yr (ARTHI-R). The student'* .Mmn.u ni 
Venereal Diieaaa*. Bciag a coaciac de*cn|>lion of tho>c affection* and their 
treatment, itmo. Cloth, %\ 00 



Kebiaaoa (IIe.\ky) and Walll— (Join* CHARt.£s). Purification of 
Water Carried Sewage. Dau fur the guidance of Corporations, Ooords of 
Health and Sanitary aathoriiic*. OcUvu. Cloch, 6a 50. 



G. P. PUTNAMS SONS 

1 82 Fifth .Avenue. .N<«- \ rk. 



THE SERIES 



American Clinical Lectures. 



OONTEN"TS OF YOLUME II., FOR 1876. 



Octavo, Cloth Extra, $3.00. 



Wo. 1.— The Principal of Physiological An- 
tag-onism as applied to the Treatment 
of the Febrile State. — By Robeiits 
Bartholow, M.D.. Professor of the Theory 
and Practice of Medicine; and of Clinical Medi- 
cine in the Medical College of Ohio ; Physi- 
cian to the Hospital of the Good Samaritan, 
etc 

No. II.— On Certain Forms of Morbid Ner- 
vous Sensibility.— By J. S, Jewell, M.D., 
Professor of Nervous and Mental Diseases in 
the Chicago Medical College. 

No. m.— The Treatment of Mild Cases 
of Melancholia at Home.— Bv E. C. Se 
ouiN, M.D., Clinical Professor of Diseases of 
the Mind and Nervous System in the College 
of Physicians and Surgeons, New York. 



No. IV.— Some Forms of Dyspepsia. — By 
FRANas Delafield, M.D.. Adjunct Profes- 
sor of Pathology and Practical Medicine in the 
College of Physicians and Surgeons, New 
York. 

No. v.— DiagTiosis of those Diseases of the 
Eye which can be Seen without the 
Ophthalmoscope.— By Henry D. Notes, 
M.D., Professor of Ophthalmology and Ot- 
ology in Bellevue Hospital Medical College ; 
Surgeon in the New York Eye and Ear Infirm- 
ary. 



No. VI.— The Modern Methods of Exam- 
ining the Upper Air Passages.— B^ 
Oeorob M. Lepfekts, M.D., tlinical Profe»- 
sor of Laryngi>scopy and Diseases of the 
Throat in the College of Physicians and Sur- 
geons, New York. 

No. VII. —On Tracheotomy and Laryngo- 
tomy.— By H. B. Sands, M.D.. Professor of 
Anatomy in the College of Physicians and 
Surgeons, and Surgeon to the Bellevue and 
Roosevelt Hospitals, 

No. Vm.— The Hypertrophied Prostate. 
—By Robert F. Weir, M.D., Lecturer on 
Genito-Urinary Diseases, in the College of 
Physicians and Surgeons, and Surgeon to the 
New York and Roosevelt Hospitals. 

No. IX.— Points In the Surgery of Chlld- 
hood.— By J. H. Poolet, M.D., Professor 
of Surgery in Starling Medical College, Colum- 
bus, Ohio. 

No. X— Spinal Irritation : Its Pathologry 
and Treatmf nt. — By William A. lUa- 
MOND, M.D., Professor of Diseases of the 
Mind and Nervous System in the Medical 
Department of the University of New York. 

No. XI.— On the Treatment of Eczema — 

ByR.W. Taylou, M.D., Physician to Charity 
Hospital, New York- 
No. Xll.-Peripheral Paralysis. -By F. J. 
Miles, M.D., of Baltimore. 



EXTRACTS FROM NOTICES OF THE PRESS. 

ITiis series will be read with much pleasure "—London Medical Secord, May 12, 1B7S. 

" The series of Clinical Lectures, edited hy E. C. Scguin, M.D., are all that conld be desired in that 
direction."- Cindnnflii Lancet and Observer, Sfpt., 18T5. 

" This brochure (No. IV.) constitutes one of the series of American Clinical Lectures now being 
published under the editorial management of Dr. Seguin. We have read it with very groat satisfaction; 
and when we say that it is one of the best contributions which Dr. Mitchell has made to practical 
medicine, we award it, in our opinion, the highest praise." — Phi'a. Medical Timet, April 14. 18"5. 

" We commend the undertaking with all our heart, and shall look for^vard to its further progress with 
a lively interest in its success."— -Vew OrUant Medical and Surgical Journal. 

" The series is heartily commended. Their special value is that they are practical in their teaching." 
— Virginia Medical Monthly, April, 1875. 

"The lecture to which we have referred In this notice is of special interest and importance." — Am. 
Journal of Medical Sciencet, Oct., 1875. 

" The first number already received, fully sustains the announcement."— Z)«(roi/ Beview of Phaimacr 
and Medicine, March, 1875. 

*' If Dr. Seguin's success in procuring lectures is as good in other departments of medicine as this of 
Dr. Mitchell's is in the one m which he labors, he will confer a benefit on the profession In issuing them.'' 
— Ohicago Journal of Nervout and Mental Disease, July, 1875. 

34 



INSI RUCTION IN DERMATOLOGY 



DR. B V LKLEY 

WItX CONTINUB HI* PRACTICAl. BSPOStTIONa OW 

DrSEASES OF THE SKIM, 
Demilt Dispensary, 



Wtvm S to SJO e'atook. 

Tha eourm will bt mtpplamtnltd bjf Didactic ijecturmj 
«4ai lk$ Mieroteopjf o( llU Skin aiul iU Panuila wSl bt 
mmwiutnticL 

^•« f*r th« Oours* of Two Months, - • 910. 

NUMBCR IN CACM COURSC LtUITCO TO TEN. 



rw Airtkac i*ftl«al»n. a**)? •• U D«*ua •nnat. M.D.. » Wwi au M^ 
Mkra II k-B.. ar %lkm Ik* Skia Cllat«M M tt* CaUa«a«f rkyitcUw *■« 8«ni»n 



Recent Medical Publications. 



The Series of American Clinical Lectures. 

"voil.tjm:k hi, for isrr. 

No. I. Transfusion of Blood and its Practical Application. 

]!y Prof. THO.S. G. MoKTON. 

No. II. Hydrocele. By Prof. D. Hayes .\>;Nr,\v. 

No. III. The Philosophy of Menstruation, Conception and 

Sterility. By Prof. Montrose A. Fallen. 

No. IV. Convergent Strabismus. By Prof. I'lios. K. Poolev. 

Further contributions for this vohime have l)een arranged for from I'ro- 
fessors S. D. Gross, S. W. Gross, Wm. Goodell, Harrison Allen, and Doc: 
tors Wm. Thomson and J. C. Wilson of Philadelphia, Prof. Wm. H. By- 
ford of Chicago, and Professoi-s Fordyce Barker, E. R. Peaslee, E. O. Jam- 
way and N. M. Schaffer of New York. 

The Numbers of the Clinical Lectures, both of this new volume, and Vol- 
..Tues I and II, will hereafter be .sold at the uniform price of 25 cents each. 
The i^rice of the volumes has been made.S3 00 each, and that of the yearly 
subscrijjtions also $3 00. 



Transactions of the American Neurological 
Association. 

VOI^TIMIC II, FOR 1877. 

Containing essays by Doctors Jewell, Hammond. Miles, Webber, Emerson, 
Weir, Mitchell, Dupuy, Beard, Schmidt, Seguin and others. Illustrated. 
Octavo. Cloth extra, [in September] $3 00. 

A few copies remain of Volume I for 1S75. Illustrated wiili lithographs 
and wood-cuts. Octavo. Cloth extra, $5 00. 

The Medical Kegister for New York, New Jersey and Con- 
necticut, for 1877-7S. Edited by Dr. A. E. M. Purdy. l2mo, cloth $2 50. 

Diagrams for the Study of Cerebral and Spinal Lesions. Pre- 
pared l>y Dr. E. C. Seguin. Sheets containing 15 figures, printed on plate 
paper, per sheet-25 cents ; printed on thin p.-iper, per sheet 10 cents. 



JOURNAL OF NERVOUS AND MENTAL DISEASE : 



■ a. «lAu-«araa »t. 



rVBLISUCO <il'AmTEKI.T. 

FiTt DoUmn p«r Anaam, in AdTaae*. 

NEW TORK. 



th 

N 

I 

\ 

CI 



•ceo 



the (orn. 
prinicU i 
•ill be .: 
■ombct.* 

will I.ol 



F.^lit..r» ..t the CHICAGO JOURNAL OF NERVOUS AND 
- ->• rsoi 

;)r«- 
'ure 

.ica- 

UT- 
lol- 

New 
H. 

rom 

will 

\ND 

A Mih 

civ 



. ticiwe. 
■•tier fai iht JoutMAL will coatimie to be m in the 



taU ArtldM. 



NmWM 9]MMI Of 

'"'^. XS'lE 

••■MKt MCk toy 

TtT a Per! 



..Alft, ttx wIm^ 4fr»zi|[r<l i 







make it all 

"rtif or that 

- -'lie to 

witb 

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■In which wc hcre- 
naL, under its uew 
Nioo, and an honor 
: the focccM of the 
rt. Under tlie new 
xi>c'.t:ng the support tjl the 



"nnccted with the Jouknal maT be ad< 
(Kc'cii cuncr to the editor*, ai 57 W aal u nglop Street, Chicago, or to the Eait* 
era publishers, G. P. Putnm'a Son*, jet Fourth Avenue, New York. 
Kespcctfallr. 

H. M. 



JEWELL. M. D. 
' BANNISTER, M. D. 
'For a than om burial ■ Csvia will b« hmsiilKd, (rrc <d posuce. lot 



Editor*, 
■mtr-inei 



ItEOElSTT ]yEE3DIO-A-3L, "V7"0RK:S 

PUBLISHED, IMPORTED, OR FOR SALE BY 

G. P. PUTNAM'S SONS, 182 Fifth Ave., NEW YORK. 



THE THEORY AND PRACTICE OF MEDICINE. 

By Frederick Roberts, M.D. Large 8vo. Cloth . . $5 oo 

A MANUAL OF MIDWIFERY. By Alfred Meadows, 
M.D. Second American from third English edition. 
Illustrated. 8vo. Cloth 3 25 

ON TRACHEOTOMY, IN RELATION TO DIS- 
EASES OF THE LARYNX AND TRACHEA. By 
W. PuGiN Thornton, M.D. 8vo. Illustrated ... i 75 

INHALATION IN THE TREATMENT OF DISEASE; 
ITS THERAPEUTICS AND PRACTICE. 
By J. Sous Cohen, M.D. Second edition, with many 
new illustrations. i2mo. Cloth 2 25 

THE CONVOLUTIONS OF THE HUMAN BRAIN. 
By Prof. Alexander Ecker. Translated by 
Dr. J. C. Galton. Svo. Illustrated 2 25 

THE ANATOMY OF THE LYMPHATIC SYSTEM. 

liv Dr. C. Klein. 2 vols. Sq. Svo. Illustrated. Cloth. 9 00 
THE NATURAL HISTORY AND RELATIONS OF 

PNEUMONIA. By Dr. Octavius Sturges. 

Svo. Cloth 4 25 

A TREATISE ON THE SCIENCE AND PRACTICE 
OF MIDWIFERY. By Prof. W. S. Playfair. 2 vols. 
Svo. Fully illustrated 1 1 25 

LECTURES ON STATE MEDICINE. 

By F. S. B. F. De Chaumont. Svo. Cloth .... 5 00 

ON AFFECTIONS OF THE HEART. 

By Dr. Horace Dobell. Svo. Cloth. Illustrated . . 2 75 
THE TEMPERATURE OF THE BODY IN PHTHISIS. 

By Dr. S. Ringer. Svo. Clofh i 10 

A COMPENDIUM OF HISTOLOGY. By Prof. 
H. Frey. Translated by Dr. G. R. Cutter. 
Svo, with 224 plate illustrations. Cloth extra .... 3 25 

CLINICAL AND MICROSCOPICAL ANALYSIS OF 
THE URINE, IN HEALTH AND DISEASE. 
Designed for Physicians and Students. By Geo. B. 
Fowler, M.D. 11 00 

THE ELECTRIC BATH ; Its Medical Uses, Effects, 
AND Appliances. George M. Schweig, M.D. 11 00 




NEUMANN'S 

Hand-Book of Skin Diseases. 

TKANSLATKO, WITH NO' IS, 

By LUCIUS DUNCAN BULKLEY, A. M.. M. D. 

I Tol.. iTO.. «47 pacM *"> M wood euU. Cloik, (i-ook 



he was fo« 
practice ol 



iu :ikiu. anc 

hrpnch, miK 

■ ■tncT 



• t^loftcsl AM:aa]P a 



iinbl* walk la lu orifiiMi *h«p*. aai 
tk«a to i» p »«t our •Hong lacooaaate 



. .>e wiJi 
■ u. „.^«.w. . ™ M., -.... y.tttdt 

M alMadorr work aa aka rt l m tw wtthls on/ r « a r *.' 

'erwUag la is 

g tenalreadT i<"''c <it>:ctvr'! Tir UrMfxbU optntoa of ik« book la p«te(. *ad •■ ilad tkal III 



'a to tb« pubuc «i !•«.' - 7j-i«. f. i» *</«, 



G P. PUTNAM'S SONS, 

PRINTERS AND STATIONERS 



182 riTTH AVENUE, NEW YOSZ, 



POSSCS-S 



r Printing NIedical Monographs and 
> the notice of the Profession. 



BVBBT DB8CBIPTION OF BOOK AMDOBNKBAL. PaiNTINO 
CABBTULLY EXBCUTBD. 



ARCHIVES OF DERMATOLOGY 

A QUARTERLY JOURNAL OF 

Skin and Venereal Diseases. 

edited by . > •■ 

Physician to the Skin Department, Demilt Dispensary, New York, Etc. 



Although devoted to the study of a special branch, and containing much 
scientific matter of a special character, the Archives of Dermatology is bj 
no means of interest alone to the specialist. 

With the aim of furnishing to the general practitioner, in each issue, 
matter readily understood and of immediate practical advantage, the Editoi 
has, during the past year, supplied, in the form of C/itiical Conversations oi. 
Diseases of the Sliin, reports of cases of the more cdmmonly met with cuta- 
neous afiections, with remarks upon their diagnosis, treatment, etc., as giver 
to private classes at the Demilt Dispensary, New York : he has also giver 
articles on " The Local Treatment of Certain Diseases of the Skin," whicl: 
present, in simple form, prescriptions in common use, with directions fot 
their safe and successful employment The very favorable reception which 
both these have met with warrants their continuance, and it is hoped and 
believed that they will be of service to the general practitioner, for whom 
they are intended. 

The department of Digest of Literature will aim, as in the past, to - ••' 
I'eference to every article published relating to Skin or Venereal Di'^ 
with a synopsis or criticism of such as contain new or interestincr "" ■ 
tical facts. 

NOTICES OF THE PRESS. 

*' We have here the first volnme of a quarterly devoted to skin aiKl vrncrrnl .li-irn-<-J. wliieli Iij ' 
sense .a credit to Aracrictm iileraturc and deserving of cMcnsivc ■; .- rorij 

" If the conductors can secnre a succession of numbers in the fir uteria 

as till? first Bpecimcn one, they will not tail, wo tliinic, to meet wii : 

"Tlie numbers of this licw dermatological 3onrnal that have appeared, and which couslilutc the llrsi 
volume, sustain well the promise of being a complete repertory of all current work iu its own department.' 
—London Praclilioner. 

"This volume Is extremely creditable to its originators. « « » « « the reviews are independent, 
deservedly severe on certain recent puhlictitious. —.HrifitfA Medical Journai. 

" It is, in my hnmble opinion, hy far the best Journal of Dermatology which has oppegriid fn any Ian. 
izuase. The articlea are not tedious and lengthy • • * * they are, for the most part, praiUcal."— J/fCa.', 
Anderson. 

Subscription $3.00 a year, in advance. Single Numbers, $1.00. 

G. P. PUTNAM'S SONS, Ptiblisliers, 

rVolume III. bt^-an October, 187G.] 182 FifthT^venue, New York. 

3G