surdity of being content with inferior results in one branch of medicine, because forsooth, there are so many others in which their medical adviser is equally or more at home. It will reason rather that he who "insists upon doing the work of ten men, manifests a quality of mind which we can only call arrogance, and which challenges for his work severe criticism." Versatility will not atone for crude and imperfect work, any more than will lack of time, hurry of life, superior wisdom, charge the wronged sufferer another and still higher fee for a "consultation", which is in reality a confession. It has been sarcastically called "the sole duty now-a-days of the ily doctor to decide what specialist shall be summoned." It certainly is his duty and a very important one as a man of honor, to decide whether any one, and if so, who can probably accomplish that wherein he admits that he himself has failed. Unfortunately, many know so little that they are even ignorant of how much is known by others; but in many respects the specialist has already raised the average standard of requirement for general practice to such an extent that much of the old routine practice of physicians who treated their patients for the very diseases for which they referred members of their own families to the specialist, has now become punishable mal-practice. But the general practitioner has his revenge in opposing as unnecessary the hospital appointment, and even the private practice of the very specialist to whom he himself flees as "a very present help in time of trouble."

ex

We are told that "the human body is made up of parts and functions so thoroughly interdependent that it can not be parcelled out into defined and isolated regions." It can and it cannot. What scientist divides a country into square miles and attempts to become thoroughly conversant with every atom isting in each of these miles? The special divisions of study are rather the flora, the fauna, the geological strata, etc., though all these may pervade identically every mile of the region. If regional surgery is possible, then specialties are certainly not contraindicated. We hear of "appalling pathological conglomerates" due to lack of "general medical treatment." Not only "conglomerates", but often single lesions are very variously di agnosticated by different keenness of competition or financial necessity, and it is merely brazen self assertion which delights "not so much in doing the thing well as in showing how well he can do it."

Believing in the ultimate achievement of all possibilities and in the progress of truth,

The purpose of the writer was to call attention to certain cutaneous eruptions of an erythematoid character occurring in connection with syphilis, and so far as possible determine their etiology. In the first place, a case was reported of a syphilitic patient who developed a peculiar eruption upon the head, hands and feet. Although the eruption presented no pronounced syphilitic characteristics, it was regarded as due to syphilis for the reasons that it was shortly followed by an outbreak of well marked specific efflorescences on various parts of the body, and, moreover, there was a transformation of the eruption upon the head, into infiltrated lesions presenting a distinct syphilitic character. The eruption first appeared on the face in the form of an erythema which was covered with vesiculo-papular efflorescences. Later a similar outbreak occurred on the nape of the neck. The vesiculopapules broke, leaving excoriated surfaces of diphtheritic character, from which there exuded an exceedingly abundant foul-smelling discharge. Soon after, vegetating growths made their appearance, which upon bearded parts of the face were quite exuberant, and resembled condylomata acuminata. These upon the neck, formed more discrete, tuberous prominences, and had the appearance of condylomata lata; while upon the upper parts of the face, the elevations were nummular, and had comparatively smooth, though somewhat lobulated surfaces. After a week or two, the erythematous areas, which formed the bases of the vegetating lesions, became the seats of a gradually increasing, coppercolored infiltration. The palms and corre sponding surfaces of the fingers were covered with a deep red, sharply circumscribed erythema, which was followed by lamellar desquamation. A similar eruption occurred in patches upon the soles. The finger nails were all more or less affected with onychia sicca. Upon the body and limbs, several crops of well-marked syphilitic papules succeeded each

the

other, and finally all the manifestations yielded rapidly to mercurial treatment. The preliminary eruption in this case was characterized as an erythanthema dependent in some way upon the specific disease. Other instances of erythematoid eruptions occurring incidentally to syphilis, were referred to as being more or less analogous to the above cited case. DISCUSSION.

DR. I. E. ATKINSON, of Baltimore. In regard to pathognomonic syphilitic eruptions a great deal of caution must be exercised, and I think we should not dogmatize with regard to the specific lesions of syphilis. Lesions similar to those described by Dr. Bronson are not of excessive rarity in cachectic subjects, and in cases of malignant syphilis, but in my experience, they have always been manifestations of late or tertiary syphilis.

DR. J. C. WHITE, of Boston--It seems to me we must have some more exact data before we can regard these affections as a necessary sequel of syphilis and as anything more than accidental occurrences. While there is nothing a priori against a causal relation existing between these conditions and syphilis, such relation has not been proven.

DR. G. H. TILDEN, of Boston.-It seems to me that in the present state of our knowledge it would be most philosophical to consider the appearances described as accidental than as dependent upon the specific disease. Dr. I. E. Atkinson, of Baltimore, read a paper on Rubella or Roetheln.

On account of the confusion existing as to the nomenclature of this disease, the speaker suggested that rubella be accepted as its proper title, and that it might be known in popular language as epidemic roseola.

Report of a Case of Lymphadenoma (Mycosis Fungoide) and Autopsy, by Dr. G. H. Fox, of New York.

In the absence of the author, the paper was read by the secretary.

Mrs. G., æt. 33 years, the mother of six children, during pregnancy in the summer of 1881, suffered with general pruritus, which passed away after confinement in October. A year later, small flattened circular tumors appeared in the axillæ and on the breasts. These became moist and were accompanied with a burning sensation. The eruption disappeared from these situations and reappeared upon the back and other portions of the body. Af ter the birth of her last child in February, 1885, a tumor developed at the inferior angle of the left scapula. The lesions on the other parts of the body disappeared, with the exception of two spots on the finger, and one on the left cheek. The tumor on the left scapula gradually softened and disappeared.

Hypodermic injections of Fowler's solution were used without benefit. Chaulamooga oil was given in increasing doses until forty drops four times daily were taken without causing any improvement.

The pacient died in April, 1886. The microscopical examination gave the usual appearances of these growths. The internal organs were found to be normal.

The next paper entitled, A Note Relative to the Bullous Eruption Occurring after the Ingestion of Iodine Compounds, by Dr. J. N. Hyde, of Chicago, was, in the absence of the author, read by the secretary.

Case I.-An infant seven months of age. Three weeks before coming under observation the eruption made its appearance-the appearance of chicken pox. The child's face, the dorsal aspect of the hands and forearms and the scalp were covered with isolated, umbilicated lesions resembling molluscous tumors. The contents of the lesions were inspissated, thick and grumous. It was learned that iodide of potassium in one grain doses had been administered. On the discontinuance of the iodide and the use of antiseptic powder, the lesions rapidly disappeared.

Case II.-A lad fifteen years of age, who had recently undergone an operation for crosis of the right femur, developed an erup. tion involving the entire body. There were two distinct sets of lesions. That which predominated was composed of annular circinate plaques varying in diameter from several centimeters to half a meter. There were also here and there, particularly about the finger ends distinct blebs. The patient had been taking iodide of potassium in fifteen grain doses. This was discontinued, and the eruption speedily disappeared.

There are two distinct types, the bullous and the quasi bullous eruption produced by the ingestion of iodide of potassium. In the first form the patients are often well advanced in years, often cachectic and frequently affected with syphilis or other grave disease. In what may be regard as a second sub-form of this exanthem, there are di- or polymorphic symptoms. Here bullæ are commingled with papules, tubercles and other patches of disease. The speaker then described other cases of similar eruptions described by various writers. DISCUSSION.

DR. R. W. TAYLOR, of New York. While the most general eruption produced by iodide of potassium is an acneform exanthem, yet it may cause dermatitis with multiform lesions with bullæ which may contain serum, pus or even blood.

DR. J. E. GRAHAM, of Toronto. I have

had one case similar to that described by Dr. Hyde in which iodide of potassium in five grain doses produced a marked bullous erup. tion principally upon the face and neck. The remedy was stopped, and the eruption rapidly disappeared.

DR. I. E. ATKINSON, of Baltimore. One year ago I saw a case of what was supposed to be malignant syphilis. The patient had had syphilis, and had been put on the use of iodide of potassium. The lesions continued to increase, and after the iodide had been taken for six months, I saw the case. There was an enormous formation of scar-tissue over the face and neck. In addition there were bullæ. The drug was stopped, and in six weeks the ulcerations had healed.

Adjourned until eight o'clock in the even

ing.

EVENING SESSION.

The first paper was on Precocious Gummata. By Dr. R. W. Taylor, of New York. After a thorough consideration of the sub ject and the presentation of a number of illustrative cases, the following conclusions were presented:

1. Like the osseous affections, affections of the nervous system, malignant syphilides in general, besides many other affections, the gummata of syphilis may be prococious in appearance, occurring as early even as the second month of infection.

2. Of the precocious gummatous syphilide or gummata, there are three quite clearly marked forms, first, the early, general and copious form; second, the more localized form which may invade several regions, is usually symmetrically distributed and sometimes even is confined to one region, particularly one side of the face or scalp and the roof of the mouth; and thirdly a form in which more or less severe neuralgias precede and accompany the eruption, which, in many particulars, resembles simple erythema nodosum, but which in its etiology is not in any way related to this simple form of eruption, but is a direct outcome of the syphilitic diathesis.

These precocious gummata partake in general of the features of those of later forms, but they differ in the more acute invasion, in a much more rapid course, and are usually not as profound and destructive in their action as the classical eruption.

4. That of these precocious forms of gummata, there are found to be two varieties, one a non-ulcerative, the other ulcerative.

5. That in the treatment of these precocious syphilides, a combination of mercury and iodide of potassium is much more efficacious than is mercury alone.

Clinical Notes on Scabies. By Dr. F. B. Greenough, of Boston.

The speaker referred to the rapid increase in the number of cases of scabies seen during he past few years. The percentage of cases of tcabies to other skin affections had risen from three-tenths per cent in 1876 to over thirteen per cent during the past year by his notes.

The facts which were especially noticed were the few cases in which typical burrows could be found; the great constancy of the manifestations on the penis in male subjects; the difference of the symptoms produced by scratching according to the situation of the lesion and the success of treatment. He had used almost entirely an ointment consisting of two parts of sulphur, one of carbonate of potash and three of petroleum ointment, simply cautioning the patient against applying it to inflamed and pustular localities. ferred to the distribution of the eruption as of importance in the diagnosis of difficult cases, and called attention to the differential diagnosis between scabies and certain other cutaneous diseases.

DISCUSSION.

He re

DR. A. R. ROBINSON, of New York.-In some cases where there was difficulty in the diagnosis, I have reached a positive conclusion by opening a vesicle and examining its contents under the microscope, and finding the young acari or the feces.

DR. L. N. DENSLOW, of St. Paul.—I have had a number of cases in which no burrows could be found, but under treatment suitable for scabies, they have recovered.

DR. E. B. BRONSON, of New York.-In many cases I have depended largely upon the elongated character of the efflorescence in making the diagnosis. For three months, I treated all cases of scabies with naphthol, using a fifty per cent preparation. This has produced a satisfactory result.

DR. S. SHERWELL, of Brooklyn.--As a prophylactic,I always direct the patient to sprinkle on the sheet of the bed a teaspoonful of the dry sulphur. This acts as a disinfectant and is unpleasant to the acarus.

DR. H. W. STELWAGON, of Philadelphia, read a paper entitled Clinical Observations Regarding the Value of Resorcin, Icthyol and Lanolin in Cutaneous Diseases. Adjourned.

-We are in receipt of the announcements of the St. Louis schools of medicine, setting forth the work contemplated during the coming winter session.

CORRESPONDENCE.

NEW YORK LETTER.

NEW YORK, SEPT. 4, 1886. Editors Review: The managers of the Presbyterian Hospital have finally decided to erect a new building for the purposes of a dispensary, and have appropriated one hundred thousand dollars for that purpose. The project has met with dissatisfaction on the part of all except the managers themselves. The institution is situated in a part of the city occupied by some of our wealthiest residents. Only four or five blocks off is the dispensary of the Mt. Sinai Hospital, one of the best equipped and most efficient institutions of its class in the city. It is true that ti besbyterian Hospital has a large tenement-house district lying east, but there is no complaint that the poor of that region are not already amply cared for in the way of medical charity. The whole project of a new dispensary seems a most decided "black eye" to the cause of charity reform, which grows very, very slowly in this great city.

above criticism. On the other hand, other departments are cumbered with useless officials who draw large salaries and do almost no work. Politics is here as elsewhere the cause. In such appointments as come under the city civil service rules, "backing" is the decisive factor of appointment, and this can be done often without any direct violation of the letter of the law. The head of the department should be a practical sanitarian, as was, for instance, Prof. Charles F. Chandler, Gen, Shaler's predecessor,and the best leader the Board ever had, but he refused to obey the beck and nod of politicians, and was denied reappointment. The department's appropriation for the past year has been nearly twenty-five per cent less than that of the preceding year. work seems to have gone on about as well under the diminished appropriation, it would seem as if the additional sum was a mere waste.

As the

The efficiency of our ambulance system has been still further increased by the establishment in the most crowded parts of the city of a new set of alarm boxes whereby any policeman can call an ambulance from wherever he may be without having to go to the nearest hospital or precinct. Much time will thereby be saved in emergency

cases.

Most worthy of commendation, however, are all those agencies which aim to give the poor excursions and temporary vacations from the hot city. One of the most recent movements in this direction is the establishment, by the charity organization society, of a "Sanitary Tent" on Bedloe's Island. This is a small island, on which new statue of Liberty is being erected, and is owned by the Government, which has given permission for the erection of the tent. The latter is large enough to hold comfortably two hundred women and children. Here poor mothers can go with their children and spend the day. The price of a ticket for the steamer running to the island is very low-only ten cents, and there are no other expenses, and free tickets are issued to deserving persons. A corps of nurses is in attendance from the Infirmary for Women and Children, under the superintendency of Dr. Daniel, of this latter institution. Several other bodies are co-operating with the charity organization society to make the project a success, and the public is appealed to for the necessary funds.

Our municipal Health Board is likely soon to be brought into public notice. The mayor has preferred charges of mal-administration against Gen. Shaler, the president of the Board, and an investigation is soon to be held. This department of our city government presents some curious features. Some of its departments are in a high state of efficiency. Those of Inspection of Foods, under Dr. Edson, and Contagious Diseases, under Dr. James B. Taylor, are worthy of especial praise. Our sanit y detective force is almost

BOOK RECEIVED.

J. E. N.

A Reference Handbook of the Medical Sciences; Embracing the entire range of Scientific and Practical Medicine and Allied Science, by various writers. Vol. III., Fac to Hys. 813 pages. Illustrated by 6 chromo-lithographs and 718 fine wood engravings. Edited by Albert H. Buck, M. D. Supplied to subscribers only. Price per vol., cloth, $6.00; sheep, $7.00; half morocco, $8.00. William Wood & Co., New York. (J. H. Chambers & Co., 914 Locust St., St. Louis.)