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charin. He also observed that on those days in which aeter with the symptoms of mal perforant du pied. This he used it he suffered from headache and other symp- young man has had frequent attacks of epistaxis. The mucous toms of membrane of the nasal cavity is studded with small pin-head- gastrointestinal derangement. sized and and shallow The recorded above confirm the work of larger tubercles irregular, ulcers, thus experiments explaining largely the catarrhal symptoms of which he com- Reigler,2 although it seems that we noted a moré power- plains. ful that him. is action than reported by This undoubt- This patient was first examined on Dee. 4, 1904, at which edly due to the using of different brands of saccharin. time a small nodule was excised for examination. The section In our work we used the "garantose" handled by Merck when stained exhibited numerous lepra bacilli and the same & Co. Reigler used that manufactured by Fahlberg, micro-organisms were thickly dispersed in a smear of the nasal List & Co. The commercial vary in secretion. products strength, Points and to obtain uniform results a of Special Interest.—Though presenting typical and quantitative chemically unmistakable of with an pure must be used. symptoms tubercular leprosy, admix- preparation ture of lesions commonly found in anesthetic types of that PHARMACOLOGY OF SACCHARIN. disease, this patient presents several points of special interest. Saccharin is used in medicine on account of its His youth and the relatively brief period of time during solely which he has the disease be named first sweetening As we have shown, it has a retard- suffered from may in properties. order. These well if an in- influence on the action of the promised appropriate therapy were ing digestive juices, espe- stituted. was on that of the saliva and Its He placed chaulmoogra oil, beginning with cially pancreas. prolonged five minims in a glass of milk administered three times daily, use tend to disor- would, therefore, produce digestive the dose being progressively increased to nearly a teaspoonful. ders. When an injected into the circulation of animal With this were administered ferruginous tonics; and a care- it produces depression and stupor, followed by labored fully directed hygiene was insured. respiration similar to asphyxia. This is evidently due The results have surprised all who have watched the progress to its inhibitory action on the enzymes in the blood and of the case. The general appearance and health of the patient also in the tissues in general. This action very prob- have greatly improved. The skin is fairer, less muddy, less in- accounts for the headache and other filtrated. Over the brows the tubercles are now scarcely evi- ably symptoms catarrhal less which follow its use. Like many of the other benzol dent. The symptoms are severe. The only feat- ure of his case in which there has not been im- it be considered a corresponding compounds, may general protoplasmic is the ulcer. This shall in that it inhibits all the fermentative provement plantar we treat surgically. poison, nearly Second: The origin of the disease. The youth almost cer- processes of the body. Consequently it interferes with contracted in. Russia. Instances of this and tainly leprosy malady, decreases the general body metabolism. originating in the United States, are, indeed, few. My colleague, Dr. Ormsby, has reported one such case, the patient having been exhibited clinic last LEPROSY, SYPHI- to this year. In his published report BLASTOMYCOSIS, LUPUS, of this case, Dr. Ormsby makes reference to the case of the LIS, ALOPECIA AREATA, LUPOID SYCOSIS. child of a leprous patient presented by me before this clinic JAMES NEVINS HYDE, M.D. several years ago, in which it seemed highly probable that the a the Professor of Diseases of the Skin, Rush Medical College. child, native American, contracted disease, presumably CHICAGO. from the father, in the state of Nebraska. Third: The demonstration of bacilli in numbers LEPRA TUBEROSA. lepra great in the nasal secretion would seem to argue in favor of the Case 1.\p=m-\J. G., male, aged 20, a native of Russia, came to opinion long sustained by Dr. Morrow, of New York, that most this six and has since country years ago, that date lived in one cases of leprosy are contracted by the medium of nasal secre- of the western states contiguous to Illinois. tions. It should be added, however, that in most of the History.\p=m-\Threeyears ago he began to suffer from a series leprosería visited by me the organs, apart from the skin and of febrile attacks, accompanied by chills and by eruptive symp- viscera, most frequently involved were without question the toms of an erythematous type, which were supposed to be eyes. The number of blind lepers in any asylum devoted to syphilitic in character and for which he was subjected, without this class of patients is pitifully large. remedial a results, to course of specific treatment. Aside from Case 2.—This patient, F. B., aged 27 years, a native of the symptoms referred to, he has enjoyed fair health. There Australia, left his home seven years ago to become a sailor. is no venereal history of disease; he has occasionally indulged History.—In the course of his voyages he has visited Ceylon, in tobacco smoking; his family record is good. His father, India, Norway, Sweden, China, and the West Indies, and has who accompanies him, is a healthy-looking, though somewhat lived an irregular sexual life in all these countries. At one Polish Jew. undersized, time he was associated with a bunk-mate supposed to have the Examination.\p=m-\Theface of the patient is seen to be the seat same disease and with whom he occasionally exchanged cloth- of a diffuse infiltration, chiefly conspicuous about the nares, ing. It appears, however, that before he left Australia an the and the brows, the lips, ears. The infiltrated area, though odd-looking "patch" appeared on his back, which may possibly diffuse, is studded here and there with smaller and larger have been the first symptoms of the disease with which he is There tubercles. is marked alopecia of the brows. On the now affected. There is a leper asylum in the vicinity of his forearms, hands, legs, and the dorsum of the feet, there are native town. His history, prior to the development of the larger and smaller poorly defined ureas of punctate pigmenta- present disease, is not significant. His parents are healthy and tion; and here, as also where no such coloration exists, there free from symptoms of his ailment. The tip of the left index are areas distinctly insensitive to hot and cold applications finger has been removed as the result of a traumatism. His and a to the prick of pin. On the extensor surface of the left functions are regularly performed. wrist is a large, coin-sized keloid developed from a burn Examination.—At the present time, the dorsum of the trunk which, he states, at the time of its infliction, produced no pain. is seen to be symmetrically, though irregularly, overspread The ulnar nerves are somewhat enlarged and corded, but the with circular and ovoid patches having a faintly erythematous not ascending great auricular nerve is involved. This special central area surrounded by annular bands from one to two nerve is said to be implicated in nearly 90 per cent, of similar centimeters in width, pigmented in yellowish-brown shades. and its induration is cases, readily demonstrated in the patient There are about a score of these visible, varying in size from whom I shall next to a present you. There is deep, funnel- the section of a hen's egg to the palm of a hand; some of them ulcer in of the foot shaped the sole left corresponding in char- are insensitive to both superficial irritation and to cold and heat. There are other areas of anesthesia where the pigmenta- 2. Archiv. f\l=u"\rExp. Path. u. Pharmacologie, vol. 35, p. 306. tion and color for about the A clinical lecture delivered before the Visiting Alumni of Rush changes are absent, as, example, Medical College at the Commencement of 1905. popliteal spaces, but more particularly over the posterior Downloaded From: http://jama.jamanetwork.com/ by a Georgetown University Medical Center User on 05/23/2015 of each forearm from the elbow to the ulnar aspect side of the now numbering more than forty in this city alone. The first hands as far as the borders. The anterior surfaces of digital instance reported by us justified the name originally given to the thighs and the left patellar region are equally insensitive. the disease by Gilchrist, of Baltimore, viz., "blastomycetic The nerve trunks in both arms are corded and the tumid; dermatitis." But the occurrence, under our observation, of auricular nerve (as in the case of the cases in great explained patient which not merely the skin, but also the viscera were is thickened and indurated. previously presented) distinctly involved, eases, in fact, in which the skin was secondarily at- There are a few subcutaneous in situation, tacked pea-sized nodules, after organisms plainly had been demonstrated as of discernible in the skin of the forehead. as in earlier Here, however, origin in the liver, spleen, or kidneys, cases going on to the skin the the and the alse of the a covering temples, ears, fatal termination, and in which, even after a first cutaneous the is more or less infiltrated. nose, integument evenly Making expression of the malady, there was later infection, allowance for the characteristic color of the skin of the native systemic revealed the subject in an entirely novel light.

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