262
MITTENDORF: Two Epidemics of
TWO EPIDEMICS OF MOLLUSCUM CONTAGIOSUM. BY W. F. MITTENDORF, M.D., NEW YORK.
THE contagiousness of the affection known as molluscum contagiosum has been a matter of dispute up to the present day, and the contagious principle itself is not known; in fact, on account of the failure of inoculations with the contents of the tumors, the contagiousness of the affection has been doubted by many.* I regret, therefore, that on account of sickness the investigations that I commenced, and hoped to lay before you to-day, are far from being satisfactory. But I wish to call your attention to the fact that two epidemics of the affection have come to my notice, which leave very little doubt to my mind in regard to the contagiousness of the disease. As these two epidemics occurred in homes for children, it may be pertinent to ask whether the affection should be classed among the diseases which, according to a recent law of the State of New York, require the isolation of the patients in public institutions, or whether they should be relieved of the trouble before they are admitted to such homes or asylums. One of the epidemics, if I may call it such, occurred at the St. Stephen's Home, at Newdorp, Staten Island, which is famous for its splendid location, and where the children have the best of care. In the spring of I885, a little girl was admitted to the Institution, with one or two small "warts" on the lids, which were noticed by the Sister in charge at the time. She paid little attent-ion to it at first, but within a few weeks several of the other girls had the same growths appear on the eyelids, and in some instances they began to spread to the lips and * Dr. Robinson, for instance, maintains that it is not a retention cyst, that it is a peculiar degeneration of cells, taking its origin in the rete of the skin, and that it is not
contagiouis.
Mollhscumn Contagiosum.
263
noses of the children. At the time of my visit to the institution, which was about three months after the admission of the first case, twenty-seven children, nearly all of them girls, were more or less disfigured by mollusca. Not one of this number had the eyelids free, and in most of them they were confined to this location, but in a limited number the growths had spread all over the face, and especially one of them, an otherwise pretty girl, of about ten years, had between forty and fifty of them scattered all over the face. The rest of the body was not affected in any of the cases. The other institution visited by this disease was the Nursery and Child's Hospital at West Brighton, Staten Island. The first case was observed about two years ago, and only a short time ago as many as forty-one children were affected. This number does not include one of the nurses and her child, because these lived outside the Nursery. At first, little attention was paid to the disease, and some of the children afflicted with it were given out to a farmer, who boarded them. In a short time the affection had spread to several of the children boarding at this farmer's place, to the child of the farmer, and likewise to his wife, disfiguring her terribly. In quite a number of cases the tumors, varying in size from a mustard seed to that of a pea, had spread to other parts of the face, but they were usually confined to or more marked at the lids; some were located at the free edge of the lid and among the eye-lashes. About three cases of spontaneous cure were observed, but as soon as my attention had been called to the disease, energetic treatment did away with it very quickly. In regard to the treatment, I found that thorough abscission witlh curved scissors and touching the base with a stick of nitrate of silver was most satisfactory. The use of acids is painful and tedious, and the abscission of the more prominent growths is connected with very little pain. In order to remove the smaller and deeper seated ones I had to give an anaesthetic. Cocaine did not produce much anaesthesia, or perhaps the children were nervous, and pretended to be hurt more than they actually were. Simply pressing, out the matter is much imore painful than the use of scissors, and unless the
264
MITTENDORF: Melano-Sarcoma
base of the growth is touched with caustic or cautery it will at times be followed by new growths of the same character. Among the adherents of the theory of its contagiousness is Virchow, who observed the transmission of the disease from one child to another, and Tilbury Fox, who saw it spread through an entire family; but the fact that the disease may assume the dimensions of an epidemic has- not ofteln been noticed, or at least not recorded.
MELANO-SARCOMA OF THE CONJUNCTIVA OF THE EYEBALL AND OF THE CORNEA. BY W. F. MITTENDORF, M.D., NEW YORK.
THE occurrence of sarcomatous tumors of the choroid are by no means rare, but when Dr. Noyes published his cases of these growths affecting and developing on the eyeball, there were only one hundred and twenty-seven of them recorded. Since this time several cases have been added to this list by Birnbacher, Hirschberg, Mason, Ormsby and others. Melanotic tumors affecting the anterior half of the eye are the rarest of all. The growths which I had occasion to remove were of the sarcomatous kind. August 22, I 884.-Mrs. E. Merriman, aged forty-six, a native of the State of New York, was sent to me by her family physician. In April of the same year she noticed a blackish-blue tumor on the lower half of the conjunctiva, which her doctor removed. Shorly after this there were one small tumor on the lower half and two somewhat larger ones on the upper half of the conjunctiva of the eyeball, extending from the upper cul-de-sac to within 3"' of the corneal margin. The tumors were of the size and shape of a cucumber seed and of such a peculiar color that I suspected them to be angiomata They were v7ery vascular, but, as the microscopic exaaminat on
MITTENDORF: Two Epidemics of
TWO EPIDEMICS OF MOLLUSCUM CONTAGIOSUM. BY W. F. MITTENDORF, M.D., NEW YORK.
THE contagiousness of the affection known as molluscum contagiosum has been a matter of dispute up to the present day, and the contagious principle itself is not known; in fact, on account of the failure of inoculations with the contents of the tumors, the contagiousness of the affection has been doubted by many.* I regret, therefore, that on account of sickness the investigations that I commenced, and hoped to lay before you to-day, are far from being satisfactory. But I wish to call your attention to the fact that two epidemics of the affection have come to my notice, which leave very little doubt to my mind in regard to the contagiousness of the disease. As these two epidemics occurred in homes for children, it may be pertinent to ask whether the affection should be classed among the diseases which, according to a recent law of the State of New York, require the isolation of the patients in public institutions, or whether they should be relieved of the trouble before they are admitted to such homes or asylums. One of the epidemics, if I may call it such, occurred at the St. Stephen's Home, at Newdorp, Staten Island, which is famous for its splendid location, and where the children have the best of care. In the spring of I885, a little girl was admitted to the Institution, with one or two small "warts" on the lids, which were noticed by the Sister in charge at the time. She paid little attent-ion to it at first, but within a few weeks several of the other girls had the same growths appear on the eyelids, and in some instances they began to spread to the lips and * Dr. Robinson, for instance, maintains that it is not a retention cyst, that it is a peculiar degeneration of cells, taking its origin in the rete of the skin, and that it is not
contagiouis.
Mollhscumn Contagiosum.
263
noses of the children. At the time of my visit to the institution, which was about three months after the admission of the first case, twenty-seven children, nearly all of them girls, were more or less disfigured by mollusca. Not one of this number had the eyelids free, and in most of them they were confined to this location, but in a limited number the growths had spread all over the face, and especially one of them, an otherwise pretty girl, of about ten years, had between forty and fifty of them scattered all over the face. The rest of the body was not affected in any of the cases. The other institution visited by this disease was the Nursery and Child's Hospital at West Brighton, Staten Island. The first case was observed about two years ago, and only a short time ago as many as forty-one children were affected. This number does not include one of the nurses and her child, because these lived outside the Nursery. At first, little attention was paid to the disease, and some of the children afflicted with it were given out to a farmer, who boarded them. In a short time the affection had spread to several of the children boarding at this farmer's place, to the child of the farmer, and likewise to his wife, disfiguring her terribly. In quite a number of cases the tumors, varying in size from a mustard seed to that of a pea, had spread to other parts of the face, but they were usually confined to or more marked at the lids; some were located at the free edge of the lid and among the eye-lashes. About three cases of spontaneous cure were observed, but as soon as my attention had been called to the disease, energetic treatment did away with it very quickly. In regard to the treatment, I found that thorough abscission witlh curved scissors and touching the base with a stick of nitrate of silver was most satisfactory. The use of acids is painful and tedious, and the abscission of the more prominent growths is connected with very little pain. In order to remove the smaller and deeper seated ones I had to give an anaesthetic. Cocaine did not produce much anaesthesia, or perhaps the children were nervous, and pretended to be hurt more than they actually were. Simply pressing, out the matter is much imore painful than the use of scissors, and unless the
264
MITTENDORF: Melano-Sarcoma
base of the growth is touched with caustic or cautery it will at times be followed by new growths of the same character. Among the adherents of the theory of its contagiousness is Virchow, who observed the transmission of the disease from one child to another, and Tilbury Fox, who saw it spread through an entire family; but the fact that the disease may assume the dimensions of an epidemic has- not ofteln been noticed, or at least not recorded.
MELANO-SARCOMA OF THE CONJUNCTIVA OF THE EYEBALL AND OF THE CORNEA. BY W. F. MITTENDORF, M.D., NEW YORK.
THE occurrence of sarcomatous tumors of the choroid are by no means rare, but when Dr. Noyes published his cases of these growths affecting and developing on the eyeball, there were only one hundred and twenty-seven of them recorded. Since this time several cases have been added to this list by Birnbacher, Hirschberg, Mason, Ormsby and others. Melanotic tumors affecting the anterior half of the eye are the rarest of all. The growths which I had occasion to remove were of the sarcomatous kind. August 22, I 884.-Mrs. E. Merriman, aged forty-six, a native of the State of New York, was sent to me by her family physician. In April of the same year she noticed a blackish-blue tumor on the lower half of the conjunctiva, which her doctor removed. Shorly after this there were one small tumor on the lower half and two somewhat larger ones on the upper half of the conjunctiva of the eyeball, extending from the upper cul-de-sac to within 3"' of the corneal margin. The tumors were of the size and shape of a cucumber seed and of such a peculiar color that I suspected them to be angiomata They were v7ery vascular, but, as the microscopic exaaminat on
