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On a Common Herpetic Epizbotle Affection,

cavity of the pel~s, I pass the two first fingers of my left hand as high as possible along the sacrum; next, holding the warmed and well-soaped lower blade of the instrument loosely in my right hand, I direct it along the introduced fingers between them and the head; when the handle, of course, points towards the thighs of the patient. Next, the index finger of the left hand is gently pressed upon the upper part of the back of the convexity of the blade, while~ at the same time, the handle is gently raised in the right hand and slowly carried backwards with a sweep towards the perineum; I invariably find that by a combination of these motions the blade, resting on the index finger as a fulcrum, slowly traverses the fetal head and finds its own way to the position most suitable to the circumstances of the case, and that the handle of the instrument, when fully introduced, lies against the anterior edge of the perineum. I t is at this stage that I find the advantage of having commenced with the lower blade, for instead of being obliged to introduce the second blade between the perineum and the first, or else, after its introduction, to cross one handle over the other, the assistant can hold the first in its place, posteriorly, where it is not at all in the way of subsequent operations. Again the first fingers of the left hand are passed along the sacrum, and guided by them, as before, the second blade is introduced, while the fingers, this time below the convexity of its edge, act again as a fulcrum. Now instead of raising the handle it is greatly depressed and carried towards the perineum, allowing the blade to traverse the upper convexity of the head, and take its position in a manner similar to the first. No force is required in any part of the operation, as the blades, guided by the wall of the uterus on one side, and the fetal head on the other, cannot fail to insinuate themselves into the chink between the pelvis and the head, and taking up a position exactly opposite each other lock readily as soon as the handle of the second approaches the perlneum.

ART. XIV.--Remarks on a Common Herpetic Epiz6otic Affection, and on its Alleged Frequent Transmission to the Human Subject. By DR. W~LLI_~ FRAZER, Lecturer on Materia Medica to the Carmicbael School of Medicine, &c.

:EARLY in March I was requested to attend a little child, about four years of age, who had contracted an eruption of the skin from

and its alleged Transmission to Man.

By DR. FRAZ~R. 295

playing with a calf whilst visiting at a farm-house on the borders of Kitdare and County Wicklow. I was informed that the rash had been much worse, but was now improving under the use of a mixture of linseed oil and castor oil applied topically, in fact the same treatment which had been successfully employed with the diseased calf. I found a well developed and characteristic patch of herpes circinatus or ordinary ringworm occupying the upper and back part of the fore-arm and elbow, fully three inches in length and above one and a half inch wide, healing in its centre, bus surrounded by a pale pink erythematous border that had passed into the chronic stage and was throwing off small scales, and ceasing to spread. A few days treatment wif~ very dilute ointment of red iodide of mercury perfectly removed all trace .of the disease in the same manner that I have known it invariably to succeed in ordinary cases of this herpetic affection. As my acquaintance with cutaneous maladies occurring in animals was limited, my interest was much excited by the information I received as to the frequent appearance of this contagious herpetic eruption in calves, and its alleged transmission to the human race, which was said to be common and notorious. I therefore sought for some more information, and think that the results of my inquiries may possibly interest others in the profession. Should our count~ friends, who must know far more of this subject than those whose daily life is restricted to a town, be able to throw additional light upon the matter, they may be assured that, for one, I shall feel most grateful for their correction or confirmation of what I state. So far as the history of the present case goes, the source of the disease appears to be ascertained beyond the smallest doubt. The farm where it occurred is one of the best conducted in Ireland, and is celebrated for the high character of the stock. For months previous no herpes whatever had existed amongst their own cattle; the calves, two in number, which were infected with the herpes were fresh purchases of high bred and expensive animals ; both had the disease in a well marked stage on their face and neck which was immediately recognized; they were purchased whilst the child was on a visit, and it was continually, from that time, in the habit of playing with them andof feeding them; its arm soon became attacked; and previous experience had taught the family that the cause of the infection was the rash upon the animals which they knew to be contagious, spreading alike to men and cattle who came in contact with it, and, as they informed me, when neglected, it would cause "very

296

On a Common HerTetlc EpizSotic Affection,

sore spots" on the face, beard, and limbs of those who were its recipients. The ordinary remedy they were in the habit of applying on the Farm was mercurial ointment, though of late they have tried the mixture of linseed oil and castor oil, as they considered, with success. The ringworm appears always to show upon newly purchased animals; and, though it is liable to extend through their own stock, the impression seemed to be that it was invariably propagated by direct contagion, and never originated spontaneously. The inquiries which I have made in different quarters would in. duce me to believe that epiz~otic herpes must be very unequally distributed; it has extensively prevailed in some localities like an epidemic; others, as certain parts of Wicklow and County Dublin, were reported to me as being perfectly free from its presence; but this interesting question would demand far more research than I have been able to enter upon as yet. In the Counties of Cavan and of Monaghan it seems to have been of common occurrence and generally recognized; I therefore append two reports relating to parts of these counties which were written by pupils and personal friends of mine. I have every confidence in the strict accuracy and powers of observation of these gentlemen, who were neither of them aware that the other was engaged in writing on the subject or of my own special interest in it. I merely enquired from each separately, did they know anything about the occurrence of" ringworm or herpes in calves, and its usual treatment, and, if so, to write for me a brief account of the disease as it had fallen under their notice, and, particularly, did they think it liable to attack human beings.

Observations ~n Ringworm in Cattle. By Mr. PATRICK BRADY, as he has observed the disease in County Cavan.--Ringworrn chiefly occurs in calves and young cattle, but is not unfrequently seen in the cow. It is noticed most frequently during the Spring months and in the early paxt of Summer; it forms round spreading patches, reaching from less than an inch to two or three inches across, smooth in the centre and rougher round the border; they continue to extend for some time, then dry up, and finally the spot appears covered with a crust os scales, thickest outside; the hair covering the part attacked falls off, leaving the skin bare, and so produces much disfiguration. The favourite situation of the eruption is about the eyes, the roots of the ears, and on the neck, but it may also occur upon the body and over the limbs. There can be no doubt that it is highly infectious, as when a cow or a calf having the disease is

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By DR. FRAZER. 297

brought amongst others that are not affected by it, the eruption speedily appears amongst them, perhaps in consequence of their rubbing themselves against the same post as the infected animal. Man is not without danger of being infected either. Herds, milkmaids, and children that are in the habit of playing with calves are most frequently attacked. When the rash appears on the human subject it is very difficult to manage. I have seen it most often on the heads and arms ; it may also occupy the face, and is particularly troublesome when it gets into the beard; sometimes it appears on the trunk of the body, though far less frequently than on the hands, arms, or face. In man the eruption is very similar to what we observe in the calf; it comes out as a reddish coloured spreading round spot, which may extend until it forms a patch like a "fairy ring" of considerable size; its course is very chronic; often the part gets inflamed, throws out a crust, and cracks if neglected, forming fissures; at other times the crust dries and appears as a mass of scales. Treatment in Man.--In some cases I saw the llq. plumbl, subacet. used with success; compound tincture of iodine is another local application which I also saw used with good results. When very obstinate the part is brushed over twice in the day with strong acetic acid, and artificial Harrowgate water given internally; I scarcely ever have known this to fail in curing the disease. Treatment in Cattle.--For cattle the only treatment I ever saw used was some irritating ointment; the best appeared to be a preparation of corrosive sublimate made from bichloride of mercury, twelve grains; lard, one ounce; powdered white hellebore, sixty grains.--Mix.

Ringworm in Cattle. ]Votes by MR. JAMES WrIIT/A, as he has observed it in County Monaghan.--In some parts of the country the practice is followed, to a limited extent, of buying up, at a very cheap rate, numbers of calves from four to eight or nine months old, about the middle and end of Autumn, and placing them through the Winter to graze, in large batches, on very poor grass land. Towards the end of the Winter they are generally sold off to other proprietors to be fattened for the butcher, army contractor, &c. The state in which they come off their Winter quarters is in the majority of cases most miserable--they are almost completely devoid of flesh, drooped, listless, and beating evident marks of starvation; they are totally denuded of flair round their

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On a Common H~rpetle Eplz6otle A ffectlon,

eyes, and large patches over the body in the same condition, nearly all the patches being of a circular form; such a state is easily altered by a little better care, and the due admixture of salt with their fodder. 1 wish to draw your attention to this, because it is a condition of things very often confounded with genuine ringworm in cattle, but it must be looked on as altogether different; still, this much is certain, that all cattle in such bad condition as I have described, are vastly more liable to outbreaks of true ringworm than those which are housed during the Winter, well fed, and in good condition when they are placed out for grazing in Spring. Ringworm in cows or calves commences with a single spot, which after a few days develops itself into a small rlng-like scaly eruption, growing larger by additions to its outer circumference, so that it increases in a manner perfectly similar to " fairy rings" in a meadow; at the same time the hairs fall out, and the interior, losing its scales, appears comparatively smooth. I f the first spot of the eruption happens to be seated on a part of the animal within reach o f being licked by the tongue or lips, other spots are speedily produced over different parts of the body; and in the course of a week or ten days may be seen reaching from the size of a fourpenny piece to that of a ring of two or three inches in diameter. A t the same time the animal fails in flesh, its milk is diminished, and its aspect becomes pitiable; the irritation and itching of the several spots keep it in a state of continual motion licking, twitching, and scraping with the hoof. I cannot doubt that this eruption is capable of being widely and rapidly disseminated by contact alone, for during the second year of my apprenticeship in the North I had abundant evidence of the fact--whole tracts of country, let in grazing, becoming annoyed with the pest of ringworm, owing to the introduction of one infected animal from a different locality. That ringworm is constantly transmitted to the human subject admits of no doubt, for during the first prevalence of the disease in the cattle the animals suffering from it were somewhat too closely, and at the same time caxelessly, examined by their owners, servants, and others. The consequence was that it soon became nearly as common amongst the people themselves as with the cattle, first appearing, as a rash, upon the most exposed parts, the back of the hands, the face or neck, and if unchecked, spreading from these to other parts of the body, irrespective of position. A t this distance of time (some four years) I cannot, unaided by notes, describe minutely any particular cases, but they were

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By DR. FRAZER. 299

numerous, and the eruption presented identical features both in men and animals. However, I remember one man who was attacked in a very severe manner, and his case is the more worthy of being cited as the people in his neighbourhood were convinced that he died from the disease communicated, as all knew, by the cattle. He was manager and caretaker on a farm held by a widow; the cows, calves, and, I believe, bullocks under his charge, had been affected with ringworm for some time. On the recommendation of a locallycelebrated "medicine man," he applied to the cattle strong mercurial ointment, rubbing it several times in the day to the spots of eruption. In a short time the rash appeared on his hands, face, neck, and arms, several developing themselves in a very severe manner about the jaw and the angles of the mouth. Having found his blue ointment so successful with the cattle, he commenced its free application to all the spots on himself, regardless of situation, appearance, or condition, and in a short time had banished most of them; but so severely salivated himself that he died in about a fortnight. Such a case occurring in the neighbourhood os a country town naturally caused a panic, and led to a more careful and better advised mode of treatment, before which the disease gradually gave way. This consisted in the use of iodated sulphur ointment, varying in strength from five to forty grains of sulphur iodatum, mixed with simple cerate, one ounce. The same treatment invariably proved successful when tried with those persons who had been infected from the cattle, occasionally using mild astringent ointments where they appeared to be indicated, such as unguentum zinei and unguentum calaminse. The different forms of epiz~otic eruptive disease have not as yet received from the medical profession the attention that they would appear to deserve; they are either totally ignored or passed over in the most superficial manner in all our numerous treatises on cutaneous medicine, nor do the usual veterinary manuals greatly aid our study of them; their descriptions of skin diseases are often loose and worthless, and their pathology and practice moss defective. In one os the latest of these publications, which may be taken as representing the state of our literature in the present day relating to bovine maladies, herpes in cattle is described with some approach to accuracy; we have also a clear statement os its decidedly contagious nature, and of its liability to infect either animals or m a n - - I allude to the recent work of Mr. J. R. Dobson--The Ox,

300

_P,enmrl~ on a Common He~et~ Epiz~otie Affection,

his Diseases, and thdr Treatment. LondOn, 1864. Published by Messrs. Longman and Co., from which the following extract is taken :.--: "Ringworm, although a disease almost unnoticed by veterinmy authors, is by no means rare in young stock, and is occasionally found in older animals. Debility and poverty seem to be the great predisposing causes. It is in fact a disease of deranged nutrition, or to use common parlance, of ' poorness of blood.' "Ringworm is, in the author's experience, a very contagious disease, although this is denied by very eminent medical authors. In fact, in two well-marked instances the author has witnessed its transference .from the horse to man, and more frequently from the ox to the horse: Although the name ringworm might lead the non-medlcal observer to suppose it owing to some living parasite, it is not so. The disease is centred in and owing to an affection of the skin itself. " Several varieties of the disease are described by medical authors, but probably the ox is not liable to more.than one--at all events, a description of the more common affection will suffice for all practical purposes. " T h e symptoms of ringworm are the appearance of a number of round scabby patches, about the size o f half-a-crown, which, when peeled off with the finger, exhibit a rawish surface underneath, discharging a yellowish exudation, which, when dry, forms the scab above alluded to. Occasionally one or more of these rings run together, and form a patch of some magnitude, although a well defined ring may always be seen. They are usually found about the head and neck, the back and thighs, but, surrounding the eyes, they are often found in great numbers, giving a most unsightly appearance to the animal. " T h e treatment should commence by a careful attention to the diet, and an exhibition of more generous food. Medical alteratives may, too, be administered--as, flowers of sulphur, one ounce, black sulphuret of matimony, half ounce in one powder, which may be given daily. With regard to local treatment, the mange liniment may be applied--oil of tar, oil of turpentine, linseed oil, equal parts, rub well into the skin every other day ; or one of the two following applications--tincture of iodine, painted on with a camel hair brush after the scab has been removed, or lunar caustic, twenty grains,

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By DR. F ~ Z E R .

301

distilled water, one ounce, to be well rubbed in with a small tooth brush. These may be alternated with the solution of bichloride of mercury, the ointment of hellebore, or any of the stronger acids. Cleanliness in this, as in all other skin diseases, is essential." -_Although the list of our systematic treatises aff~ord us so |;m]tcd and defective a description of this important eruption, yet it has not been altogether overlooked by Continental authorities, and I would particularly refer to a paper by M. Gerlach, Professor at the Royal Veterinary School of Berlin, which contalnR much more definite views respecting the nature and c~arac~ of epiz~k~ic herpes. The essay is briefly reported in the valuable periodical edited by Mr. Gamgee, The Edinburgh Veterinary Review, Vol. II., for 1859-60. M. Gerlach gives an admirable description of the eruption, its appearance and progress, and satisfactorily identifies it with herpes eirclnatus (the tinea eircinata of writers, when it occurs in the parts covered with hair of human beings), for he procured from its crusts the same parasitic vegetative growth (triehophyton tonsurans) which is present in that disease. He further effeeted its transmission to oxen, horses, and dogs,, but failed to induce it in sheep or pigs. He inoculated his own arm, and also some of his pupils, with the crusts taken from oxen, and in every instance a patch of herpes clrcinatus was developed, the crusts of which "contained thd vegetable parasite observed in the dartres of the ox." M. Gerlach's paper enumerates several authentic cases of the transmission of the disease to human beings from an;reals, derived from French and German sources, which it is unnecessary to particularize, as the abstract of his essay is easily accessible. I have not as yet had any opportunity of examining the microscopic appearance of the disease in the calf, but I obtained same hairs which were taken from the vicinity of the affected part in a calf from the County Cavan, and around their bulbs I got distinct proof of the presence of a parasitic eryptogam that was apparently identical with trichophyton, but in too imperfect a condition for me to figure it. As for the child, when I was consulted the eruption was already disposed to heal, and therefore unfavourable for microscopic observation.