466

universally admitted that the meeting was a most successfulone and that great credit was due to the administration forthe excellent arrangements made. The foreign visitors wereparticularly pleased with the excellence of the organisationand the profusion of the hospitality.

SECTION OF DERMATOLOGY.

WEDNESDAY, AUG. 5TH.Discussion on Keratosis.

Dr. UNNA (Hamburg) read a paper on the Etiology andVarieties of Keratosis, giving his exhaustive researches intothe process of keratinisation, a process which takes placenormally in the preparation of the epidermal cells as

they approach the surface of the skin. He viewed thesubject from a physiological and pathological standpoint,comparing the two. Pathologically the process takes placein excess in the formation of callosities, when the cellsbecome heaped up into solid masses ; in psoriasis, when theycrumble away in silver flakes ; and in ichthyosis, whenthey form flakes cracked at intervals. A large number ofbeautiful microscopic specimens of these affections were

shown, some of the specimens having been previously digestedby pepsin and hydrochloric acid and some not digested.

In the discussion which followed Dr. H. G. BROOKE(Manchester), Dr. W. DUBREUILH (Bordeaux), and Dr.AUDRY (Toulouse) took part.

S’arcoma Cutis.Professor SCHWIMMER (Budapest) contributed a paper (in

English) on Sarcoma Cutis illustrated by drawings, in whichhe advocated the use of arsenic, which, according to hisexperience, cured the disease.

Dr. COLCOTT Fox (London) made a few remarks on a caseof primary Sarcoma Cutis of two years’ duration which hehad shown that afternoon, of which a microscopic exami-nation had been made.

Dr. J. J. PRINGLE (London) also made reference to a caseunder his care.

Dr. LASSAR (Berlin), who spoke in English, thought thatleprosy often ended in this way.

Professor SCHWIMMER, in reply, doubted if cases of

leprosy ever terminated in sarcoma, and once more he

emphasised the value of arsenic in gradually increasing dosesin the treatment of the disease.

Various Papers.The following papers were also brought forward :-Professor RIEHL (Leipzig) : Epithelioma and Endothelioma

Cutis.Dr. GAUCHER (Paris) : The Treatment of Cutaneous Epi-

thelioma.Dr. L. WICKHAM (Paris) : A Case of Rhinoscleroma.Dr. ZEFERINO FALCAO (Lisbon) : Contribution to the

Study of Xeroderma Pigmentosum.Dr. DARIER (Paris) : Pseudo-xanthoma.Dr. 0. ROSENTHAL (Berlin): The Treatment of Skin

Diseases by Hot Water.Dr. P. G. UNNA (Hamburg) : A New Form of Impermeable

Medicated Plaster.Dr. EDWARD SCHIFF (Vienna): A New Vehicle for the

Application of Remedies to the Skin.Dr. WALSH (London): The Action of Certain Internal

Remedies on the Skin.M. NUMA RAT (St. Kitts) : Framboesia or Yaws.Mr. WATTS (Antigua) : Frambœsia.

THURSDAY, AUG. 6TH.Connexion of Tuberculosis with Diseases of the Skin other than

Lupus Vulgaris.Dr. NEVINS HYDE (Chicago) in his paper formulated the

following propositions, supported by arguments and facts.It may now be accepted that primary and secondary infectionof the skin with tubercle bacilli may take place, and auto-infection of the skin may also occur. The diversity betweenthe several clinical forms of cutaneous tuberculosis

may be explained by the quantity of micro-organisms presentin any given case ; by differences in the tissues on whichthe germs are implanted ; and by accidents of exposure ofthe infected region. The various skin lesions (other thanlupus vulgaris) due to tuberculosis may be classified asfollows :-Those in which the bacillus tuberculosis hasbeen demonstrated-(1) verruca necrogenica; (2) tuberculosis

verrucosa cutis (Riehl and Paltauf); (3) tuberculosis papillo-matosa cutis (Morrow’s type) ; (4) fibromatosis tuber-culosa cutis (Riehl) ; (5) elephantiasis tuberculosa cutis ;(6) tuberculosis cutis ulcerativa ; (7) tuberculosis gummatosaulcerativa (cutaneous scrofuloderm); (8) lymphangitis tuber-culosa cutanea (Besnier) ; (9) tuberculosis cutis serpiginosaulcerativa ; (10) tuberculosis cutis fungosa; and (11) tuber-culosis nodosa atrophica (lupoid form). Skin lesions inwhich the bacillus tuberculosis has not always been demon-strated, but in which there is every reason to believe that itwill be in the future-(1) lupus erythematosus, concerningwhich Dr. Hyde has come to the conclusions (a) that it doesnot originate from, nor is it the source of, tuberculousinfection ; (b) it occurs in non-tuberculous subjects as a

result of causes as yet undetermined ; and (c) it also occurs intuberculous subjects and then there exists a relation betweenthe two ; (2) erythema induratum scrofulosorum (Bazin’s

disease) ; (3) lichen scrofulosorum ; (4) tuberculosis suppu-rativa et bullosa acuta (Hallopeau) ; (5) a group of acnei-form, sycosiform, and follicular disorders in which it ispossible that tuberculosis may be responsible for some of theresults ; (6) klloid ; and (7) ulcus molle complicated withtuberculosis. In the last group the author names-(1) afew eczematoid disorders (neuro-dermatites) ; (2) erythemapernio ; (3) exceptional forms of erythema multiforme;(4) some of the melanodermata; (5) purpura of the cachectic;and (6) a few of the drug dermatoses.

Dr. HALLOPEAU (Paris) insisted on the necessity of earlyrecognition of tuberculous lesions of the skin. This diagnosiscould be effected by (1) the possibility of transmitting tuber-culosis from such lesions by a series of inoculations of themorbid matter; (2) the presence of the bacillus tubercu-losis in the tissues of the lesions; (3) the production ofsimilar eruptions, such as lichen scrofulosorum, under theinfluence of tuberculin ; and (4) the production of thesymptoms of a reaction and visible changes in the skinby the hypodermic injection of tuberculin. But none

of these conditions can be regarded as a sine quâ non.

The types of elementary skin lesions which have up tothe present been connected with tuberculosis are: (1)sclerotic and warty tuberculosis, where the processinvolves the papillary body ; (2) the anatomical tubercle;(3) tuberculous gummata; (4) tuberculous tumours re-

sembling mycosis fungoides ; (5) tuberculous ulcerations;(6) erythema (lupus erythematosus) ; and (7) other super-ficial forms of tuberculosis of the skin, such as lichenscrofulosorum, suppurative folliculitis, and the like. The

multiplicity of these various manifestations is explained bythe different liability of the various constituent elements ofthe skin, the state of the health, and the age of the patientsattacked.

Dr. RADCLIFFE CROCKER (London), in his communicationlaid stress on the fact that, while there are a certain numberof diseases of the skin directly due to the presence of thebacillus tuberculosis, there are many other skin diseaseswhich, though they are not due to this organism, find afavourable soil in those persons who seem to be predisposedto invasion by the bacillus. Examples of such a conditionare to be found in persons who present the phe-nomena of easily excited bone disease, glandular en-

largement, &c. -clinical conditions which come underthe head of the "scrofulous diathesis." Cases were

narrated and drawings shown in illustration of this.It was advisable to retain the word scrofuloderma forapplication to some conditions of the skin which wereattended by involvement of glands, extensive suppuration,and ulceration of the skin.

Professor PETRINI DE GALATZ (Bucharest), ProfessorPELLizzARI, and Professor JACOBI (Freiburg) continued thediscussion.

Dr. JADASSOHN (Breslau) read a paper on LichenScrofulosorum.

Professor CAMPANA (Rome) read a paper on the Mode oAction of Tuberculin.

Dr. Louis WICKHAM (Paris) read a paper on the Value ofMultiple Scaritication in Erythematous Lupus.

Dr. AuDRY (Toulouse) read a paper on Eczema Elephan-tiasa in a Tuberculous Subject.

Ringworm and the Trichophytons.Dr. SABOURAUD (Paris) opened the subject with a lucid

exposition of his extensive researches. He commenced bypaying a high tribute to the researches of Gruby conducted

467

fifty-three years ago, and which had forestalled many of thediscoveries which he (Dr. Sabouraud) had made. His descrip-tion was divided into two parts, the first dealing with thetrichophytons (with large spores), and the second withthe microsporon Audoumi (with small spores), which, it.should be remembered for a proper understanding of whatfollows, Dr. Sabouraud holds to be totally distinct.

1. A trichophyton may best be defined by its effects-i.e.,it gives rise on the skin of man to a circinate lesion containingonly two cryptogamic forms- a filament (the mycelium) anda mycelial spore (endospore). In the lesion it excites itnever assumes the form of external sporulation, but in an.artificial culture it always does so. It is easily culti-vable at low temperatures (from 15° to 20° C.), and in arti-ficial cultures assimilates hydrocarbons, especially sugar.All trichophytons have these characteristic. The techniqueof their culture was then described, and the fact thatthe results were always constant emphasised. Intradermicinoculations were made in guinea-pigs. After three

years’ experimentation the conclusions arrived at are that.there is a very large number of fungi which are capable of,producing "ringworm" in the human being, and that theyall belong to the class sporotrichum of Link and Saccardo.Trichophytons may be divided into trichophyton endothrix,which form by far the largest number of cases of ringwormof the scalp, which invade the hair shaft, are never foundin animals (domestic or other), and never attack the beard,.and trichophyton ectothrix, which do not invade the hairshaft, but may be found on the surface of the skin. Thelatter are rare in man, but common in animals. Certainmixed forms (endo-ectothrix) exist in Paris which penetratethe hair root for a certain distance, and many, if not all, ofthese have an animal origin. When these are met with inman an animal source must always be sought-horses, cats,dogs, calves, fowls, &c. In trichophyton of the beard tricho-phyton endjthrix is never found, but always endo-ectothrixor pure ectothrix. Similarly trichopbyton of the nails is

always due to the same species, never to endothrix. Itfollows that both of these are, or may be, of animal origin.The best means of sub-division is by the character of thecultures, thus-(1) crateriform cultures, three species known ;2) accuminate cultures, three species known ; and (3)white powdery cultures, six species known. It is highlyprobable that trichophytons can have a separate saprophyteexistence because, amongst other reasons, cultures may beobtained from organic materials. As regards the pyogenicproperties of these organisms, some are always attended bypns formation (as the white cultured trichophytons from the- cat), some are nearly always (trichophytons from the horse),and some never, suppurative (endothrix and endo-ectothrixwith accuminate culture). This explains the variable pre-sence of suppurative folliculitis and kerion. The spores of alltrichophytons are formed by a breaking up of the mycelialelements.

II. The nosography of the scurfy patch (taigne tondante) ofGruby must be studied quite apart from that of the trichopby-ton, as a distinct morbid entity, characterised clinically as a ]collection of patches consisting of fine, dry, grey, adherentdesquamation affecting the heads of children. The parasite in this affection is the microsporon audoumi (Gruby, 1843). The hairs, about six or seven millimetres long, are curved, and when pulled out break off about a millimetre below the skin. It is accompanied by fugitive inoculations on the skin around. It is extremely contagious in children. It is ex-

tremely rebellious, lasting for five, six, or more years, ter- minating spontaneously, if untreated, at puberty without, asa rule, baldness following. A microscopic examination of the hairs shows them to be surrounded by a layerof small spores, not arranged in chains, never entering the hair. In the interior of the hair there existsa series of thick mycelial threads arranged in parallel lines, divided at long intervals, giving off at an acute angle very Ifine branches which make their way to the surface bear- ing a lot of spores at their extremities which surround theoutside of the hair. The cultures of this microbe differ ]completely from those of the trichophytons. The disease isvery frequent in England and France, but it seems not to exist in Italy, Germany, or Hungary. Only one species of’this microbe affects man. Another species affects thehorse, which is possibly contagious to ma,n. In conclusion Dr. Sabouraud referred to a variety of favus which gives rise :to trichophytoid lesions. ]

Professor ROSENBACH (Gottingen) contributed a paper confirming in general terms Dr. Sabouraud’s researches, but !

as regards those relating to the transmission of certain

trichophytons from animals some caution must, he thought,be exerched before adopting them.Mr. MALCOLM MORRIS (London) read a paper embodying

the results of his researches on the Ringworm Fungi. He

gave a lantern-slide demonstration of a series of microscopicpreparations illustrating the fungi found in the cases andshowed cultures of them made on agar-maltose. The hairswhich supplied the material for examination were taken fromthe scalps of 126 children. In 116 of these the fungus wassmall spored, in the remainder large spored. Attention wascalled to the gre tt preponderance of the former vauet.y (92 percent ) as compared with the proportion (60 per cent.) givenfor France by Dr. Sabouraud. On the other hand it might beinferred that the large-spored parasite was comparatively rarein this country ; it was suggested, however, that this mightbe because the affection which it produced was easily over-looked. Mr. Morris showed from measurements made fromhis specimens that the difference in the size of the spores ofthe two varieties of fungus was not sufficiently great toconstitute a differentiating feature, this was rather to befound in the arrangement of the spores and their modeof growth on the hair. The chief difference in thecultures of the fungi was in the colour, the small-

spored being white and the large-spored being brownish-red.He considered that the classification of large-sportdfungi into an "endothrix" and an "ectothrix" varietywas unwarranted, as being based only on an accidentof position. He showed cause for believing Dr. Sabourau t’sviews, that the small-spored fungus only attacks the scalp, tobe erroneous, but he believed that mixing of breeds sometimesoccurred in trichophytic (large-spored) ringworm. He alsostated that in his experience the parasite in ca’-es of keri.’nis small-spored, not large-spored, as taught by Dr. Sibouraud.His conclusion was that there were only two varieties of

ringworm fungus which concerned clinicians: one small-

spored, causing the obstinate form of ringworm whichoccurred epidemically in schools; and the other large-spored,which was responsible for the more tracta,ble forms of tineatonsurans of the scalp and probably mo"t other forms ofringworm.

Mr. H. G. ADAMSON (London) read a paper on the samesubject, recording his results in the artificial cultivation ofthe various forms, and confirming the greater frequency inLondon of the mi ’rosporon Audoumi (95 per cent.) as com-pared with the trichophytons (5 per cent. of 263 cases of

ringworm ").The discussion was continued by Dr. UNNA (Hamburg),

Dr. COLCOTT Fox (London), Dr. LESLIE ROBERTS (Liver-pool), Dr. WICKHAM (Paris), and Dr. VoN SEHLEN(Hanover).

FRIDAY, AUG. 7TH.

The Nature and Relations of the Erythema MttltiformeGroup.

Dr. Ts. VEIEL (Stuttgart) opened this discussion with apaper, in which he came to the conclusion that ErythemaExudativum Multiforme, as described by Hebra, is a wellcharacterised and independent infectious disease, which is tobe distinguished from the erythemata accompanying otherinfectious diseases in spite of a morphological similarity. Itis not identical with Erythema Nodosum and is independentof gout and rheumatism. It cannot be considered to be anangioneurosis, but is an inflammatory process in the skin setup by the local irritation of an infective matter.

Dr. STEPHEN MACKENZIE (Lond m) read a valuable paperdetailing a clinical investigation into the Etiology of the

Erythema Multiforme Group and giving an analysis of 167cases with this object, which showed that the most frequeatvariety is erythema nodosum (115 ca?es), the others in orderbeing erythema multiforme (33 cases), erythema marginatum(6 cases), erythema papulatum (5 cases), erythema fugax(5 cases), and erythema tuberculatum (3 cases). Reasonswere given for including erythema fugax and excludingpurpura rheumatica (S-,h8nlein’s peliosis rheumatica), whichDr. Mackenzie regards as a disease distinct from erythemamultiforme. The marked incidence of the disease on thefemale sex (4 or 5 to 1) and in the second and third decadeswas referred to. As regards erythema nodosum, 23 percent. showed distinct evidences of articular rheumatism,and taking all varieties together some evidence of rheu-matism was obainable in quite 50 per cent., and the associa-tion of the disease with rheumatism is confi,med by the ageand sex incidence.

’

468

Papers were read by :Dr. CORLETT (Cleveland, U.S.A.) : On Dermatitis Hiemalis

with a consideration of its Pathological Anatomy.Dr. MENEAU (La Bourboule) : On Chilblains in the Aged.Dr. BARSE (Paris): On the Pathogenesis of Pellagrous

Erythema.Dr. PHILLIPSON (Palermo) : Clinical and Anatomical

Observations on a case of Pemphigus Vegetans.Professor MmELLI (Parma) : Contribution to the Study

of Hydroa Vacciniforme of Bazin.Dr. TÖRÖK (Budapest) : On Pemphigus Vegetans ; the

results of Clinical, Anatomical, and BacteriologicalResearches.

Professor PETRINI DE GALATZ (Bucharest) : Histologicaland Bacteriologièal Study of Generalised ExfoliativeDermatitis.

Dr. NATALI AMICI (Rome) : On a Special Method for theLocal Treatment of Erysipelas.

Dr. P. G. UNNA (Hamburg) : On Impetigo.Dr. SABOURAUD (Paris) : On Alopecia Areata.Dr. BLASCHKO (Berlin) : On an Experimental Investiga-

tion into Alopecia Areata.Dr. PERRIN (Marseilles): On the Contagiousness of

Seborrhceic Eczema in the Inguinal Folds.Dr. GIARROCHI (Rome) : Observations based on 500 cases

of Alopæcia studied from the point of view of the lawswhich regulate the Distribution and the Topographical Suc-cession of the Bald Patches (with illustrations).

Dr. VAN HOORN (Amsterdam) : The Micro-organisms ofSeborrhcea.

Dr. BULKLEY (New York) : The Restriction of Meat in theTreatment of Psoriasis.

Dr. MAPOTHER (London) : Mercurialisation in Psoriasis.Dr. BOUFFE (Paris): Note on the Favourable Results

obtained by means of Injections of Orchitine in the Treat-ment of Psoriasis and Leprosy.

SATURDAY, AUG. 8TH.Papers were read by :-Professor GÉMY and Dr. VINCENT (Algiers), communicated

by Dr. BESNIER : On a Rare Case of Madura Foot.Professor PETRINI DE GALATZ (Bucharest) : On a New

Variety of Acne (Acne Rubra Seborrhceica.).Professor CAMPANA (Rome) : Leprosy in Relation to the

State.Professor PETERSEN (St. Petersburg) : On Colonial

Leprosy.Professor NEUMANN (Vienna) : Statistics as to the Local

Prevalence of Leprosy, and Recommendations for Inter-national Rules as to Preventing its Extension.

Mr. NUMA RAT (St. Kitts) : Leprosy in St. Kitts. ,

Dr. DUBREUILH and Dr. AUCHÉ (Bordeaux) : On Sudori- !,parous Fatty Cysts.

Dr. FRBCHÈ on Onychorrhexis.Dr. BLASCHKO (Berlin) : On Leprosy in Germany.Dr. PERRIN (Bordeaux) : Note on the Leucoplasies.Dr. SAUCHER : On a case of Neuropathic Solid Œdema of

the Upper Limb.Mr. M. MORRIS and Dr. GALLOWAY : On a case showing

the Development of Horny Cysts in the Skin after Injury.

SECTION OF SYPHILIS.

THURSDAY, AUG. 6TH.The Duration of the Period of the Contagion of Syphilis.Mr. JONATHAN HUTCHINSON (London) opened a discussion

on the above subject. He said it was universally admittedthat primary and secondary manifestations of syphilis werecontagious. No doubt cases are met with where contagionhas occurred very long after the primary sore, but these areexceptions, and Mr. Hutchinson considered that contagious-ness had generally ceased by the end of the first year, andthat it was very exceptional indeed for it to continuemore than two years. He had always allowed patients tomarry after two years, and he could only remember twocases where the children of such marriages had shown anysigns of syphilis. He had seen cases where the powerof transmitting syphilis had lasted longer. In one case

a man who had never had syphilis had brought three of hischildren in succession to Mr. Hutchinson, and they were allsuffering from congenital syphilis derived from the wife;later the husband contracted syphilis from kissing his ownchild. In a large majority of the cases it is only the eldestchild who suffers, but occasionally more. In all the cases

of vaccino-syphilis which have been recorded the vaccine-has been taken from children under eight months, neverfrom children over a year old. This fact seems to prove thata case of hereditary syphilis ceases to be infective by theend of the first year.

Professor CAMPANA (Rome) did not think that it was.

possible to fix with certainty the limit of the duration of thecontagiousness of syphilis. Undoubtedly some manifesta-tions of syphilis were not infective, such as the gumma, andthey might say that those lesions which tended to undergo,caseation were not capable of transmitting the disease; butshould such a tertiary manifestation occur before thesecondary stage has come to an end even a gumma mayprove infective. Probably during the whole of the time thatthe disease is hereditarily transmissible the disease is con-

tagious. If anti-syphilitic treatment has been properlycarried out the disease and its results have probablydisappeared by the end of the third year.

Professor LASSAR (Berlin) said that general statements.with regard to syphilis have often very little meaning. The-contagiousness of syphilis persists as long as any syphilitic-signs appear, but the intensity of the contagiousnessdiminishes as time goes on. The localisation of the tertiarymanifestations is probably a great element in preventinginfection from them, and that they are incapable of com.municating the disease has by no means been proved.

Dr. H. FEULARD (Paris) considered it certain that in,different persons the length of the contagiousness of syphilis.varied greatly. For three or four years from the primaryinfection syphilitic manifestations appear and recur fromtime to time ; during the whole of this period there was riskof contagion, and therefore during this time patients shouldnot be allowed to marry. Contagiousness in rare cases maypersist still longer-for five, ten, or fifteen years-and inone case even twenty years after the primary infection a,

case had transmitted the disease. Local irritation seemed tobe a cause of eruption, leading to late transmissions. Thus.the use of tobacco and in children dentition have been metwith as exciting causes of these late eruptions. Treatmentseems to have little influence on the duration of con-

tagiousness of syphilis.Dr. TARNOVSKY (St. Petersburg) said he had seen many

cases in which contagiousness had lasted seven or eight,years and one case had led to infection after fifteen years.

Dr. BLASCHKO (Berlin) said the question had its theo-retical and its practical side. Theoretically a case of

syphilis was infectious as long as the bacillus of syphilis waspresent ; practically infection rarely occurred after three orfour years, though in one case he had seen it after twelveyears.

Dr. SCHWIMMER (Budapest), Dr. DRYSDALE (London)Dr. FITZGIBBOX (Dublin), Dr. BALZES, Dr. JULLIEN, Dr.VIENNOIS, and several others spoke.

FRIDAY, AUG. 7TH.

Malignant S’yphilis.A discussion on this subject was opened by Professor

HASLUND (Copenhagen), who began by saying that the term-malignant syphilis had been somewhat loosely used, but hewould apply it to those cases in which extensive ulcerationappeared not long after infection. The name should neverbe applied to cases in which there was widespread tertiaryulceration ; severe symptoms might be present in these cases,but they were not cases of malignant syphilis. So far as the-primary sore is concerned there is very little to note, and,

certainly extra-genital sores are not specially prone to be-. followed by it. Professor Haslund has never seen it occur: later than the first year after infection. The prog-tnosis is comparatively favourable, and the disease,: even without treatment, tends to a spontaneous cure.. Of the cases under his care occurring in males more than,l two-thirds lasted less than two months. As to the frequency

of malignant syphilis, among 8691 cases of syphilis treated’) in the Copenhagen Municipal Hospital during fourteen) years malignant syphilis has been observed thirty-nine-r times, and with equal frequency in men and women. It isdifficult to ascribe it to any particular cause. It is certainlys not in the virus, as cases of malignant syphilis do not give-3rise to malignant syphilis. It has been attributed to a

1 general weakness on the part of the patients, but it has.; been observed in those who are otherwise strong. Professori Haslund is inclined to think that it is liable to occur int families where the ancestors have been but little affecteds with syphilis, so that there is little power of resistance