A post-mortem examination was made on Monday, February 20th, when a considerable growth was found in the mediastinum (probably primary), pressing upon the right bronchus, and smaller growths sparsely distributed in the pleura, lungs, retroperitoneal glands, etc.
CURRENT LITERATURE.
ON THE QUESTION OF BLASTOMYCOSIS OF THE SKIN AND ITS RELATION TO “FOLLICULITIS EXULCERANS SERPIGINOSA NASI” (KAPOSI.) Brandweiner. (Archiv f. Derm. u. Syph., August, 1904, p. 49. One plate.)
This paper is based on a case which occurred in Dr. Matzenauer’s clinique in Vienna. The patient was a shoemaker, aged 37 years, who suffered from a papillated crusted lesion on the lower part of the left side of the nose. The diseased patch occupied the ala nasi, and extended up as far as the bridge, where it faded into the surrounding skin. It was reddish-brown in colour, raised and irregular in shape, and covered with yellowish inspissated pus. It had been noticed first about a year before. On histological examination the stratum corneum was found to contain numerous unicellular organisms of from 4 to 10 µ in diameter, which stained with polychrome methylene blue, were doubly contoured and were believed to be blastomycetes. The epithelium had proliferated and presented small necrotic pustules containing these organisms. There was a round-celled infiltration in the corium in which the blastomyces was also detected. An attempt to cultivate the organisms and to inoculate them in lower animals was unsuccessful. On the ground of this not quite convincing case the writer took the opportunity of reviewing the literature on the subject. He referred in detail to several cases described by Kaposi with the title of “Folliculitis exulcerans serpiginosa nasi,” which he regarded as most probably identical with “blastomycosis.”
J. M. H. M.
A NOTE ON THE TREATMENT OF SYPHILIS. Jonathan Hutchinson. (The Practit., August, 1904, p. 145.)
In this short communication the writer refers at the outset to the remarkable fact that mercury obtained its reputation in the treatment of syphilis almost immediately after the introduction of that disease into Europe, and “the pills—which were known as Barbarossa’s, and of which a large quantity was furnished for the treatment of Francis the First—were probably essentially the same as those which Messrs. Burroughs Wellcome and Co. now supply by the million.” In opposition to a number of writers, especially on the Continent, the writer is a strong advocate of the early use of mercury, and of what has been called the “suppression treatment.” He commences mercurial treatment immediately the syphilitic character of the sore is definite. The prevention of late or tertiary phenomena being the most important aim in the treatment of the disease, efforts should be made to this end, and he considers that the immediate use of mercury, which may prevent the secondary stage from developing, has also the effect of reducing the possibilities of the development of the late stage. With regard to the length of time the patient should continue to take the mercury the writer strongly believes in the efficacy of prolonged and continuous treatment. He does not see the object of intermitting the course and giving the specific virus any chance of renewing its activity unless the mercury is interfering with the health of the patient. The plan of treatment usually adopted by the writer is as follows: “A pill is prescribed containing one grain of grey powder and one of Dover’s powder, and this the patient is to take after meals, and only three times a day at first. If no diarrhœa follows, the pill is to be given four, five, or six times a day.” The diet is regulated, and the patient is told that the treatment must be continued without intermission for a year at least. An alum mouth-wash is ordered to prevent ptyalism. If there is debility, a grain of quinine is added to the pill. In using the iodides he considers that the iodides of mercury are much less manageable than the two separated, and prefers to give the iodide of potassium in a fluid dose along with the mercurial pills.
J. M. H. M.
URANIUM IN THE TREATMENT OF LUPUS: A PRELIMINARY NOTE. Norman Walker. (The Scot. Med. and Surg. Journ., September, 1904, p. 207.)
The method of applying the uranium which was adopted by the writer was to prepare an oxide of uranium from the nitrate, incorporate it with a negative base such as bees-wax, and spread this on leather to form a plaster of the usual thickness and the required extent. The plaster is enclosed in waxed paper gummed at the edges. The uranium plaster was applied at first in cases where the limbs were affected with lupus and later on the face. Exposure for three days and three nights to an affected arm was followed by no reaction, but on the face it was found that a slight reaction followed in cases where the exposure exceeded twenty-four hours. The plaster may be worn only at nights and removed in the morning. The results have been encouraging, and the risks appear to be negligible. The treatment is cheap, since the cost of making the plaster has been estimated at about one shilling, and experiments have shown that the plaster remains active after four months. This short paper is illustrated by reproductions of four skiagraphs, one taken by thorium and the other three by uranium plasters. These demonstrate the fact that the radio-activity of the uranium salt is much greater than that of thorium.