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WILLIAM F. BREAKEY, M. D.
CLINICAL PROFESSOR OF DERMATOLOGY AND SYPHILOLOGY IN THE UNIVERSITY OF MICHIGAN.
THE range of dermal affections due primarily to parasitic causes is constantly widened by investigations in dermatology of the human race and by the study of parasitic disease of the lower animals, the latter conducted in this country by the Bureau of Animal Industry, and abroad by similar governmental commissions. Such supposedly simple conditions as seborrhea, acne, and alopecia areata are now held by reputable-we may say eminent-authorities to be caused by definite. parasites. Eczema, which has held domain in literature over a wide group of variable conditions, is being parceled out into various forms of dermatitis and their complications. And these many times are shown to be the result of primary parasitic infection. The same may be said of ecthyma, impetigo, sycoses, dermatitis, and is conceded in furunculosis, and in many conditions exciting pruritus.
Among other interesting items of Doctor Senn's recent letterst while with Peary in Greenland and farther north, and showing the wide range of his observations, he mentions the fact that birds infested. with vermin in the Arctic region are carriers of pathogenic germs, either in feathers or intestinal discharges, or both. A cutaneous affection has long been known to attack domestic fowls-poultry, pigeons, and sometimes geese,-to which the names of cutaneous psorospermosis and molluscum contagiosum have been given. It chiefly affects the head, and consists of more or less numerous round or oval yellow,
*Read at the Ann Arbor meeting of the FIRST COUNCILOR DISTRICT MEDICAL SOCIETY, December 22, 1905.
+Journal of Cutaneous Diseases, 1904.
salient nodules. Diphtheria is an ordinary complication of this affection in birds and is often mistaken for it. This disease of birds is contagious from one to another, and there is much reason to believe it is communicable to man. Like the molluscum contagiosum of man this affection of birds closely resembles Paget's disease of the nipple in its early stage. These affections of man are caused by parasitic coccidia. The subject is still in the domain of preliminary study. Doctor Bowen, of Boston, reported last year a case of acute pemphigus attributed to infection from an epizootic of so-called foot and mouth disease. The fact mentioned, that the infection from the lower animals is attended with more severe and disabling symptoms than when infected from human source, makes it more important that the condition be early recognized and treated before the infection reaches the deep tissues and phlegmon and suppuration occur. It is important also to differentiate between pure dermal affections, whether due to parasitic or other causes, and exanthemata or other skin lesions, which are but the outward expression of systemic disease.
Something over a year ago several cases-private and hospitalof parasitic sycosis communicated from cattle, brought to me through inquiry and correspondence reports of a large number of similar cases in this and other states, and I made a hurried preliminary report of some of them before the American Dermatological Association in June, 1904. The occurrence in the winter and spring of the present year of numerous identical cases, together with the extent of territory in which this and other communicable diseases from domestic and other animals to man was prevalent, led me to believe that it was more deserving of study and medical notice, and perhaps of more care from public health authorities, than it had heretofore received. The cases reported in 1904 represented but two families in different counties, at a distance of twenty miles or more from each other, but a dozen or more patients became infected in these families and their neighbors. The first patients coming to me-young men had each been caring for and handling cattle affected with a disease of the skin and hair, the herds having been infected in one case by an infected animal bought from a drover, and in others by animals from neighboring herds on roads or across line fences. Several of these patients were disabled for weeks with deep nodular pustules and burrowing abscesses of the kerion type. In the cases reported a year ago I was unable, for lack of time, to demonstrate by culture tests the identity of the parasite found on the animals and on the men. In the cases coming under observation in March and April last, the tinea was demonstrated microscopically in the face and hairs of the patient, as well as in the scrapings of the skin and hairs from the infected animals, and by maceration of samples of the scrapings and incubation on bouillon media, a culture was obtained demonstrating the mycelia and spores of the megaloendothrix sporon, from which in turn a guinea pig was antiseptically inoculated, producing a typical ringworm lesion, the hairs from
margin of which microscopically examined showed the typical trichophyton.
The dermatomycoses resulting from vegetable parasites are fewer in number and form a somewhat distinct group. Neuman says each dermatophyte exhibits constant characteristics in relation to the disease it induces, and has received a particular name. It is undoubted-so far as dermatology is concerned-that each dermatophytic species preserves its autonomy-the fungus that is derived from favus never produces anything but favus; that of tinea tonsurans has never yielded anything else than a trichophyton; and all endeavors of cultures to obtain the transformation of these fungi into true moulds have been unsuccessful, while the results of application of moulds to the human skin are superficial and symptomatically analogous to the true dermatomycosis.
Tinea tonsurans is a parasitic and contagious cutaneous affection caused by fungi belonging to the genus trichophyton, and which affects the ox, horse, cat, goat, sheep and pig as well as man, young animals being much more susceptible. Infection sometimes ends spontaneously. Cleanliness and grooming-as in the better kept horses-facilitate recovery. Shedding the coat expedites recovery, as does removal from infected stables to outdoors, and the opportunity to roll in dry earth. It may extend to all animals on a farm or in a stable, or in a regiment, and also to the people who attend upon them, and it is therefore important to promptly diagnose and treat the condition.
Trichophytosis in man, derived from animals, is generally more acute and severe than it usually is when communicated from man. Contagion of tinea occurs not only between animals of the same species, but also between animals of different species, and from animals to man and from man to animals. The number of such recorded observations would take too much space to mention separately. The communication of the trichophyton from horned cattle was observed as early as 1820, while discovery of the transference to horse, dog, cat, et cetera, is more recent. The infection is conveyed by direct contact in handling animals, as pet dogs, cats, in milking cows, grooming horses, and through the media of halters, harness, combs, brushes, saddles, et cetera. The spread of the disease is more active in moist, warm conditions of atmosphere. Gerlier describes an epidemic that began at Forney among the children of a horse clipper who had cut their hair with his clipping machine. I have observed the trichophyton in several young men who had used in common the same face mask in fencing, and in other cases where the same locker for clothes in a gymnasium had been used without disinfection. The acarus is sometimes a carrier of trichophyton also, thus causing a double infection.
It is seen that the trichophyton will accommodate itself to very different organizations; and because of this fact Longuet asks if it might not be admitted that the trichophyton of man is always of animal origin-just as many dermatologists are inclined to believe that the favus of the mouse is the primary source of favus of children. It is
strongly probable, he says, that the original soil of the trichophyton is the ox, that from this animal it is transferred to the horse when they are in pasture or stable together, and that from it man more or less directly receives his tinea tonsurans. The behavior of the lesion, and its frequent inflammatory character-in the case of contagion from animal to man— appears to be pathognomonic of a parasite in its first cultivation--that is, immediately derived from the cow or horse.
Megnin and Bazin think the trichophyton is not always the same species in the ox and horse, and instances the fact that the trichophyton of the ox vegetates more especially in the hair follicles and the epidermic layers, causing inflammation of the derma and shedding of the hairs, while that of the horse passes into the hair itself and renders it friable and breaks it up. But while it is shown that the malady does not manifest itself alike in every animal this does not offer an argument against the identity of the parasite. The difference—as in larger vegetable growths-may be due to the soil and environment. Gerlach showed long ago that in the ox the dark colored hairs break, while the white ones rarely do so.
As to the vitality of the parasite, Gerlach undertook some experiments to determine the duration of the germinative faculty of the spores, and found that crusts more than three months old had lost their potency when placed on an unprepared skin, but spores six months old. still germinated, and produced perfectly developed ringworm when inoculation was done by scarification. Megnin successfully inoculated a dog with crusts eighteen months old. Thin, in making some interesting experiments with cultures of the trichophyton in Koch's nutrient gelatin, found the spores of trichophytic hairs dead after immersion in water eight days, but they survived two days' steeping. They preserved their germinative power after forty-eight hours in olive oil, lard, or vaseline, while an hour's contact with soft soap or a one-per-cent solution of acetic acid appeared to be sufficient to kill them. A one-per-cent solution of sodium carbonate was less efficacious, germination taking place in three days. Sulphur ointment had slow action upon them and required several hours to sterilize spores. Citrine ointment was an active destroyer; after an hour's contact with it spores would not germinate. On the other hand oil was wholly inefficacious as after eight hours' immersion in it the trichophyton preserved its vitality.
Tinea favosa, caused by a fungus-the achorion schoenleinii-affects man, the cat, mouse, dog, rabbit, and fowl. It is communicable from all these animals to each other, and is the severest of all forms of tinea, as well as the most persistent, by reason of burrowing infection of deep tissues, and suppuration and complications of dermatitis.
A careful inquiry as to history and occupation of patients will often aid in diagnosis, and early treatment greatly expedites a cure.
Treatment contemplates cleanliness, parasiticides-without needless irritants, persistence.
ACUTE PNEUMOCOCCIC CEREBROSPINAL MENINGITIS
OF NASAL ORIGIN: REPORT OF CASE, WITH
HUGO A. FREUND, A. B., M. D.
FIRST ASSISTANT IN INTERNAL MEDICINE AT THE UNIVERSITY OF MICHIGAN.
It is not uncommon to see from time to time cases of cerebrospinal meningitis in the smaller inland towns and in the rural districts. Particularly is this so when an epidemic is progressing in the larger cities. The past two years has witnessed the scourge of this disease in some of the eastern cities, and with its advent opportunity was afforded for a considerable amount of useful research with reference to its contagiousness, its source, and its mode of infection.
The chief infecting agent in the epidemics such as New York city experienced in 1904 and 1905, where over two thousand five hundred. cases died, has been the diplococcus intracellularis meningitidis of Weichselbaum. At the last meeting of the.American Public Health Association, Doctor W. H. Park dwelt on the infectious nature and the likelihood of contagion of the epidemic form. He stated that during the first ten days of the infection, one-half of the patients have nasai and mouth secretions laden with the meningococcus. He cited an instance of five attendants whose nasal discharges were badly infected with these virulent organisms. That this is an avenue of infection in many cases seems certain.
Goodwin and von Sholly carefully examined a large series of cases for the diplococcus intracellularis. They found the organism present in fifty per cent of the patients during the first two weeks of the disease. In addition ten per cent of the people who came into contact with the sick likewise showed the presence of the meningococcus. They believe in early isolation of these cases and insist that it should be kept up during the first two weeks at least.
Bolduan and Goodwin made a similar study during the New York epidemic, reaching the same conclusion.
Hare reported an extremely interesting experience arguing strongly for the contagious nature of the disease. In his case the physician who had been in constant attendance upon a fulminating case contracted it himself and soon died. Others in connection with the case, including Doctor Hare, had tonsillar and slight febrile infections with no further ill results.
That other cocci may gain access to the meninges by a similar route and cause an acute meningitis is plausible. In fact they may be abetted by acute or chronic antrum disease which frequently paves the way to sinus and meningeal infections. In the crowded districts of our large cities cases of acute meningitis are always to be found. The nature of these is varied, especially as far as the etiology is concerned. Thus in analyzing various health reports one finds that in