1 CARBON AS AN ANTISEPTIC DRESSING FOR BY DAVID STEWART, M.D., of Port Penn, Delaware. The writer was the first contributor to the U. S. Pharmacopoeia from Baltimore, through your Society, perhaps the only one in the decade commencing in 1830. In testimony of this, your Committee presented to him an interleaved Pharmacopoeia, by order of the Board, in 1840, and appointed him their delegate in 1850, as will ap pear in the preface to Pharmacopoeia; also, that he was appointed at Washington, with Wood, Bache and others on their special Committee on Publication. You may, therefore, appreciate his desire to continue to use your Committee after having served in it and all the other Boards during many years—although he be no longer "a member," and now resides in another State. Consequently his opinion of the following most modern surgical dressing, and the most improved formula therefor, may, through your Board, reach the Pharmacopoeia of 1890. Pure carbon, atomically porous, the most perfect disinfectant and absorbent substitute for lime. Digest one pound of ivory black (imp. carbo. animalis) in one pint of common muriatic acid (ac. hydro. chlor. imp.) for one day, or till effervescence ceases, then remove the muriate and phosphate of lime by decanting the water (being stirred with the magma) until it is tasteless. If the magma then measures one pint, add thereto 8 grs. of corros. sublimate (Hg. Cl. Cor.) dissolved in 3 ij of alcohol (or about 1 gr. to every 1,000 grs.). Preserve the magma carefully from bacteria, etc., in a "salt mouth" jar glass fruit-jar, hermetically sealed. As a disinfectant and deodoriser, this has ever excelled all other such means, in pharmacy-in the chemical laboratory, etc. The following may illustrate one of its numerous applications in surgery, being very inexpensive, perfectly pure, permanent and dispensing with the antiseptics which may be absorbed. It also saves more than one-half of the time of the surgeon, where wounds demand a fresh dressing every day or two by becoming offensive. And thus it is abundantly proved that more rapid cicatrization progresses. A gun-shot wound of fore-arm-say 6 x 2 inches and inch deep -became offensive if not dressed every other day, until above was applied; then, five days could elapse. Moreover, in another case ten or twelve days elapsed after a first dressing with carbonaceous matter, and such a wound was found rapidly healing with very little pus. In the former case, after strapping as usual with adhesive plaster, these straps were covered with above magma, say, about onequarter of "proportion," or about one-half inch thick-(by interposing "butter muslin" it does not escape). A single roller was then run up the arm, and on returning embraced a moist paste-board, which fixed firmly both bones and also the metacarpal bones, though only occupying the lower part of arm and the hand. No salve or other means were used. It is admitted that all unnecessary disturbance of such wounds should be avoided; if so, this is the most perfect and successful dressing. DISCUSSION OF DR. STEWART'S PAPER ON CARBON DRESSING. DR. JOHN MORRIS remembered that his preceptor was accustomed to use a dressing composed of equal parts of charcoal and sugar. DR. TIFFANY. I have seen patients tatooed by charcoal dressing. I should have been glad if the report had stated whether such a result had been noticed in this case. DR. EARLE thought that as Dr. Stewart had used hydrarg. chlorid. corros. in the preparation of the carbon that a large part of the good results were to be referred to that antiseptic. DR. CHRISTOPHER JOHNSTON, SR., explained that this was entirely washed out before carbon was used, and described minutely the method of purifying animal charcoal. ABSTRACT OF A PAPER ON HARD CHANCRE OF THE TONSIL. BY FRANK DONALDSON, JR., B.A., M.D. Hard chancre of the tonsil is by no means as infrequent as was formerly supposed. Its etiology, symptoms and appearance, however, are very variable. The case in point was that of a prostitute who came to the author's clinic with two sores, one in her upper lip hard, superficial and indurated; the other.of somewhat the same appearance on the left tonsil. She had had no connection with a man for thirteen weeks, having been ill with peritonitis; but had kissed again and again a man with whom she was familiar, and who was suffering from severe syphilitic sore throat. Shortly after this the two sores made their appearance simultaneously. The case was referred to Prof. Atkinson, whose diagnosis of hard chancre of the tonsil and lip was fully confirmed by the appearance shortly after of a roseola-general adenopathy—alopecia—arthritis-mucous patches, etc. She improved rapidly under antisyphilitic treatment. Speaking generally there are about one hundred cases of hard chancre of the tonsil on record. They are rather more frequent in women than men, and are usually unilateral, though I find two cases where there was a chancre on each tonsil. When situated in the pharynx hard chancre is most often found on the tonsil. The mediate and immediate methods of infection are many and disgusting. Suffice it to say the infection results from kissing and beastly practices, from the use of the spoons, knives, glasses, cigar stumps, or even tooth powder of those suffering from secondary syphilis. The physical signs of chancre are very variable and from them alone a diagnosis is very difficult. Chancre in this situation begins with slight redness and swelling with slight hypertrophy of the gland, which is increased until swallowing becomes painful. On examination there will be seen upon the tonsil a superficial, greyishwhite erosion, with indurated base. The exact amount of induration in different cases is difficult to make out; for the induration depends upon the amount of hypertrophy of the tonsil-the greater the hypertrophy, the greater the induration, and vice versa. More or less marked, and an early submaxillary adenopathy on the affected side is another prominent sign. These swollen glands are more painful than those which follow a genital chancre and sometimes become extremely large, but are always resolved without suppuration. The tonsil erosion may assume the phagedenic form of a deep sloughing ulcer with great tumefaction and induration of the neighboring parts, though this would seem to be a new complication of tonsil chancre. The functional symptoms of tonsil chancre are general but slight. An outbreak of a roseola ̧ being the first intimation the patient has of his trouble. As a rule there is pain on deglutition and Rollet declares that of all the chancre of the mouth those back of the anterior pillar are the most painful. When the ulcer becomes phagedenic the pain is very great, swallowing impossible and there is great prostration. As may be seen the positive diagnosis of hard chancre of the tonsil is beset with many difficulties. It is to be differentiated from epithelioma, from tuberculous ulceration (according to Cohen); from psoriasis of the mouth, the milky patches of smokers; from mucous patches, whose favorite seat when in the fauces would seem to be upon the tonsils, and from the perforating ulcer of tertiary syphilis. Pivaudran thinks tonsil chancre may be mistaken for diphtheritic deposit and for a gangrenous throat angina; it must not be confounded with an ulcerating gummy tumor of that gland. In general we may say that, if the tonsil lesion is unilateral, superficial greyish-white, with indurated base and hypertrophy of the gland itself; if there is a history or even a suspicion of syphilitic exposure; if there is glandular enlargement in the affected side; if the angina appeared for ten days to three weeks after exposure and there is absence of chancre in other parts; if the patient has not been 'subject to tonsillar angina; if the pain and soreness has lasted some time and has not excited febrile reaction; and finally, if an outbreak of secondary syphilis developes in due time, we may be safe in our diagnosis of the lesion upon the tonsil as a hard chancre. STRICTURE OF THE URETHRA, WITH CASES AND SPECIMENS. BY J. H. BRANHAM, M.D. To avoid inflicting a lengthy and tedious paper on this Society (which would necessarily be largely a recapitulation of facts and opinions already repeatedly published), I have concluded simply to note a few cases, and to show some specimens, which, with a few brief comments, I hope will be of interest. About a year ago I was requested to see A. D., white, aged 19; machinist. His history was as follows: He had never had gonorrhoea or any injury to his penis; formerly masturbated, but claims to have quit this over two years ago. For the past two and a half years, he has suffered from frequent, painful and often difficult urination, severe pain in the loins, seminal emissions, slight discharge from meatus, great mental depression and general debility, so, that lately, he had almost entirely stopped work. He had been treated by sundry druggists, and by eight or ten physicians, including two of the leading genito-urinary specialists of this city. His meatus measured 23 mm., and about half an inch back of it was a contraction to the same size. The remainder of the canal would readily pass a 32 (F). The anterior part of the urethra was divided freely and he was given a short straight steel sound, with instructions to pass it twice a week at first, and then less frequently. He improved rapidly, soon returned to work, and nine months afterward reported himself entirely well. Four months since a physician, aged 32, came under my care, suffering with the following symptoms: Two months previously he had contracted a gonorrhoea, which under very active treatment soon disappeared, with the exception of a very slight discharge, which seemed to come from just behind the meatus, where the canal was sensitive. |