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MANY physicians are not aware that an acute lung cyst may occur almost immediately following closed-chest trauma. Failure to arrive at a correct diagnosis will cause confusion and may lead to unnecessary studies and even unwarranted surgery. Report of Cases Case 1.— A 6-year-old boy was brought to the emergency room on Sept 27, 1973, one hour after falling against the edge of a table and striking the right upper chest. Physical examination showed slight swelling and abrasion of the right chest that measured approximately 2 cm in diameter, with surrounding tenderness and some subcutaneous crepitus. There was some pain on the right side that increased with inspiration, but there was no dyspnea nor cough. Examination of the heart and lungs detected no abnormalities. Chest roentgenograms taken less than two hours after the injury showed a traumatic right lung cyst with an air-fluid level and considerable surrounding hemorrhage but no

PHENCYCLIDINE (PCP) is a popular "recreational" drug. Complications of its abuse are myriad and range from mild behavioral disturbances to death. 1-5 Death caused by PCP intoxication is usually due to the "behavioral toxicity" of the drug. 1,2 A case of massive intracranial hemorrhage in a PCP-intoxicated patient is reported herein. Aside from the effects of the drug, no other cause for the fatal hemorrhage could be determined. Report of a Case A 20-year-old man was brought to the emergency department by paramedics. According to the patient's companion, the patient collapsed after smoking "marijuana." The companion had used the same substance without apparent ill effect. On arrival, the patient was deeply comatose. His BP was 180/100 mm Hg; pulse rate, 130 beats per minute; respirations, 26/min. There was a small abrasion above the right eye, with no other signs of trauma. Pupils were initially 2 mm bilaterally. Within a few minutes

The possibility of the appearance of the skin manifestations of anthrax from time to time is admitted, and the necessity of having a clear idea of the classic picture of an anthrax pustule is therefore apparent. In reporting three cases of anthrax occurring in this camp within four weeks, we hope to impress on the reader the distinguishing points in diagnosis, and the necessity for early treatment. Anthrax is definable as a specific and highly contagious disease due to Bacillus anthracis . Fortunately the organism never enters the unbroken skin, but gains entrance at the site of an abrasion. Any commercial animal product—hide, hair or wool— and the articles manufactured therefrom afford the source of contagion. SYMPTOMS The usual appearance of the skin manifestations of anthrax is as follows: Following a period of incubation varying from one to five days, a small red papule appears at the site of abrasion, with

SCHAEFFERSTOWN, Pa., Feb. 14, 1902. To the Editor: —To a great many physicians a sore arm after vaccination signifies immunity, regardless of the nature of the soreness. A proper vaccination is attended with slight, or no, local or constitutional disturbances. The extreme local and constitutional disturbances, such as erysipelas, hospital gangrene, abscess, phlegmon, septicemia, pyemia, and tetanus, are due to an abrasion of the surface, admitting the entrance of the different bacteria. In my opinion the proper way to vaccinate is by means of a spring lancet, which leaves no open wound for the introduction of germs. It requires very little lymph to produce a proper vaccinia, one capillary tube being sufficient to produce half a dozen. The puncture made by the lancet is barely discernible, and leaves no abraded surface for any sort of exterior infection. During the epidemic of 1874-75, I vaccinated, by means of the lancet, over

To the Editor: —We should like to report an unusual case of subcutaneous emphysema of the face and neck in a 75-yr-old man after trauma to the left zygomatic complex and without radiologically proved fracture. The patient fell in the bathtub, hitting the lateral aspect of his left orbital rim. Shortly after the accident he asked for medical aid because of swelling of his left cheek. One of us (C. J. W.) first saw the patient about 3 hr after the accident. He complained of some "stiffness" of the neck and showed a well-defined hematoma of the left side of his face. There was also minimal abrasion in the left temporal area. Streptokinase-streptodornase (Varidase), 5,000 units four times a day, was prescribed. The next morning the patient was seen in the office. He complained of stiffness of the neck and difficulty in swallowing and even breathing. He noticed that when

The method consists in using the flat end (about 2 mm. wide) of sterile wooden toothpicks instead of the von Pirquet borer or crisscross scratching with a needle. It is applied as follows: After cleansing the flexor surface of the forearm in the usual manner, the flat end of the sterile toothpick is dipped into the tuberculin, is next gently pressed on the desired spot on the skin, and, while held in the middle by the thumb and index finger, a few turns (two to and fro turns, or four in all, to be exact) are made by rolling the toothpick on its own axis between the fingers. The result will be a very neat round abrasion of the epithelium without the appearance of blood. The toothpick is burnt after use. The same procedure is gone through with the control abrasion, another toothpick being used, of course. It is recommended

Following division of the sensory root of the gasserian ganglion for the relief of trigeminal neuralgia, a subsequent anesthesia remains over the skin, the cornea and the conjunctiva supplied by the trigeminal nerve. This anesthesia is a sequela that the patient must accept in lieu of the excruciating pain that is associated with the disease. The anesthesia is not of any particular significance except in the cornea, where it allows the entrance of foreign bodies into the eye and the consequent abrasion of the cornea without the patient's knowledge. Injuries of this kind are extremely serious, since postoperative corneal ulcers heal slowly and often fail to respond to the usual treatment; they may result even in serious opacities of the cornea and finally in loss of vision. Hence, it is highly imperative that the patient protect the cornea, on the side operated on. For this purpose, a special corneal shield

To the Editor:— A haze distinguishes between a procedure that is done in the operating room and the same procedure that "we might as well do" in the emergency room. The aims are the same: to do the best for the patient, consistent with high medical standards, with the means available and with concern for the patient's economy and time. We can be extremists and take every patient with abrasion or gashed muscle to the operating room for absolute sterile precautions and cleanliness. Or, we can reasonably use essentially the same precautions and techniques and perform the procedure more quickly in the emergency room. Why, then, is it that many doctors lose their trained senses when they "do it in the emergency room," and suture and otherwise treat raw tissues with bare hands, bare faces, and bare heads?

To the Editor:— Dr. Thale seems much disturbed over the use of the phrase "removal of scars." From our experience with this technique in many hundreds of cases over a period of 15 years, we see nothing wrong in using the expression "removal or elimination of scars," since we have found that this can be done in the majority of cases. We often remove shallow acne scars with one dermal abrasion, while the deeper ones may need this procedure repeated two or three times at intervals of 6 months to 1 year. There is always a definite improvement after each abrasion treatment. Dr. Thale admits that the number of abrasions necessary depends on the extent of scarring. Dr. Thale lists a number of complications and untoward reactions. From our own experience we have encountered them rarely. In fact, the only complications we have seen have been temporary pigmentations, including temporary

This case is interesting, perhaps more in its origin than in the lesion produced, though none the less instructive. Patient. —A man, aged 32, laborer, was employed with a wheelbarrow on a scaffolding six feet from the ground, when a misstep caused him to fall, the wheelbarrow following and the handle striking him in the right iliac region. Examination. —When first seen, a short time later, there was a soft hemispherical mass, 6 cm. in elevation and 8 cm. in diameter, in the region of the injury, with but slight abrasion and no discoloration of the overlying skin. Extreme pain prohibited manipulation, but as the diagnosis was apparent the man was sent to the hospital. There, when placed in a recumbent posture, the mass receded, and a hiatus could be felt in the supporting structures of the abdominal wall. In fact, the margin of the lacerated aponeurosis was plainly palpable.

The greatest danger that threatens an obstetric case is septic infection. In comparison with this one other dangers fall into insignificance. The main channel of entrance for the septic material is the vaginal canal. It may attack any laceration or abrasion in any part of this, or simply pass through it into the uterus. The most common carriers of infection in obstetric cases are foreign bodies introduced into the vaginal canal, such as douche points, fingers or hands, instruments, lubricants, etc. Air and auto-infection are generally admitted to be rare, and the principal factors of contact infection are those mentioned. The principal aim of the Obstetric Staff of the Health Department should be to avoid puerperal infection in the practice of its members and to aid and assist the midwives, and perhaps other practitioners, in the avoidance of the same. While the antiseptic and aseptic eras have witnessed a most

My reason for reporting this case is because it is one of great rarity. Statistics go to show that keratitis bullosa is the least frequent of all corneal troubles. It is fortunate for both the physician and the patient that such is the case, for it is one of the most painful affections that the eye is liable to, and in the majority of eases baffles all therapeutic and surgical measures adopted for its relief. The disease occurs in the eyes, the cornea of which is more or less clouded and sensitive, or in eyes with a large corneal cicatrix, or eyes which have been rendered blind by iridocyclitis or by increase of tension. Jansen1describes a primary form occurring as the result of an abrasion of the cornea by the finger-nail, a twig or some such object. But the majority of cases are secondary and occur as the

Eczema due to contact with various substances in the environment is a well recognized condition to which the literature contains many references.1 The diagnosis of the cause in the individual patient is not easy, and the case reported here demonstrates the need of prolonged study and observation and the good results that will reward the effort. It also shows how widely distributed the cause of trouble may be. REPORT OF CASE A man, aged 29, developed a small area of eczema on the left wrist in November, 1928. Similar lesions soon appeared on the dorsal aspect of both hands and fingers. They were of the acute, vesicular type, with oozing and thickening of the skin. It is of interest to note that the lesions made their first appearance at the site of an abrasion caused by a stiffly starched cuff. Various local applications had no apparent effect on the course

Ascites due to cirrhosis has been treated by producing adhesions about the liver and other viscera, as first described by Drummond and Morison in 1896 1 and by Talma in 1898. 2 This type of operation came to be used widely, but then was abandoned because of the unpredictable results. More recently, Madden et al 3 described a method of hepatopexy, in which magnesium trisilicate powder was applied to abraded adjacent surfaces of the liver and the diaphragm. The technique, coupled with renewed emphasis on lymph exudation from the surface of the liver as a factor in the pathogenesis of ascites, 4 suggested a new evaluation of Morison's operation. In a previous report, 5 we demonstrated that experimental ascites can be prevented by enclosing the entire liver in dense adhesions created by abrasion and application of magnesium trisilicate powder. However, the technique produced perihepatic adhesions of variable extent and density, often