J. M. H. M.
OBSERVATIONS ON THE USE OF EUCAINE B. AND ADRENALIN AS A MEANS OF INDUCING LOCAL ANÆSTHESIA. George L. Chiene. (The Scot. Med. and Surg. Journ., September, 1904, p. 215.)
In this communication the writer makes some interesting and instructive observations on the value of combining adrenalin with encaine or cocaine as a local anæsthetic for minor operations. Satisfactory results were obtained by employing a mixture of a 2 per cent. solution of eucaine B. and 1-5000 adrenalin chloride, thirty minims of the solution being injected. The chief drawback to the method was the fact that adrenalin solutions did not keep well, and readily became inert and contaminated. This difficulty has now been obviated to a large extent by the introduction by Messrs. Burroughs Wellcome and Co. of a new preparation of the supra-renal gland called “Soloid Hemisine,” which is said to represent the hæmostatic principle of the supra-renal gland in a more stable form. The writer has had compound soloids prepared by the same firm which when dissolved in 10 c.c. give a solution of 1 per cent. eucaine B. and 5 minim. of adrenalin (1-1000.) By injecting this a carbuncle the size of the palm of the hand was excised without pain or discomfort, and at a later date the surface was skin-grafted, the same anæsthetic being used. The writer believes that the addition of the adrenalin not only increases the efficiency but also the safety of the eucaine or cocaine as local anæsthetics.
J. M. H. M.
DERMATITIS FRAMBŒSIFORMIS. F. Sauerberger (Archiv f. Derm. u. Syph., October, 1904, lxxii, p. 3).
In this contribution the writer describes an unusual case which occurred in Professor Janovsky’s clinic at Prague. The patient was a coal-miner, aged 18 years. At the age of 14 he began work in a mine and soon afterwards he suffered from a severe attack of furunculosis, which persisted for a year. As it got steadily worse he had to leave his work for a time. When he was able to work again he got employment in another mine. After some time he went to the original mine and the furunculosis returned rapidly and he was again compelled to leave work. He blamed bad drinking-water as the cause of it. Several other miners in the same pit were similarly affected and among them was the patient’s father. Soon after leaving work for the second time the pustular lesions began to be replaced by raised papillomatous masses which were especially well-marked about the face and neck. The eyelids, forehead, tip of the nose, nasal orifice, lips, chin, and left side of the cheek became covered with crusted papillomatous lesions. A few similar lesions developed on the body in the inguinal regions, and both the cervical and inguinal glands were enlarged. A microscopical examination of one of the lesions showed a proliferation of the interpapillary processes, and a dense cellular infiltration in the papillary and sub-papillary layers, consisting chiefly of leucocytes and mast-cells and dilatation of the capillaries. The lesions did not react well to local treatment, but eventually with tonics and by persevering with local remedies a cure resulted. There was no history or evidence of syphilis. The disease was similar in many respects to tropical frambœsia or yaws, and corresponded closely to a case which Lewin described as sporadic frambœsia.
J. M. H. M.
ON THE RADIO-THERAPEUTICS OF RINGWORM. Sabouraud. (Ann. de Derm. et de Syph., July, 1904, p. 577.)
In a previous paper (published in January, 1904, in the Annales de l’Institut Pasteur) Sabouraud had proposed a method of treating ringworm with X-rays, which he sums up as follows: “The application in one sitting upon a given point of the scalp of a quantity of X-rays equal to 4-1/2-5 H-units of Holzknecht is made; fifteen days later a complete epilation will occur on the region treated, healthy as well as diseased hairs being shed. New and healthy hair will commence to grow ten weeks after the treatment, and will be completely restored within ten weeks. The infectivity of the disease will cease with the fall of the last diseased hair, within twenty-five days at latest of the treatment.” This formula, Sabouraud maintains, has been amply proved to be true by his experience of the six months which have intervened since his paper of January, 1904. Some very striking results are quoted. Thus while in six months before this treatment was adopted 57 patients were discharged as cured, in the past six months 134 such patients were discharged; moreover, a very large number of patients were treated without admission and also cured. An entire section of the hospital, consisting of one hundred beds set apart for favus cases, has been closed and will be converted to the uses of general medicine, as being no longer required for its former purpose.
Certain additional knowledge has been afforded by the experience of the past six months, which may be stated in the following practical rules: The penetration of X-rays is proportional to their number; the more penetrating they are, the more numerous they are. The danger of X-rays is proportional to their penetration; it is thus more dangerous to handle X-rays of 8°-11° (on Benoist’s radio-chromometer) than rays of 3°-5°. Now tubes change progressively with use and these changes are marked by colour changes in the glass. At first, after about ten hours’ use, the tubes take a violet coloration; with this there is no impairment of function. But with further use, after about thirty hours, a brown tint becomes marked, and the tube is said to be “smoked.” With this change it becomes increasingly difficult to obtain rays of a low degree of penetration. For epilation rays of all degrees of penetration serve equally well; rays of 3° are as effective as rays of 11°, but the treatment must be for a longer time. Thus a tube working at 3° caused an epilation in twenty-five minutes. The same epilation would result in eleven minutes from a tube at 8°-11°; and if one used the latter tube for twenty-five minutes, a dermatitis would result. This is entirely unnecessary for epilation and is attended by mischievous consequences, even when quite slight, and must be avoided. All forms of dermatitis, except that of transient erythema, produce permanent baldness. Permanent alopecia may also result without dermatitis in cases where the amount of X-rays given has been insufficient to cause epilation, and a second séance has been necessary. In this case certain hairs will have received a dose beyond the maximum for safety, and these will be permanently destroyed. For safe working, it is necessary to have a measure of the rays coming from the tube at any given time; and the measure must be constant for every variety of tube. This is obtained by certain colour changes taking place in specially prepared substances, these changes being proportional to the amount of X-rays derived from the tube. The pastilles of Holzknecht have been used for this purpose, but they are a secret preparation, expensive, and not everywhere procurable. Sabouraud has devised small discs made of paper which is the same as that used for screens and is coated with a preparation of platino-cyanide of barium. These discs change in colour in a fixed manner, comparable from time to time with test-colours, and their use makes it impossible, with care, to overstep the limits of safety.