HARVEIAN SOCIETY OF LONDON.

518 important that they should be of a sufficiently solid consistency not to run into the covering and leave the surface dry. Later resort might be had to stimulating applications tc, Varieties of Eczema and their Treatment. patches which proved resistant and it had even been recom.. A MEETING of this society was held on Feb. 16th, Mr. mended to scarify very old and thickened parts. Dr. GALLOWAY remarked that he thought that Dr. HENRY JULER, President, being in the chair. had taken an appropriate opportunity for protestWhitfield Dr. WHITFIELD read a paper on Varieties of Eczema and their Treatment. After pointing out that the older classi- ing against the too easily accepted hypothesis of the.fication into idiopathic and symptomatic was based on pure bacterial origin of eczema and he especially agreed with, Dr. Whitfield in protesting that no special coccus such as.. theory and that the other classifications merely indicated the " morococcus had been discovered to act as a specific: stages in the process of the regions attacked he proceeded to examine the evidence on which Unna’s variety of sebor- organism. If anyone took the trouble to examine carefully rhoeic eczema was based. After excluding psoriasis and the evidence on which Dr. Unna had based his description of morococcus as the specific cause of seborrhoeic eczema, simple pityriasis of the scalp the question was whether his it would readily be seen how slight it was. In the casehe answered in This remained. question anything the affirmative and defined seborrhoeic eczema as a which Dr. Unna demonstrated before the Hamburg. disease starting in the follicles, afterwards possibly Medical Society, in which he had produced what he. his inoculation vesicle from pure cultures of attacking parts which were destitute of follicles, having called this " whitecoccus, the important clinical fact outa well-defined border to the edges of the patches and a strong tendency to serpigincus advance. Audry’s case of standing was that the lesion so produced was not. seborrhceic eczema occurring on scar tissue was then dis- eczema at all but something much more closely resemblingcussed in order to show that although seborrhosic eczema impetigo. From the time of this demonstration this coccuscould occur on areas of skin which possessed neither had been quoted by Unna and many of his disciples as thesebaceous nor sweat glands, nevertheless it flourished much specific organism in his large group of seborrhceic eczema. more easily on normal skin. The fact of Audry having About the same time as Dr. Unna Professor Welch of the" succeeded in inoculating the disease from one part of the Johns Hopkins University had published his observations on; bacteriology of the skin. He showed that the organism patient to another was also mentioned as tending to show the that the disease was parasitic in origin. Dr. Whitfield then which he called the "staphylococcus epidermalis albus was. it lived a sapropbytie shortly mentioned the other varieties of eczema which were a constant denizen in the skin, where no existence and to to appeared pathogenic effects.own a produce the eczema parasitic origin-namely, supposed folliculorum of Morris, that of Neisser, the eczema myco- No sufficient evidence is on record to prove that the moroticum of Hans Hebra, and the eczema circumscriptum of coccus is not an organism of the same class, and’ Crocker. He considered that the clinical evidence in there is much to support the view that it is simply favour of these diseases being. due to organisms was a saprophyte. One could not help coming to the conrather strong but that until the different microbes had clusion that if any organism does produce seborrhoeic. been determined so that the diseases could be properly eczema, at any rate it is not the morococcus. classified, as had been done in ringworm, it was more Dr. Galloway felt inclined to look upon eczema as theconvenient to group them all under the heading of ordinary inflammatory reaction of the skin to many varieties’ seborrhoeic eczema." Passing on to the so-called simple of irritation. There was little doubt that amongst these eczema Dr. Whitfield said that there were two main opinions various irritants bacteria exercised considerable influence. The type of eczema which appeared to be of parasitic origin, as to the origin of the disease, one of which was that the disease was an outward manifestation of a constitutional was the seborrhœic variety, but he wished to emphasise theHARVEIAN SOCIETY OF LONDON.

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disorder and the other that it was due to some local irritant. He then proceeded to inquire what evidence there was of the relation of the disease to gout and quoted Garrod’s paper on the subject to show that although gouty patients were undoubtedly more prone to the disease there were no distinguishing points to indicate an eczema of gouty origin from that due to any other cause. Colombini’s researches on the toxicity of the urine in acute, weeping, and chronic dry eczema were then referred to and it was pointed out that as far as they went they were rather against the supposition of a toxaemia as the cause of acute eczema. The supposed danger of the sudden suppression of discharging rashes was then entered into and although there were one or two cases on record which seemed to show with reasonable certainty that the attempts at curing an extensive eczema had been followed by untoward results the accident was undoubtedly one of extreme rarity. On the other hand, a case had been published of a child who had died from septic infection from a wide-spread eczema and this danger seemed a much more important one than the supposed production of metastases. The parasitic theory of simple eczema was then referred to and was considered as entirely unproved. The recent papers of Leredde and Torok were quoted and the incompleteness of the arguments for the bacteriological origin of eczema were pointed out. The great confusion appeared to be due to the wrong use of terms and it was strongly to be deprecated that observers did not more accurately describe the lesions about which they were writing. The probability was that there were at least two diseases, one of which was of entirely unknown origin and might be called simple eczema and the other was probably of parasitic origin, unknown, and this was although the parasite was at present the disease to which the term ’’ seborrhceic eczema" might be restricted. Turning to the treatment of eczema, it was pointed out that in the supposed parasitic variety antiparasitic remedies could be used much more boldly from I the start than in the simple variety. In the treatment of acute weeping eczema it was best to treat the skin with soothing lotions which had just sufficient antiseptic power to inhibit the growth of any accidental contamination with cocci which would be sure to occur. Later, when the discharge had ceased, ointments could be used and it was

fact that the evidence in favour of this at the present time is. almost completely clinical and has no definite bacteriological support. It is most important, however, from the practical point of view, to recognise the fact that these varieties’ exist, as the use of appropriate remedies must be determined by the exactitude with which we are able to define thecausation of any individual attack. The value which has. long been appreciated of antiseptic remedies in the treat=ment of eczema depends upon the fact that certain manifestations of it are produced by parasitic influence. The more. clear we are, therefore, in our recognition of the found facts: of eczema produced or influenced by micro-organisms, themore successful will our treatment of the clinical varietiesbecome. Dr. ALFRED EDDOWES said that he found Dr. Unna’s, bottle" bacillus so frequently in cases of seborrhoea that he was disposed to think with Dr. Unna that it probably had a causal relation to the disease. But this was hardly the timeto deal with the bacteriology of eczema in detail. Hethought the word eczema" should mean a condition, not a definite disease, unless the word were qualified with an’ adjective. It was useful clinically to speak of seborrhœic Heeczema, impetiginous eczema, tuberculous eczema, &c. had accidentally inoculated two of his nail-beds by handling. a patch of impetiginous eczema and had obtained purecultures of the staphylococcus aureus from the resultDr. Sims Woodhead re-ing subungual abscesses. ferred to the fact in a paper in THE LANCET some’ years ago. He showed a photograph of a case of eczema contracted probably from a school thimble and expressed his. opinion that this slowly advancing form of dry eczema was of tuberculous nature. He also showed a photograph to illustrate what he called "sympathetic eczema." He had painted a chronic, stationary, sharply defined patch of eczema on the right forearm of a gouty (?) patient with strong iodine tincture. On the next week an exactly symmetrical patch of eczema appeared on the left forearm. In attempting to explain this remarkable reaction he suggested that

the vaso-motor system, like the muscular system, of nerves was so linked together that a sufficient stimulus to the centres could produce bilateral response, as was observed in the involuntary, genuine, bilateral laugh of the hemiplegic-

519 Mr. LARKIN showed, for Dr. JOSEPH WALKER a large As for treatment there was much that might be said. It was easy to lay down certain definite principles which werePedunculated Soft Fibroid of the Labium Majus removed always useful. We should keep in mind the physiological Jfrom a middle-aged woman. state of normal skin. We must dry a wet skin and grease a Mr. NEWBOLT showed the Left Humerus of a boy, aged 16 - dry skin. Dabbing with spirit and dusting with powder years, the upper end of which was occupied by a round.answered the first requirement and ointments the latter,celled sarcoma. Amputation was done 10 months ago and - while pastes occupied the intermediate place and were most as yet there was no recurrence. - valuable. Take, for instance, a bad case of "scald head," Dr. G. G. STOPFORD TAYLOR showed a Microscopic Section One thorough dressing with a of eczema of scalp, in a child. an Epithelioma of a Lupus Scar. The growth was situated paste such as Lassar’s frequently left nothing more to be on the left side of the neck of a man, aged 46 years, who "done by the medical man or the mother for a whole week, had suffered from lupus for 40 years. ..and at once made such a case greatly better and quite Mr. DOUGLAS CRAWFORD showed some Microscopic manageable. He was surprised to hear Dr. Whitfield say Sections of a portion of an Enlarged Prostate. The part had that he did not find pastes of great service. been removed by suprapubic prostatectomy for urinary Dr. BEZLY THORNE said that he attached more importance obstruction. The patient was 54 years of age and had already ’to toxic conditions of the blood in relation to eczema than had bilateral vasectomy performed with no permanent Dr. Whitfield was disposed to accord to them, and that he - could not regard as valid the argument that if the kidneys benefit. The section was much more glandular than was usual. were sound they must be innocent of mischief, because they Dr. ALEXANDER showed the Brain of a Male and habit be inhibited from regimen might by performance aged 20 years. There was complete atrophy of Epileptic, the left of their normal function. He gave as an instance the case lobe and the posterior parts of the frontal temporo-sphenoidal who had for seven a suffered from a severe of lady years The fits began in and afEected chiefly the right - form of eczema palmaris with inflammation of the matrices convolutions. side of the body. The right leg was permanently partially .and deformity of the nails, amounting in the index fingers but the paralysis was always much increased after to ;partial destruction. The total daily ingestion of fluids, paralysed, a fit. -consisting of tea, coffee, and claret, barely amounted Dr. BUCHANAN showed specimens illustrating the Structo seven-eighths of a pint. In three weeks the ture of Molluscum Contagiosum. ’disease was arrested by the use of an ointment containing A short discussion followed in which several members took ammoniated mercury, of a mixture containing grain doses of part. potassium iodide, and by the ingestion of two pints of water - daily. This result which had been maintained up to the PLYMOUTH MEDICAL SOCIETY.—A of ,present time was mainly if not entirely due, Dr. Thorne felt convinced, to the water which had restored to the kidneys this society was held on Feb. llth, Mr. M. H. Bulteel, Presithe power of promoting the purity of the blood. He added dent, being in the chair.-Mr. F. Everard Row read a paper that he entertained no fear of the local effect of salt water, on the Diagnosis and Treatment of Surgical Diseases of the as in every instance in which patients affected with seborKidneys with especial reference to Stone and Tubercle. The rhœic eczema had, under his observation, undergone a course chief symptoms for the diagnosis of stone and tubercle were. of saline baths the skin had become sound before the he said, (a) pain, (b) the condition of the urine, (c) termination of the treatment. That result might possibly be enlargement or otherwise of the kidney, and (d) reflex attributed to the diuresis which the baths in all cases symptoms such as vomiting and retraction of the testicle. The pain in both diseases was liable to the greatest possible induced. variation both in intensity and situation, but more especially Dr. WHITFIELD replied. so in calculus, and was due to several causes, as, for instance, to the passage of either a stone or debris of new growth down the ureter producing what was known as renal LIVERPOOL MEDICAL INSTITUTION. ___________

meeting

colic.

The

pain of

stone was more

frequently retlected and

and was often referred to the neck of the bladder to which attention was drawn instead of the true Anatorny of the Pineal Gland.-Some Points in the Structure cause, but be reflected anywhere from the shoulder to may the Dental Tissues.-Exhibition of of Specimens. the neck. Large stones embedded in the substance of the A MEETING of the Pathological and Microscopical Section kidney as a rule caused less pain than smaller stones, which of this society was held on Feb. 16th, Mr. F. T. PAUL being might be free in the pelvis of the kidney or become impacted in the chair. in the ureter. Hæmaturia was a frequent accompaniment Dr. ALFRED W. CAMPBELL read a paper on the Anatomy of stone, but was not so frequent in tubercle. Pus was uof the Pineal Gland and on Certain Pathological Conditions present in both tubercle and stone ; but in tubercle .-arising in it. He carefully described the naked-eye and it appeared early in the disease ; in stone it was not microscopical characters of this organ. He had examined a present unless pyelitis had been set up by the irritation large number of pineal glands and showed that in all there of the foreign body. Unless a kidney was much en-existed either a definite central cavity-a ventricle-or else larged it was not easy to palpate it. When the enlargecollection of specialised tissue resembling neuroglia. When ment was due to calculi crepitus might be felt by placing the cavity was present it was surrounded by similar tissue. one hand in the loin and pressing the kidney towards In some pineal glands he had found pigmented elements the fingers of the other on the abdomen. As to the reflex similar to those found in the retina. He also described symptoms, vomiting due to renal colic did not differ several pathological conditions which he had found in the from that due to other causes. Retraction of the testicle pineal glands of insane patients. (The paper was illus- was one of the most important features in renal stone. In trated by anatomical and microscopical preparations and by tuberculous disease early nephrectomy afforded the best ,some beautiful drawings and numerous lantern slides.)- chance of cure. When disease of the other kidney was obvious Mr. PAUL, Mr. LARxrn-, and Dr. GRUNBAUM discussed the or even uncertain nephrectomy was a futile or dangerous tpaper and Dr. CAMPBELL replied. proceeding and nephrotomy and drainage should be Mr. F. T. PAUL read a note on Some Points in the resorted to. In calculus the treatment resolved itself into palStructure of the Dental Tissues and illustrated his remarks liative and operative. Palliative treatment consisted in relievby some microscopic specimens and lantern photographic ing the pain of renal colic by hot baths, fomentations, and transparencies.—This note was discussed by Mr. RusHTON anodyne injections. The operative treatment consisted of PARKER, Mr. LARKIN, Dr. GRUNBAUM, Dr. MONSARRAT, exposing and puncturing the kidney and if a stone was found and Dr. BLTCHANAN. incising the organ and removing the foreign body. If Mr. C. G. LEE showed an Epithelioma of the Auricle and the kidney was disorganised by a number of stones ’discussed its frequency and relative malignancy in this and by pyelitis and the other kidney was known to be present and in fair working order either by cysto- situation. Mr. THELWALL THOMAS showed a Testicle with part of the scopic examination or by an incision in the loin nephrecSpermatic Cord attached into which an extensive heamor- tomy was indicated. In order to determine this latter point rhage had occurred. It was removed from a man 32 years abdominal nephrectomy was taking the place of the lumbar of age. The swelling appeared spontaneously. There was method.-Cases and specimens were exhibited by Mr. Row, great pain and the testicle was drawn up to the external Mr. Woollcombe, Dr. Pethybridge, Dr. Rider, and Mr. J. R. .abdominal ring. The microscope showed no new growth. Rolston.-A communication was read from the Corporate

paroxysmal