Special Notices. IN LARYNGEAL OR WINTER COUGHS.-Dr. Walter M. Fleming (Journal of Nervous and Mental Diseases) says, that in acute attacks of laryngeal or winter cough, tickling and irritability of larynx, antikamnia and codeine tablets are exceedingly trustworthy. If the irritation or spasm prevails at night, the patient should take a fivegrain tablet, containing four and three fourth grains antikamnia and one fourth grain sulphate codeine, an hour before retiring, and repeat it hourly until the irritation is allayed. Allow the tablet to dissolve slowly in the mouth, swallowing the saliva. After taking the second or third tablet the cough is usually under control, at least for that paroxysm and for the night. Should the irritation prevail in the morning or at midday, the same course of administration should be observed until subdued. In neuralgia, in short, for the multitude of nervous ailments, he doubts if there is another remedial agent so reliable, serviceable, and satisfactory, and this, without establishing an exaction, requirement, or habit in the system, as morphine does.— The New York Medical Journal. MANY saline laxatives and cathartic pills are contraindicated in the treatment of habitual constipation on account of their tendency to deplete the system too rapidly. Physicians frequently report a progressive inefficiency from their continued use. Doctors say that the more one takes of salts and pills the more constipated the system becomes, while, on the other hand, one enjoys both the method and results when Syrup of Figs is taken; it is pleasant and refreshing to the taste, and acts gently yet promptly on the kidneys, liver, and bowels, cleanses the system effectually, and overcomes habitual constipation permanently. The great trouble with all other purgatives and aperients is not that they fail to act, when a single dose is taken, but that they act too violently. Ladies and children enjoy the pleasant taste and gentle action of Syrup of Figs, find it delightful and beneficial whenever a laxative remedy is needed; for business men it is invaluable, as it may be taken without inconvenience, and does not gripe nor nauseate. THE ONLY ONE.-"I am glad to be able to give you the following testimony regarding a patient who has been an invalid for many years, and has had great trouble with her diet, I think due to a subacute inflammation of the mucous membrane of the stomach and bowels. For months at a time she has been unable to take a particle of starchy food, and naturally a number of the prepared foods have been tried and different ones have seemed for a time to agree with her, but Imperial Granum is the only one she can always rely on, often using it exclusively as a diet for weeks at a time. In one or two instances we feel that it has almost saved her life." SANMETTO RELIEVES QUICKLY IN PROSTATIC TROUBLES.—To say that Sanmetto does all that could be reasonably expected of it, in all troubles of the genito-urinary organs, is not an adequate description of its therapeutic value. For it aids in any congestion more or less, and is therefore an invaluable remedy for all congestions, especially of the prostate gland, affording relief quickly. Drake, Mo. H. A. GROSs, M. D., 1858, Med. Dept. Washington Univ. (St. Louis Med. Col.), St. Louis, Mo. "COCA" has maintained its reputation as a powerful nerve stimulant, being used with good results in nervous debility, opium and alcohol habit, etc. The highly variable character of the commercial drug makes it uncertain, however. Robinson's Wine Coca (see advertisement, this issue) we believe to be a uniformly active article, it being prepared from assayed leaves, the percentage of Cocaine being always determined by careful assay. Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN. Original Articles. SYCOSIS.* BY JOHN EDWIN HAYS, A. M., M. D. Professor of Dermatology, etc., in the Hospital College of Medicine, Louisville, Ky. I desire to present to the Society this evening a few thoughts of a practical kind on a somewhat rare and obstinate skin affection, namely, sycosis. Considering the prominent locality it usually invades, its disfiguring and annoying effects, and its frequent chronicity, the disease assumes considerable importance. The views expressed by modern dermatologists, that sycosis should be defined as an inflammatory affection, involving the hair follicles, caused by pus infection and characterized by the presence of hairpierced papules, pustules, and sometimes nodules and crusting, can be accepted without reservation. For a long time sycosis was regarded as non-contagious. At present nearly all observers agree in the opinion that its contagious nature admits of no doubt. The microscope reveals the fact that the hair follicles in sycosis. have been invaded by pus organisms- the staphylococci, both aureus. and albus — and it is in response to irritation by these organisms that the disease is attributed. This explains the fact why the disease when once started successively attacks the adjacent follicles of the patient, and also under favorable conditions its transmission to others. The pus organisms of sycosis are implanted by contact, but they only take root where the soil is in a favorable condition to their development. In what this favorable condition of soil consists it is not yet * Read before the Louisville Medico-Chirurgical Society, November 4, 1898. For discussion see p. 416. definitely known, but it is very probable that the mode of life, the hygienic surroundings and constitutional state of the patient have a considerable influence in determining the degree of susceptibility to the infection. If the tissue vulnerability were the same in all individuals the disease would in all probability be of frequent occurrence, since every one is frequently exposed to the contagious principle of suppurative inflammation. In a typical form and when fully developed, sycosis can hardly escape instant recognition. There is little likelihood of mistakes in sycosis for any other affection if we bear in mind its distinctive clinical features. Briefly these features are as follows: First, that it is a disease wholly confined to parts covered with hair, with a special affinity for the bearded portion of the face. Second, that during its development and evolution papules, pustules, and nodules are formed, each of which at its center is perforated by a hair. Third, that the inflammatory process is attended with burning sensations, some pain, and as a rule an absence of itching. If these facts are borne in mind, diagnosis is easy. In exceptional cases, however, sycosis has been confounded with pustular eczema, tinea barbæ, and syphilis, notwithstanding the fact that the differential data of these diseases, when carefully considered, are such as ought to prevent the occurrence of any mistake in arriving at a diagnosis. Sycosis is differentiated from a pustular syphilide by the absence of a history and concomitants of specific disease. These are usually sufficient for the purpose of establishing a diagnosis. The diagnosis between forms of sycosis and tinea barbæ is more difficult, and in some instances an appeal to the microscope must be made before clearing up the doubt that exists and a differentiation can be made. The presence of trycophyton fungus in the hair follicle is conclusive evidence of the latter affection. In eczema of the pustular variety it must be remembered the lesions are not confined to the hairy parts as in sycosis, and, the follicles not being involved, the hair is normal. The prognosis as to cure in sycosis is good, but the disease is sometimes extremely refractory to treatment. Hence the prognosis should be very guarded in respect to the length of time the affection is likely to last. It must also be remembered that a long continuance of the affection frequently results in ugly scars and permanently bald spots, owing to suppurative processes and obliteration of the hair sacs. As to the treatment, there is no internal remedy that has any specific effect on sycosis, internal medication being necessary only when the general health is not all that could be desired. By improvement of the general nutrition good results to patient, when necessary, are obtained by rendering soil in and around hair follicles uncongenial to pus organisms. We expect, however, a positive cure of the affection by the proper use of local remedies. To obtain best results from the strength of any given remedy the application should be carefully adapted to the degree of the inflammatory process and the tolerance of the skin to the remedy. An application of greater strength than necessary is very likely to injure the tissues and add to the inflammatory process, especially in the acute stages; very strong remedies invariably aggravate the eruption, increasing its extent and adding to its severity. As a rule it may be stated that the more chronic the affection the greater should be the strength of the application used. Before applying any remedy the field of action should be cleared by the softening and thorough removing from the affected area all crusts. For this purpose a preparation containing carbolic acid one part, balsam peru two parts, and olive oil ninety-seven parts, will be found extremely serviceable. Next all loosened hair should be removed, and those remaining should be clipped as closely to the skin as possible by curved scissors. As shaving is quite painful and frequently increases the inflammatory process, it is better not to advise it. After removal of all loosened hair, all pustules as far as possible should be punctured with an acne lance for the purpose of facilitating drainage and treatment. I shall not attempt to name all the remedies of a sedative, astringent, and parasitic nature which have been utilized from time to time in the local treatment of this affection. Among the most prominent of these remedies may be mentioned the mercurials, sulphur, creosote, iodoform, beta naphthol, salicylic acid, resorcin, and tannin. My own experience in this affection leads me to place greater value on sulphur and its compounds than any other remedy. Brief mention of two stubborn cases of sycosis treated during the last year will best illustrate the good results which attended the use of Vleminck's solution of sulphur: Mr. A. F., aged twenty-five years, a resident of one of our interior towns, consulted me last December for the relief of sycosis. His history was that the disease appeared on the upper lip about eight months previously, and since then had continued and extended. There was considerable infiltration and also pustulation of nearly all the bearded region of the face. He had discontinued shaving, and his face was tender to a remarkable degree. He kept his beard closely cut to prevent a collection of crusts. Many of the hairs were easily removed at the time with epilation forceps. He was given Vleminck's solution on his return home, and directed to apply it several times daily by hot compresses in such strength as the skin would tolerate. He was also carefully instructed how to keep the surface clear of crusts, remove hairs, etc., before applying the sulphur lotion. He was not seen again for six weeks. His face had greatly improved in the time, and treatment continued. About two weeks later he informed me through letter that all visible traces of the disease had disappeared, and since then there has been no recurrence. The second case was one of corresponding severity and of longer duration. The patient was thirty-one years old and in good condition of general health save the mental distress occasioned by the eruption. The disease began about two years ago, developing gradually. When first seen he gave me a long recital of his sufferings, physical and mental, from the time of its appearance up to the time he called at my office. No treatment that he had used had accomplished more than to hold the disease temporarily in abeyance. The disease was more intensified on the upper lip, probably made so by a coexisting nasal catarrh. A similar line of treatment to Case 1 proved effectual in the course of several weeks. No fresh outbreak has occurred since the treatment has been discontinued. LOUISVILLE. JAMBUL IN DIABETES MELLITUS.* BY ARTHUR W. SMYTH, A. M., M. D. Chief of Eye, Ear, Throat, and Nose Clinic, and Quizmaster in Materia Medica and Therapeutics in the Medical Department of the University of Louisville. I was led to select jambul for the subject of this paper because it was so conspicuously absent from all medical literature of the present day. The examination of thirty-six standard works on practice and materia medica reveals the following facts: Loomis, Fagge, Whittaker, Tyson, Watson, Von Niemeyer, Barlow, Bennett, Strumpell, Bernheim * Read before the Louisville Society of Physicians and Surgeons, November 1, 1898. |