Page images

even iritis, strangely resembling those caused by syphilis, adds more difficulty by lessening the reliability of the classical diagnostic signs.

However, the presence of the above characteristics, wholly, or in part, at once gives direction to the investigation of any given case. The most reliable indications of syphilis are as follows:

(a) When the initial lesion is present, it usually appears on the glans penis, lips, throat, labia, os uteri, and in the case of sodomists, on the anus or higher in the rectum, in fact, may be found on any mucous membrane with which the virus comes in contact.

This lesion looks so impotent and of so little consequence to the patient, with its indurated base, well defined edges, cup shape, with little secretion, lack of soreness, and tendency to heal in comparatively short time, that he is not aware of his possession until he has a sore throat and eruptions appear upon the skin.

A case of the above sort presenting itself, usually does not cause much difficulty in diagnosis, because the disease has not been • modified by injudicious mercurial treatments, which so frequently aggravate.

(b) The cutaneous lesions, frequently, if not usually are the only guides to a diagnosis, and skill in interpretating them can only be acquired by objective study; not from pictures, but from real cases in private practice and in clinics. The senses can be so educated to recognize the disease and to differentiate it from other skin lesions, that the knowledge thus gained, can not be imparted by the most skilled didactic teacher.

The value of comparative study can not be too highly appreciated, owing to the above statement in regard to the similarity of these lesions to other skin affections, therefore, the profession at large can assist very materially in the study by furnishing cases to our college clinics. It is not the ordinary cases which are so difficult to diagnose, but those presenting variations, that tax the diagnostician's skill.

There is no class of diseases in which a correct diagnosis is more important, principally for two reasons. (a) If not syphilis, the patient should not be subjected to the psychical strain and the medication usually administered, both of which may endanger the life and happiness of himself and family. (b) If it is syphilis and not diagnosed, then the consequences may be still more disastrous to the patient and all with whom he may be associated.

There are at least forty-five different names given the syphilids, the results of efforts of ambitious syphilographers and dermatologists to coin names and become famous.

They are, principally, products of the imagination and not from any real difference in the lesion. For example, the following are some of the names employed to designate the disease: Tubercular ecthymatous, lichinoid, psoriasiform, herpetiform, frambesoid, acniform, pemphigoid, varicelliform, squamous, pigmentary, erythematous, nummular, macular, populo-squmous, varioloform, vesicular, pustular, lenticular nodular, etc. The above are named from their fancied resemblance to some other disease or object, also, a number of names are formed from the location of the lesion, all of which are confusing and unscientific. This, however, illustrates the multitude of features comprising syphilitic eruptions, and also, the necessity of educating the sight in order to recognize the disease. The following case, which came first to the college clinic and finally was sent to the city hospital, illustrates a peculiarity seldom seen. .

There was a positive 'history of infection, which of course, removed all doubts as to the nature of the case.

The peculiarity of the eruption was the pearly scales and the mixeil form comprised of annular and irregular shapes resembling psoriasis; color peculiar to syphilids was absent; considerable itching, etc. When scales were forcibly removed, there was left an almost raw surface, with a tendency to bleed.

The case was treated mostly by inunction of mercury, following the usual plan of using ordinary mercury ointment, rubbing a small amount on the skin in the subaxillary region and inside of the thighs. Every third day cleaning the skin and then waiting two days before applying the ointment again.

We followed this treatment throughout the case, in order to test its efficacy. At the end of six months the eruption had mostly disappeared, leaving only slight discoloration.

(To be Continued.)




Dr. Junius H. McHenry of Cleveland, in recent paper read before the Clinical and Pathological Section of the Academy of Medicine of Cleveland, May 10, 1909, reviews the literature of the rare condition of fracture of the anterior spine of the ilium by muscular contraction. He finds but nine cases reported, Dr. McHenry's case making ten in all. I desire to add to this list a case strikingly similar to Dr. McHenry's, and to call attention to the peculiar fact that eight of the ten cases reported were seventen years of age, and one of the two remaining eighteen years. The tenth case is that of a man of seventy years.

The author's case, R. D., tall, rather slender but muscular boy of seventeen years. Had been training for several weeks for High School Athletic contest. He was preparing for hurdles and short distance dashes. While practicing hurdles he felt a sudden “lameness'' over the anterior superior spine of the ilium. A physician near by pronounced it a sprain and prescribed painting it with iodine, which was done. In a week the patient was able to resume athletic practice. On day of contest he had run about fifty yards of a dash, when sudden pain compelled him to stop. A pair of crutches was obtained and later with conveyance was taken to his home. That evening, four hours afterward, he came to my office. Fracture of the anterior superior spine of the ilium was easily diagnosed. He was sent home, placed on a bed, where, after careful examination and confirmatory examination by consulting physician, dressing was applied. The fragment was about two inches long and displaced downward and inward.

Fragment was replaced by manipulation and adhesive straps were used to retain fragment and limb was immobilized in a double inclined wire splint. Recovery was rapid. On the fifteenth day part of the dressing was removed and apparently good union had occurred. The dressing was left on until the twenty-sixth day when walking with a cane was permitted and complete recovery followed rapidly.



The Transportation Committee, through its Chairman, Dr. Charles E. Fisher, has called on all the roads going West from Chicago and all are anxious to do their best in equipment, time, etc., to take us West.

We have tentative plans of the trip offering all sorts of schedules, etc. As yet the Committee has made no choice of road, and will not do so until a rate is made, but in order to show the members what we have in mind, we present a tentative schedule handed in by one

of the roads. This is given solely because it gives all details more fully than some of the others. My Dear Sir:

Referring to our recent conversation in reference to the above meeting to be held in Los Angeles during July, 1910, I beg to submit herewith itinerary of special train for the accommodation of your delegation. You will note same is so scheduled to accommodate all delegates who will arrive in Chicago during the day, July 6th. It also provides for a five hour lay-over at Denver and about the same lay-over at Salt Lake City and is so scheduled to take in the principal scenic points of interest through Scenic Colorado. Schedule as follows:

Via Chicago, Rock Island and Pacific R. R.
July 6, Lv. Chicago

9:15 P. M. Thursday,

July 7, Lv. Rock Island 1:20 A. M. Thursday,

July 7, Lv. Davenport 1:35 A. M. Thursday,

July 7, Lv. Iowa City 4:35 A. M. Thursday,

July 7, Lv. Des Moines 7:10 A. M. Thursday, July 7, Lv. Omaha

11:30 A. M. Thursday, July 7, Lv. Lincoln

1:55 P. M. Friday, July 8, Ar. Denver

6:30 A. M. Stop at Denver from 6:30 A. M. until 11:30 Noon.

Via Denver and Rio Grande R. R.
July 8, Lv.Denver

11:30 A. M. Friday,

July 8, Lv. Colorado Springs 2:00 P. M.

July 8, Lv. Pueblo : 3:10 P. M. Saturday,

July 9, Lv. Salt Lake City 4:50 P. M. Stop at Salt Lake City from 4:50 P. M. until 9:30 P. M.

Via San Pedro, Los Angeles and Salt Lake R. R. Saturday,

July 9, Lv. Salt Lake City 9:15 P. M. Sunday,

July 10, Ar. Los Angeles 9:00 P. M. Special train to consist of the highest class modern up-to-date equipment, to include buffet-library car, dining car for all meals, with sufficient high class standard Pullman sleepers to comfortably take care of your party, also to include observation sleeper to be used for social purposes.

You will appreciate that it is a little early at this time to advise what fares will be authorized for the meeting, however, it is safe to


say that the fares authorized will be such as to induce a large attendance.

The diverse route privileges authorized on California tourist tickets are such as to give your delegation an opportunity of going one route and returning another. For instance, going through Denver, Scienic Colorado and Utah, direct to Los Angeles via the San Pedro route and returning optional, either via San Francisco through Utah and Colorado or via San Francisco, Portland, Seattle and the Canadian Rockies via St. Paul, or via San Francisco returning again through Los Angeles and the Grand Canyon of Arizona. For those desiring to take in Yellowstone Park at the time of your meeting, tickets may be so routed as to bring them back via Livingston, Mont., or Yellowstone, Mont., for the side trip through the Park.

At a later date when the rates are settled, I will be very glad to quote you further details regarding your special train arrangements and will issue the necessary itineraries or any other printed matter to circularize among the members of your association, advising them in detail conditions of rates, diverse routes, etc.”

There comes to our mind the question whether the Profession would prefer to remain in Denver so that an excursion can be made to the Moffatt Road. If so, now is the time to acquaint the Committee with your views.

Does this schedule meet with the approval of the Eastern members? If not, now is the time to make your views known.

You see we want to go on a special train, and are anxious that you shall enjoy the entertainment on the way out that is being arranged for by the Profession of the various cities and the Committee.

Does the date of leaving please you-or would a day later, or a day earlier be better? Remember the committee wants to please all, and are anxious that all go together.

Secretary of the Transportation Committee.

The fair young debutante was surrounded by an admiring crowd of officers at the colonel's ball. Mamma was standing near by, smiling complacently at her daughter's social success. The discussion was over the quarrel of the day before between two brother officers.

“What was the casus belli?” asked the fair debutante.

“Maud !” exclaimed mamma, in a shocked voice. “How often have I told you to say stomach ?”

« PreviousContinue »