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blistering are present. The parts are extremely sen-
sitive. Vaginal discharge often.

Subacute stage: Edema is slight or absent. The
skin is a dull red. No oozing, weeping or vesicles.
Excoriation from scratching in almost every in-
stance. Papules, scales and crusts may be seen.
Much of the sensitiveness of the skin is gone.

Chronic stage: The skin is dry, thickened, leath-
ery, hardened, pigmented and brownish. The dull
appearance is characteristic.

HISTORY RECORD

Symptoms inquired into as to:

Burning, itching, pain, ardor urinae, duration, family



218



SOUTHERN MEDICINE &■ SURGERY



June, I 44



history of allergy, appearance of eruption at onset, any
previous attacks, history of allergy, skin lesions elsewhere
on body, recent nervous shock or worry, sugar in urine,
skin usually dry, oily, vaginal discharge.

Have you or anyone else applied any local remedies,
special prescriptions, proprietary preparations? Which?
When?

Do you scratch the parts?

Taken any medicine internally, for bowels, nerves, etc.?

Do you know of any foods that aggravate the condi-
tion?

EXAMINATION

Parts involved: external genitalia, thighs, anal region.

Dermatological: acute, subacute or chronic; lesions of
other dermatologic entities.

Specificity: a. trichomonas; b. m6nilia, in vaginal dis-
charge; c. central clearing of ringworm.

Diagnostic lesions: a. ringworm of feet, hands u.nder
breasts and elsewhere; b. pellagrous rash on arms, face; c.
seborrhea on chest, back, scalp; d. contact allergic rash on
wrists, neck.

Special tests: a. of scrapings for mycelia of ringworm;

b. intradermal trichophyton test (in chronic stage only) ;

c. culture on special media for monilia; d. patch tests (in
chronic stage only) ; e. urine and blood sugar, glucose tol-
erance test; f. Wasssermann.

TENTATIVE DIAGNOSIS

1. Eczema-dermatitis of unknown etiology.

2. Eczema-dermatitis of known etiology — infestations,
allergies, vitamin deficiencies, physical agents.

TREATMENT

SYSTEMIC THERAPY

1. Rest, psychotherapy, catharsis

2. Non-allergic diets (elimination diets)

3. Vitamin therapy

4. Estrogenic therapy, locally or parentally in senile
caginitis and pruritus vulvae

5. Dyhydration:

a. Dilute HC1 or acidulin by mouth and acid-ash diet

b. Reduce carbohydrates

c. Restrict fruits, fruit juices and soft drinks

d. Stop alcohol.

6. Calcium gluconate by vein and mouth

7. 10 c.c. of patient's own blood intramuscularly

8. Insulin and diet for diabetes.

DIRECTIONS TO PATIENTS

a. No soap-and-water cleansing: use Tersus (Doak) or
Acidolate.

b. Make all tub baths less irritating by the addition of
bran or oatmeal (}4 lb.) or boiled starch (1 lb.) The
bath should be tepid, neither cold nor hot.

c. Cleanse carefully the labial folds and the clitoris.

d. Use "cotton" underwear or none at all. A "T" binder
of soft cloth may serve.

e. Absolutely no rubbing or scratching.

f. Insert a cotton plug or tampax into the vagina as
needed to prevent any discharge reaching the labia.

g. Use toilet paper from front to back. If paper irritates,
use soft cloths instead.

h. No intercourse and keep hands away from the parts.
i. No nail polish, nail lacquer, hair lotions, deodorants,
j. Reduce carbohydrates in diet. Stop fruit juices, soft
drinks, alcohol.

THERAPY OF THE ACUTE STAGE

The more acute the lesion the milder and more
cautions the therapy. The appearance of the lesion
is the guide. Begin with sitz baths, and bland lo-
tions, for a day or so. Then employ sitz baths
once or twice daily and wet compresses for 30
minutes or several times daily followed with a



soothing lotion. Make no attempt at specific ther-
apy except as to breaking contact with allergens,
trichomonas; treating glycosuria, etc. Make no
patch, or intradermal trichophytin. tests in this
stage. See to it that the prescriptions given for the
acute stage contains no possible irritants. If im-
provement is not prompt, the therapy is too active
or the cause has not been removed. Dermatologists
get most of their cases because others have applied
strong medicaments that have flared up the proc-
ess. Always test the remedy on a small area be-
fore applying it to the entire inflamed skin.

1. The Sitz Baths:

a. Corn starch baths (soothing) — y 2 to 1 lb. of corn
starch boiled to make soluble and added to a tub-
ful of water.

b. Bran bath — very hot water is run over a cheese-
cloth bag containing ! /z to 1 lb. of oatmeal bran.
Complete the filling of the tub with lukewarm
water.

c. KMn0 4 (soothing, disinfectant, toughening) . One 5
gr. tablet to 3 quarts water equals a 1:9,000 solu-
tion.

2. Wet Dressings:

a. Milk, or 1 dram of Burow's solution to a pint of
milk.

b. Burow's solution (begin with a 1:20 dilution).
Boric acid solution.

d. KMn0 4 solution 1:9,000 to 1:1,000.

e. AgN0 3 solution Y A % to 1%.

3. Bland Shake Lotion:

Rx Phenol 2% 2.5

Tragacanth 1% 1.2

Zinc oxide 6% 7.0

Calamine 6% 7.0

Olive oil 33 1/3% 40.0

Distilled water qs ad 120.0

Sig: Apply with a flat paint brush every 3 or 4
hours.
Open dressings are more soothing and allay the
itching better than closed dressings. Use soft
pieces of cloth rather than gauze or cotton, partly
wrung-out and applied soppy but not running.
Change q 2 to 4 h. It is often advisable to leave
off the wet dressings during the sleeping hours,
applying a soothing lotion.

LOCAL TREATMENT OF SUBACUTE STAGE
Principle: Shake lotions and bland soothing
pastes and ointments, with or without the addition
of anti-inflammatory ingredients.

Shake lotion listed for the acute stage, or one
of these Rxs.

Rx Zinc oxide 50.0

Talc 50.0

Bentonite 10.0

Petrolatum 60.0

Camphor 1.0

Menthol 1.0

M.
Sig: Apply to inflamed areas twice daily, cover
with a sprinkle of talcum powder.

Rx Boric acid cream 5.0

Menthol 0.25

Phenol 0.5



June, 1944



SOUTH ER.X MEDICINE & SURGERY



Ung. Aq. Rosa ps 100.0

M.
Sig: Apply to inflamed area twice daily.
Rx Liquor carbonis detergens 5.0

Benzocaine 5.0

Calamine liniment (N. F.) qs....l00.0

M.
Sig: Apply to inflamed areas twice daily.
Rx Ichthyol ' 8.0

Glycerine 16.0

Rose water 16.0

M.
Sig: Apply to inflamed areas twice daily.

The pyogenic infections of eczema-dermatitis are
apt to yield to KMn0 4 (1:20,000 to 1:4,500) as
sitz baths or wet dressings, or AgN0 3 (0.1 to
0.59c ) as wet compresses, or sulfonamide emulsions
or ointments.

LOCAL TREATMENT OF CHRONIC STAGE
Principle: Therapeutic applications that contain
active ingredients, parasiticidal and keratolytic.

Note: Try medicaments on small area first. Skin
may be intolerant to any active medicament.
Calamine liniment, coal tar, benzocaine.
Ichthyol and zinc oxide ointment.

Crude coal tar paste.

Rx Crude coal tar 4.0

Zinc oxide 4.0

Castor oil 4.0

Corn starch 30.0

Petrolatum 26.0

Mix tar with castor oil and add zinc oxide, mix well and
let stand 24 hours, mix corn starch with petrolatum. Com-
bine the two mixtures and triturate until smooth.
Rx Liquor carbonis detergents.. ..drams l />
Lanolin

Olive oil aa ounces 1

M.
Sig: Apply locally twice daily.

Refractory cases may require x-rays.
TREATMENT OF CHRONIC FUNGUS INFECTION
Ringworm (Tinea Cruris) :

Pragmatar ointment (sulfur, salicylic acid and
tar).

Constellani's paint (basic fuchsin and resorcin — ■
use diluted with equal parts of water first).

Rx Thymol grs. 5

Phenol m 10

Ung. picis liquid drams 1

Cold cream ointment qs ounce 1

Use to paint area.
Monilia (Yeast Vulvitis, Thrush):
Xote: Common in diabetes.
Rx 2% Aqueous solution Gentian Violet
Sig: Apply morning and night for 10 to 14 days until
exfoliation occurs.
Rx Lugol's solution '/i of 1%
Sig: Paint vagina once weekly.

Rx Hesseltine's capsules (0.125 gm. of mixture of potas-
sium iodide and potassium iodate)

Sig: Insert one capsule in vagina nightly.



FLARE-UP UNDER MEDICATION
Bland sitz baths. Wet compresses of dilute Bu-
row's solution or boric acid alternating with appli-
cation of soothing shake lotion.

PRURITUS VULVAE
This may be a symptom of eczema-dermatitis,
or of trichomonas, pin-worm, acarus, pediculus or
other infestation. It may be due to atrophy or
dryness of skin, senile vaginitis, menopausal pru-
ritus, diabetes, jaundice, leukemia.

Rx Zinc oxide 20.0

Talc 20.0

Glycerine 15.0

Water 70.0

Menthol 0.5

Phenol 0.5

KMn0 4 (1:9,000) sitz baths are very effective.
Subcutaneous injections of 1:3,000 HC1 or 95%
alcohol.

Estrogenic therapy (in natural or artificial men-
opause, senile vaginitis, kraurosis vulvae, atrophic
vaginitis)

a. Apply locally 30 c.c. of an ointment with
lanolin base containing 10 mg. diethyl stil-
bestrol per 30 c.c. of ointment.

b. Stilbestrol in oil inunctions (Wharton).

c. Estrogen per os or parenterally.
Adequate management of diabetes.
Therapeutic test for pin-worm — Enseals of Gen-
tian Violet (0.06 gm.) t.i.d. for 8 days.

X-ray therapy.

Conclusion

As concomitant gynecological problems cause the
patient with eczema-dermatitis of the external gen-
italia to consult her family physician or a gyne-
cologist, it behooves us all to understand the prin-
ciples of its therapy.

The guide to treatment is the appearance of the
inflamed parts. The more acute the lesion, the
milder must be the medicament. All cases are
treated similarly during the acute stage, without
regard to cause. The dictum should be "do no
harm" — soothe the parts into quiescence, and later
cautiously apply more sharply focused causal or
specific therapy. Consultation and collaboration
with a dermatologist should be routine in the more
severe cases.



SUMMER DIARRHEA IN BABIES
Casec (calcium caseinate), which is almost wholly a
combination of protein and calcium, offers a quickly effec-
tive method of treating all types of diarrhea, both in
bottle-fed and breast-fed infants. For the former, the car-
bohydrate is temporarily omitted from the 24-hour for-
mula and replaced with 8 level tablespoonsful of Casec.
Within a day or two the diarrhea will usually be arrested,
and carbohydrate in the form of Dextri-Maltose may
safely be added to the formula and the Casec gradual!)



220



SOUTHERN MEDICINE & SURGERY



June, 1944



reduced till none remains. Three to six teaspoonsful of a
thin paste of Casec and water, given before each nursing,
is well indicated for loose stools in breast-fed babies.

Please send for samples to Mead Johnson & Company,
Evansville, Indiana.



THERAPEUTICS

J. F. Nash, M.D., Editor, Saint Pauls, N. C.



TWO CASES OF INFLAMMATORY AND
ARTERIOSCLEROTIC HEART DISEASE

Two cases are outlined 1 in both of which the
cause of death as determined by necropsy, escaped
clinical recognition while the disease was diagnosed
correctly. The lessons taught may well find appli-
cation in our practice.

A 25-year-old white woman complained of pal-
pitation, muscular pains, fever of 101° for one
month. She had been hospitalized on several occa-
sions with the diagnosis of organic heart disease.
No history of rheumatic fever. Systolic and dias-
tolic murmurs were heard over the apex. Petechiae
were present under the fingernails, a slight anemia,
leucocytes 18,850. Blood culture disclosed strepto-
coccus viridans. B. p. 118/50. Sulfadiazine was
given repeatedly. A week before death pain was
felt in the left leg and no pulsation in the dorsalis
pedis. Moist rales developed in the chest and the
patient expired.

Diagnosis was subacute bacterial endocarditis.

Autopsy: A few petechial hemorrhages in the
conjunctivae, face slightly cyanotic. Pleural cavi-
ties 500 c.c. clear liquid, peritoneum 800 c.c. Heart
enlarged (350 gms.), mitral leaflets thickening
along line of closure, chordae tendinae thickened
and in part fused, a few grayish vegetations up to
2 mm. on the thickened areas. On left and pos-
terior aortic cusps luxuriant grayish-brown vegeta-
tions up to 1.0 cm. Vegetations also on adjacent
endocardium of interventricular septum. Minute
ulcerations throughout the free margins of the
cusps adjacent to the vegetations, few white fibrous
ridges were present on endocardium of the i.-v.
septum. Myocardium gray, a few yellowish and
white dots irregularly throughout the cut surface.

Liver 1600 gms., chronic passive hyperemia; in
middle of the right lobe, a cyst-like structure 1.5
cm. in diameter contained reddish-gray (throm-
botic) material, communicated with hepatic artery.
Spleen enlarged (300 gms.), firm, several infarcts,
chronic passive hyperemia, acute hyperplasia. Kid-
neys, cloudy swelling and passive hyperemia.

In the left popliteal space was a grayish-brown
embolus adherent to the wall and completely oc-
cluding the lumen of the popliteal artery.

1. O. Saphir, Chicago, in 111. Med. JL. April.



Diffuse cloudy swelling of the fibers of the myo-
cardium, with foci of early fatty degeneration. Sev-
eral small and larger infarcts. Small emboli in va-
rious stages of organization within the smaller
branches of the coronary arteries. No Ascholf
bodies or remnants of Aschoff bodies encountered,
nor any perivascular fibrosis.

Clinical diagnosis subacute bacterial endocarditis
likely superimposed upon a rheumatic endocarditis
with death from sepsis. The diagnosis was verified
but it seems obvious that the patient did not die
as the result of sepsis but of heart failure, brought
about by the multiple myocardial infarcts and my-
ocarditis.

A 66-year-old white man entered complaining of
dull abdominal pain and back pain, vomiting and
constipation with cramp-like pain in the right
lower quadrant; history of coronary thrombosis six
years ago, since then anginal attacks at irregular
intervals. Thrombosis of the femoral artery with
amputation of the right leg nine months before his
death. Partial prostatectomy 13 years ago. Regu-
lar heart rhythm, rate 78, b. p. 110/74, heart en-
larged to the left. Moderate spasm of the abdom-
inal muscles and tenderness over the right side; 2 A
hours after admission severe pain in the region of
the right hip followed by collapse; b. p. at this
time 0. In spite of heroic measures, the patient
expired one-half hour later. Death thought to be
due to pulmonary embolus, coronary thrombosis, or
abdominal hemorrhage.

A large amount of partially liquid and partially
clotted blood was found encasing the descending
aorta, right kidney and right suprarenal; also along
both common iliac arteries. Heart enlarged (450
gms.), an old aneurysm (4 cm.) in the apical por-
tion of the left ventricle, extending to the adjacent
interventricular septum. Coronary arteries showed
arteriosclerosis with occlusion of the anterior de-
scending branch of the left, a number of severely
narrowed portions in other coronary branches, no
recent thrombus. The aorta was the seat of a
severe arteriosclerosis with many areas of hyalini-
zation, calcification, and atheromatous ulcers. Two
cm. proximal to the bifurcation into the common
iliac arteries was a large saccular aneurysm filled
with lamellated thrombi, communicating with the
retroperitoneal space. There were two similar,
though smaller, aneurysms in the uppermost por-
tions of both common iliac arteries, and two small-
er ones in both internal iliac arteries. Grossly, no
changes were found in the residual prostate, but
on microscopic examination in one area structures
lined by one or two layers of cuboidal cells, which
showed marked anaplasia, many atypical mitotic
figures — early adenocarcinoma.

(To Page 223)



June, 1944



SOUTHERN MEDICINE & SURGERY



SOUTHERN MEDICINE & SURGERY

Official Organ

James M. Nortiiington, M.D., Editor

Department Editors

Unman Behavior
Jamrs K. Hall, M.D Richmond, Va

Orthopedic Surgery
John T. Saunders, M.D Asheville, N. C.

Urology
Raymond Thompson, M.D Charlotte, N. C.

Surgery
Geo. H. Bunch, M.D Columbia, S. C.

Obstetrics

Henry J. Langston, M.D Danville, Va

Gynecology

Chas. R. Robins, M.D Richmond, Va.

Robert T. Ferguson, M.D Charlotte, N. C.

General Practice
J. L. Hamner, M.D .Mannboro, Va.

Clinical Chemistry and Microscopy

J. M. Feder, M.D., \

.- ~. ., t y Anderson, S. C.

Evelyn Trkble, M. T. f

Hospitals
R. B Davis, M.D Greensboro, N. C.

Cardiology
Clyde M. Gilmore, A.B., M.D Greensboro, N. C.

Public Health
N. Tnos. Ennett, M.D Greenville, N. C

Radiology

R. H. Lafferty, M.D., and Associates Charlotte, N. C

Therapeutics
J. F. Nash, M.D Saint Pauls, N. C

Tuberculosis
John Donnelly, M.D Charlotte, N. C.

Dentistry
j H Guion, D.D.S Charlotte, N. C.

Internal Medicine
GF.o«..t R Wilkinson, M.D Greenville, S. C.

Ophthalmology
Hr.RRF.RT C NebletT, M.D Charlotte, N. C.

Rhino -01 o- Laryngology
Ci ay W Evatt, M.D Charleston, S. C.

Proctology
RUSSELL von L. Buxton", M.D Newport News, Va.

Insurance Medicine
II K Stahk, M.D Greensboro, N. C

Dermatology
J. Lamar Callaway, M.D Durham, N. C.

Pediatrics

Offering for the page oj this Journal are requested and
given careful cnnsideral'on in each case. Manuscripts not
found suitable for our use will not he returned unless author
encloses postage

As is true of most Medical Journals, all costs oj cuts,
ttc , Jor illustrating an article mu'l he borne by the author.



MEDICINE IS NOT GUILTY

Wliat's come to perfection perishes. — R. Brotolning.

The starry-eyed would-be re-e-formcrs of every-
thing in the heavens above, in the earth beneath,
and in the waters under the earth, and of things
medical in particular, never tire of pointing to the
records of rejection under the Selective Service
System. Scandalous is about the mildest word they
use in describing the situation, and they accuse
Doctors of Medicine of allowing or causing this
situation to develop. It is one of their stock argu-
ments for Socialized Medicine. Not a little of this
has its origin in absurd reasoning of certain mem-
bers of the profession, a good many of them on
Government payrolls.

Let us consider briefly certain statements of the
Chief, Medical Division, Selective Service System,
as republished in May. 1

All of us will agree with the statement that "re-
liable statistics on remediable diseases are not
readily available." The Chief accepts as the best
data those of October, 1941, to March, 1942. He
gives a chart of "proportion of rejected registrants
with correctible defects, by type of defect." Ac-
cording to this chart hernia is responsible for 27
per cent; conditions of teeth, mouth and gums for
19 per cent; venereal diseases for 14 per cent;
underweight for 13 per cent. Other percentages:
musculoskeletal conditions 6 ; nose and throat con-
ditions 4; genito-urinary conditions 4; varicose
veins 2}' 2 \ cancers and tumors 2 l /2. The remainder
of the rejections are attributed to eye and skin
conditions, and "other."

As he himself says "it is of interest that the first
three defects listed — hernia, dental defects and ve-
nereal diseases — account for 65 per cent of those
regarded as correctible." But he does not call at-
tention to these obvious facts: (1) nobody knows
how to prevent hernia, nor how to induce anything
like all those having hernia to submit to operation;
(2) nobody knows how to prevent dental decay,
or to induce all those in need of dental treatment,
even all those fully able to pay for it, to have their
teeth kept in condition acceptable to the Armed
Forces; (3) everybody knows that no human
agency can keep young men from contracting ve-
nereal disease.

To correct is to free from fault. Underweight
for which no causative disease condition could be
found, was most likely a family peculiarity, in no
sense a disease except to those who do not distin-
guish between the abnormal and the pathological.
The strong presumption is that, despite the cock-
sureness of the Chief, had the condition been rem-

I. "Correctible Defects at Selective Service Age," by Leonard
G. Rowntree, M.D., Colonel, M.R.C., in Medical Annnh District
of Columbia, May.



.S()LTIIER.\ MEDICINE & SURGERY



June, 1944



ecLable (a better word), it would have been reme-
died long ago. We dearly love to be standardized.
From a standardized cradle to a standardized cof-
fin, we are hurried, flurried, worried and buried.

One can but wonder as to the nature of the mus-
culoskeletal, nose and throat, and genito-urinary
conditions which make up 14 per cent of these
''correctible" causes for rejection. Most likely most
of these are developmental, and about as amenable
to human control as the movements of Mars.

Varicose veins in cne part betoken a weakness
of the veins in general. It is highly improbable
that 10 per cent of those rejected could be made
acceptable for the Armed Forces by the exercise of
the best skill of the surgeon. If anybody knows
any way of preventing the development of varicosi-
ties he should pass it along.

Cancer still kills most of those it attacks, despite
the best efforts of the best doctors. It is axiomatic
that the younger the cancer patient the less the
chance of cure. Can any one conceive of a greater
absurdity than stating that cancer in the selectees
is ''correctible"? As to the other ''tumors," most
likely they caused no discomfort, and were there-
fore disregarded — perhaps wisely.

Obviously, so vague a label as "other" offers no
opportunity for refutation.

In a tabulation of "principal causes of rejections
of registrants 18-37 years of age in class 4-F as of
January 1st, 1944, educational deficiency is given
as a cause in 10.4 per cent of the cases, mental
disease in 14.5, mental deficiency in 3.3 — non-med-
ical causes 1.1.

The Chief makes this remarkable statement:
"illiteracy, while not strickly speaking a medical
problem, is to say the least a close relative of dis-
ease"; and he excludes the rejections for this
cause from the "non-medical" causes in the table!
Verily, "Ignorance is the curse of God,
Knowledge the wing wherewith we fly to Heaven."

The figures given for rejections because of edu-
cational and mental deficiency, and mental disease
— all three listed as medical causes, and by impli-
cation the fault of Doctors of Medicine — add up
to 28.2 per cent. Maybe our vanity should be grat-
ified at having doctors thought to have the knowl-
edge and the power to adequately instruct the
whole population, to raze out the written troubles
of the brain and to give ripe wits to fools. Cer-
tainly nothing in the implication deserves serious
consideration or comment.

The Chief arrives at the following conclusions:

1. The present health situation in the Nation is
unsatisfactory from the standpoint of procurement
of manpower for the fighting forces and, to a lesser
extent, for industry.

2. Tn order to meet their manpower needs, the
a " - "' forces in the midst of war have been com-



pelled to shoulder the burden for the remedy of
correctible defects of those accepted for military
service.

3. Though this country has elected to become
the arsenal of democracy, large numbers of defec-
tives, now numbering some four million, are denied
military service, and are being turned over to labor
and industry without adequate provision for the
care of their correctible defects.

Of course the health situation is unsatisfactory.
Satisfaction is one of the strong words. Philoso-
phers have always held anything short of perfec-
tion to be unsatisfactory. Witness the King James
Version, the greatest of authorities on our lan-
guage: "I shall be satisfied when I awake in His
likeness."

Most of these defects are correctible by the
land of Omnipotence only.

This country has not elected to become the ar-
senal of democracy. Every member of the British
Commonwealth, Russia, China and a good many
other countries share this burden and this honor.
To attempt to claim a higher merit than our allies
is as absurd as to say the heart is the most im-
portant organ in the body. Life cannot go on with-
out a liver, or without a kidney, or without a pan-
creas, or without a gastrointestinal tube, or without
a suprarenal gland, or without some sort of a brain.
Manifestly, no organ can be more important than
any one organ without which life could not be con-
tinued.

Disparagement of any one of our allies in this
life-and-death struggle brings to mind the words
of Talleyrand, "It's worse than a crime; it's a
blunder."

Medicine is not directly accused; but, inasmuch
as these figures have been used over and over again
to support arguments for a radical change in the
way of rendering medical care, it should have been
expressly stated that Medicine is not responsible



Online LibraryGreensboro CollegeSouthern medicine and surgery [serial] (Volume 106 (1944)) → online text (page 42 of 98)