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ideal in nature, this may be possible. Few will deny the desideratum; none will expect to see it realized. For the present we will aim to be fairly content, striving to do the best we may, without undue attention to the rabid sensationalists seeking notoriety no matter at what cost.

THE school commitee of the Polk County, Ia., Medical Society, appointed sometime ago to investigate the subject of the proposed two weeks' extension to the school year, reported adversely to an addition to the present term. A full thirty-six weeks of actual work, the committee thinks, is too long a time for pedagogues to teach the young idea how to shoot, by means of ferule and extra studies. The committee has discovered that three kinds of parents exist: Those who are ambitious for their children and crowd them; those who want long terms of school so they may escape the trouble of training their children, and those who do not. wish to injure the health of their children to cram them with knowledge. In addition the committee. recommends that attention be given to pupils engaged in earning a livelihood in the summer.

It

is doubtful whether the effete East, usually considered in the van of progress, can cite an instance where a medical society has appointed a school committee with a serious purpose in view, and, if appointed, whether it really made such specific and needful recommendations as those above mentioned.

THE versatile Wm. J. Robinson very properly says: "A thick journal is not necessarily a good journal. In medical literature, more than in anything else, is quality more important than quantity.". This seems trite, and yet, like any familiar truth, it needs reiteration. Journalism of the strong, virile kind is much in evidence in the smaller publications, whether lay or professional, and the blanket-sheets have not nearly the vogue as authoritative organs of public opinion as formerly. It is being recognized that the bigger periodicals cover up their defects of thought by a plethora of words, whereas the smaller ones usually eliminate everything ponderous, diffuse, in favor of the plain fact simply stated. It has been but a short time ago that one of the editors of an overgrown weekly medical journal predicted the early death of a number of small periodicals, because the medical public had no patience with anything not ultra-scientific. But the aforesaid journal is not as firmly seated in public esteem as formerly, while the vicissitudes of time shows the contemned papers quite well supported. Hence, again, quality

has been found more important than quantity. Robinson has done a service in reiterating an old truth.

A POINT of unusual medico-legal interest was decided in the Macon, Ga., superior court last week. The question at issue, should a physician receive pay for an unsuccessful operation, was decided negatively. A medical man of that city sued a res

ident for $99 for services rendered to the latter's daughter, aged eleven. The patient, in addition to phthisis pulmonalis, had a tubercular knee joint. It was believed by both the medical attendant and the family of the patient, that if the necrotic. tissue were removed, it would assist in her recovery. This was done, although the patient later succumbed to phthisis. The jury held that the surgeon was not entitled to remuneration for his services in an unsuccessful operation. If this decision establishes a precedent, then the profession can be mulcted at any time by families unwilling to pay for services rendered, simply because the ultimate recovery of a patient was not attained. The increased comfort given to the sufferer, the lengthening of his span of life by every art known to medical science, will count as naught. A great principle is here involved.

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DEGENERATIONS.

HE process of cell degeneration may be defined as a series of intercellular chemical changes eventuating in end-products impossible to the manifestation of life. Considered in the abstract, a body cell is a highly differentiated, complex and unstable mechanism, in which a most remarkable series of chemical phenomena are going on. The character of the reactions varies, of course, with the function of the structure of which the cell is a constituent. In bone cells the series of changes are simple compared to those taking place in the brain and nervous system. Complex function is always associated with complex structure and reaction. Again, the resistance to inimical influences is in inverse ratio to the differentiation of the cell.

In the broadest sense of the term, degenerative processes in the body cell may be divided into primary and secondary. A caseous degeneration occurring as a result of tuberculous infection may be cited as a primary degeneration, while amyloid degeneration occurring in an organ distant from an actively destructive process, may be looked upon as a secondary type. In a primary degeneration in an infectious process, the abstraction from the

cell of elements necessary to structural integrity causes the highly organized mechanism to collapse, with the new formation of compounds impossible to life. Or again, disorganization is due to contamination between cell compounds with excretory products of the invading pathogenic organism, bringing about the same result. In secondary degenerations of the amyloid and fatty types, metabolic changes in the body as a whole are responsible for the deposition of the abnormal elements in the body cell. The exhausting suppurations which are the forerunners of amyloid degenerations cause metabolic disorganization because the energy content of the body is applied to the foci of disease, leaving normal and uninvolved areas without sufficient power to carry on their function and sustain nutritional equilibrium. Fatty degeneration is due to practically the same series of causes.

The character of the degenerative process varies, of course, with the factor inducing it. Chronic poisoning leading to fatty degeneration, i.e., phosphorus, arsenic, etc., would be considered a primary degeneration, the metabolic disturbance being secondary to the degenerative forces. The majority of degenerations associated with deposition of foreign compounds in the cells, are of the secondary type, and the essential cause of this is metabolic disturbance of varying severity.

H. S.

THE PREVENTION OF INFANT MOR-
TALITY.

HE reduction of infant mortality has engaged the attention of every humanitarian, every economist and every obstetrician for centuries. In the old days the propagation of the species was rapid, since life was simpler and less. strenuous. In the eighteenth century, as Taine has shown, the fecundicity of women was very great among the peasantry of France, and it was admittedly necessary, since the incessant wars in which that country was engaged required a large supply of Kanonenfutter. But while the average life is being lengthened at present, owing to greater care as to sanitation and hygiene and prophylaxis, there are fewer births than formerly. The causes of this will perhaps appear explicable to every student of the subject. The fact is undoubted that not only in France, but in every country justly calling itself civilized, the birth-rate has decreased. Statistics could easily be quoted to prove this, but are unnecessary. Admitting this to be the case, it would appear incumbent upon every lover of humanity to endeavor to prevent this, especially by reducing infant mortality.

Since the days of Sparta, and perhaps before, the question of what to do with weakly, handicapped infants has been considered, and while the Spartans actively put these out of the way, we accomplish the same result by means of indifference and neglect. We know how great is the evil of abortion, but, like the Mohammedan, we deprecatingly leave the result to fate. Asphyxia, atelectasis and traumatisms at birth carry off a large percentage of newborn infants, and we read the mortality returns and dismiss the subject as unpleasant to contemplate. Diseases of the respiratory tract, gastro-enteritis, the exanthemata, carry off thousands, and we express polite regret.

It must be admitted the Conference on Infant Mortality, the occasion being the third mid-year meeting of the American Academy of Medicine, at New Haven, last November, has done much to bring the subject of infant mortality and its cause before the general public. Viewed at first with suspicion, as being only another attempt of dillettante economists to play with a great subject, the conviction has gained ground that a very serious purpose animated the participants in the conference. Newspaper reports have already whetted the appetite of an intelligent public, which perforce had to await an official, ungarbled account of the meeting. The Bulletin of the Academy of Medicine (February) contains comprehensive details which gladden the heart of every humanitarian. The temptation to quote liberally is almost irresistible; suffice it to say that the newly formed American Association for the Study and Prevention of Infant Mortality has contributed more to a correct understanding of the causes operating in inducing infant mortality than all the learned discussions in ultra-scientific publications could possibly do. The future activities of the association will be awaited with much interest. In the meantime it deserves support.

Necrology.

Dr. Frank Weber, Oakland, Md. Dr. John W. Martin, Warren, Ark. Dr. William H. MacDonald, Boston, Mass. Dr. W. T. McKnight, Marlin, Tex., aged fifty. Dr. G. C. Horine, Graefenburg, Ky., aged sixty-five. Dr. F. J. Gregory, Keysville, Va., aged seventy-four. Dr. T. H. Mansfield, Ocean Park, Cal., aged sixty-five. Dr. Frank Howard, San Antonio, Tex., aged fifty-eight. Dr. Batts Overton Schulte, Louisville, Ky., aged twentysix.

Dr. J. A. Lilly, Jumping Branch, W. Va., aged seventyfour. Dr. Henry Kirke Cushing, Cleveland, O., aged eightythree.

Dr. Charles F. McGahan, Aiken, S. C., aged forty-eight. Death due to lobar pneumonia.

THE WEEK'S NEWS. The big State of Texas will observe "clean up day," March 10.

Christian county, Ky., board of health has been formally organized by the election of officers.

The Arkansas State Medical Society will hold its annual convention in Little Rock on May 3-6.

The proposition to build a hospital at Athens, O., is opposed, because, forsooth, the city is already too deeply in debt.

The attorney general of Texas has ruled that under a recent law a physician cannot hold both the county and city health offices.

The next meeting of the American Medical Editors' Association will be held at the New Planters Hotel, St. Louis, June 4 to 6, 1910.

Epidemic cerebrospinal meningitis has appeared in Indiana. The first case in Fort Wayne in November. The second case was in Richmond during December.

After March 1 the Columbus Academy of Medicine inaugurated the new system of holding meetings each week instead of each month, as has been the custom since the beginning of the organization.

The health of Indiana in January, 1910, was not quite as good as it was in the same month last year. The deaths for January, 1910, numbered 2,883, rate 12.3. In the same month last year, the deaths numbered 2,874, rate 11.8.

A large and representative gathering of San Antonio, Tex., men and women at a meeting, February 17, organized the San Antonio Free Dispensary and Hospital Association. Nothing was said about avoiding indiscriminate charity.

A very unique experiment, which is designed to place radium within the reach of medical men, is about to be made in London. It is proposed to open a radium bank which will loan small quantities of the substance for short periods.

The secretary of the Delaware county, Ind., board of health has issued a warning to the residents of the county against tacking up measles signs before they have consulted a physician or have definitely decided that there are measles in the home.

The board of health of New Orleans has passed a resolution expressing its displeasure that the Federal census is to be taken during the summer months. It is said that not only New Orleans, but many other cities will suffer if the census is taken during the hot months.

Mr. J. C. Eaton, of Toronto, Ont., has undertaken, at his own expense, to construct the entire surgical wing of the new General Hospital of his city. The philanthropic project will be in memory of Mr. Eaton's father, the late Mr. Timothy Eaton, and will cost about $250,000.

In order to prohibit the gathering together of great numbers of foreigners or other persons in one house or from five to twenty persons sleeping in one room, the Springfield, O., health board considered an ordinance to regulate tenement houses at its last meeting. Cincinnati papers please copy.

The Kentucky Senate committee on State university and normal schools has decided to report favorably a bill providing an appropriation of $25,000 to establish a medical school in connection with State university at Lexington and $25,000 annually for its maintenance. The original bill called for $150,000, and $45,000 annually.

The committee composed of Louisiana State medical men, State and Government engineers and sugar planters from around the Bayou Teche country, which was appointed by the State board of health to investigate the cause of the pollution of the waters of the Bayou Teche, met in the offices of the State board of health last week. In order to make a report to the health board in April, a sub-committee was appointed by Dr. Smith, who will in turn report to the head committee two days before the next meeting. The following were appointed to serve on the sub-committee: Dr. H. Jones, chairman; Colonel Lansing Beach, Jules Godchaux, Dr. Porter and Mr. Kerr. This committee will meet on March 11.

Alabama's brand of hookworm will be placed on exhibition in the Memphis public museum to prove to the world that this new found plague is not a myth or a fad. A letter came to a Montgomery physician a few days ago, from Lida Steed, curator of the museum, requesting of him samples of the hookworm for purposes of exhibition. Only substantial achievements in science and long years of valuable service to humanity could have brought forth such a testimonial as is to be tendered to Dr. William H. Welch on April 2. The presidents of Yale, Harvard and Princeton and other educators and many physicians will gather at a banquet in his honor and will present him a gold medallion in token of his contributions to medicine. With a large attendance, the Joint Association of Surgeons of the Illinois Central, Yazoo and Mississippi Valley and the Indianapolis Southern Railroads, opened its meeting on February 23 at New Orleans. Officers were elected as follows: Dr. John E. Owens, of Chicago, president; Dr. Luther Sexton, of New Orleans, vice president; Dr. F. T. Fort, of Louisville, Ky., second vice president, and Dr. T. P. Ranney, of Chicago, secretary

treasurer.

Kentucky dairymen, whose cows when afflicted with tuberculosis have been killed, will get little comfort from a recent decision of a Louisville court. Judge William Field, in the suit of Gottfried F. Gauman against Dr. W. B. Smock, county health officer, and Dr. F. T. Eisenman, State veterinarian, has made a ruling which has the effect of throwing the case out of court, and which, if it stands, will be a large point in favor of the anti-tuberculosis milk campaign.

The polluted condition of the Ohio River was discussed by the members of the Indiana Sanitary and Water Supply Association at length, at a recent meeting at Indianapolis, and a number of leading water chemists, municipal officials, civil engineers and others were present. Notices had been sent out to every county in the State, and those acting as health commissioners had been urgently requested to be present: Papers were read and discussed from every standpoint of water sanitation.

Local Affairs.

The first systemized effort at the physical examination of the pupils of the Covington public schools has just been completed.

Dr. H. T. Smith, Secretary to the Faculty Ohio College of Dental Surgery, has acquired the oldest dental journal in this country, established in 1843, the American Journal of Dental Surgery. It will be revised shortly by the alumni association of the dental college.

The regular meeting of the Price Hill Medical Society is postponed from March 3 to March 10, 1910. The following papers will be read: "Pancreatitis," Dr. Manss; "Treatment of Diseases of the Liver," Dr. Savage. The society meets in the new Carnegie library building.

The tubercular policy holders of the Cincinnati district of the Metropolitan Insurance Co., will soon receive the attention of the visiting nurses' association of this city. Arrangements are being perfected by which those entirely incapacitated will be visited daily and advice given.

The following is the program of the Academy of Medicine for March 7, 1910: Section on Specialties: Paper"Sexual Impotence in the Male," A. W. Nelson; Paper"Report of a Case of Lichen Ruber Acuminatus," E. H. Shields; Discussion, A. Ravogli, E. B. Tauber.

The Board of University Trustees, at its last meeting, formally accepted the resignations of Drs. N. P. Dandridge and A. G. Drury, and they were made Professor Emeritus of Surgery and Hygiene respectively. Dr. Edmund M. Baehr resigned as Assistant Professor of Physiology. He has, however, another very responsible position on the teaching staff. Dr. Charles Goosman has been appointed Demonstrator in Pathology.

Oakland Medical College, California, contributes one of its faculty to the teaching staff of the Medical Department of the Cincinnati University. Dr. Henry Fischer will occupy the Joseph Eichberg Chair of Physiology with the beginning of the next term. He is a graduate of Rush. The appointment seems to give general satisfaction. It is to be

hoped he will justify the reputation which German scientists possess for thoroughness. In the meantime, there is no dean to the college.

Dr. A. J. Miles has given up his practice for the present, until he regains his health, and has gone to his native town, Ludlow Falls, O. He has presented the somplete transactions of the Obstetrical Society of London, since Volume I and in all over thirty volumes, to the Cincinnati Hospital library.

The weekly report of the Board of Health for February 26, was one of the best ever issued by the department. Plain, simple statements as to prophylaxis are most commendable. The laboratory, mortality and infectious discase reports were lucid. It is to be hoped it will be maintained at the present standard.

Dr. Derrick T. Vail was recently honored by his election as a foundation member of the Oxford Ophthalmological Congress, Oxford, England. This organization was begun five years ago, but was formally organized during Dr. Vail's recent visit at Oxford, England, July last. The other American charter members are Dr. Arnold Knapp, of New York, and Dr. Wendell Reber, of Philadelphia.

The Harvey Society.

The newly organized Harvey Society, composed of students of the Cincinnati University Medical Department, is justifying the highest hopes of those instrumental in its inception. The following program, presented at last Friday's meeting at the medical school, will give an idea of its scope: "Fatigue and Exhaustion," Mr. Kiely; "Thermotaxis," Mr. Hutzelman; "Fever," Mr. Hoerner; "Calcium Metabolism," Mr. Gilfillen. The last meeting was attended by sixty-five persons, showing the interest attached to the deliberations of the Harvey Society. There will be another meeting on Friday, March 11.

'Tis passing strange that it has been deemed necessary to issue an edict against the consumption of rabbit meat. It would seem that people ought to be aware of its unwholesomeness at this time of year.

Doctors' and Druggists' Rapprochement.

The movement to bring out the dependence upon each other of physicians and pharmacists, and to show that their interests are mutual has been gaining impetus of late by the decided efforts of the Ohio Valley Druggists' Association. With the surprising exception of the Cincinnati Academy of Medicine, an exception perhaps due to neglect rather than indifference, every medical society was represented at the last meeting. On March 23 there will be another meeting at the Hotel Sinton, when the following will make addresses: Mr. Kutchbaugh, President Ohio Valley Druggists' Association; Mr. Samuel Straus, of the same association; Dr. Wm. L. Schollenbarger, representing the McDowell Medical Society; Dr. D. D. DeNeen, representing the West End Medical Society; Dr. W. E. Murphy, representing the Price Hill Medical Society. The question of refilling and giving of prescriptions will be the main topic of discussion, but the prescription question in all its phases, together with legislative matters will be considered.

The committee appointed by the President of the Druggists' Association, composed of Messrs. Straus, Kisker, Igler, Stier and Fallon, has been actively at work to ascertain the general sentiment of doctors and druggists upon a number of questions at issue and will report at the forthcoming meeting.

Physicians have with justice complained of certain acts of commission and omission on the part of pharmacists. The effort to discuss these shortcomings and to enlarge upon the mutual interdependence of the two professions will be fraught with great good. It is to be hoped a large attendance will encourage the promoters of the laudable

movement.

A Meritorious Bill.

Well, Mr. General Practitioner, a bill has been prepared (and now awaits the action of the general assembly at Columbus) that comes nearer representing your interests than any measure heretofore drawn up.

This bill (intended as a substitute for the Probst bill) was, strange as it may seem, prepared by gentlemen not engaged in the general practice, and therefore not per

sonally interested except as their sense of justice prompted them to oppose an obnoxious measure calculated to work a hardship upon the general practitioner. Up to date, the aforesaid general practitioner has been giving a very artistic demonstration of the sleeping beauty, so far as his efforts to push this bill is concerned; probably he assumes this attitude on the premises that a post-mortem upon the remains of the proposed law will afford an excellent opportunity for learned discourse.

Now, gentlemen, we have had a bill prepared for us; we, as general practitioners, will be the ones to profit by its provisions, and surely we should take enough interest in our own affairs to urge its passage. Therefore, sit down to-day and write to the representative of your district, and urge him in the strongest language you know to vote for this measure. EDWIN J. KEHOE, M.D.

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Dispensary-Drs. Mitchell, Kreidler.

Fraternal Organization and Membership-Messrs. Boden, A. F. Levi, Davis, Brady, Lueders.

Relief-Messrs. White, Boden, Brady.

Lectures-Drs. Juettner, Iglauer, Mr. Frank Stevens. Printing and Publicity-Drs. Thompson, Allen, Iglauer. Sanitation-Messrs. Raabe, Schuchardt, Nelson, Drs. Faller, Kreidler.

Dr. B. G. Harff, who suffered a dislocation of the hip joint recently, is improving and is able to resume his practice.

An Innovation in the Program of the Academy.

The Secretary of the Academy, Dr. E. O. Smith, is responsible for a most commendable innovation in issuing a larger and typographically excellent program with notes, etc., to increase the interest of members in their society. It will be issued monthly, and will contain news items, anrouncements, etc. The following is taken from the issue just out:

"The following resolution was presented to the Academy at the last meeting and will be discussed and voted upon Monday evening, March 7, 1910:

'Resolved, That the Commissioners for the City Hospital le asked to provide a meeting-place for the Academy of Medicine of Cincinnati in the Library Department of the new City Hospital.'

"Dues for 1910 are now due. If you have not already attended to this matter do so at once by sending your check for $4.00 to Treasurer A. G. Drury, 710 W. Eighth Street, so that your name will be included in our report next month to the Ohio State Medical Association. "There are more than 1,000 physicians in Hamilton County. Less than 500 are members of the Academy. Let every member get busy and increase our membership. "Come to the meetings; you will profit thereby. "E. O. SMITH, Secretary." Newport, Ky.

Newport, Ky., is trying to foist the care of her outdoor poor on the county authorities, who cannot see it that way without some money coming along with them. Dr. W. D. Richards, of Dayton, Ky., is away on a six weeks' trip to the island of Cuba.

The post-graduate course of the Kenton-Campbell County, Ky., Medical Society lags. This is largely due to the indifference of the members, only a few of whom are prompt with their papers. There is too much lethargy displayed by some members, some of whom show up only at the annual banquet. Such conduct will disrupt any society. The Newport doctors and druggists are looking a bit more cheerful. Business has been fairly good the past two months.

The Newport Board of Health has elected the following three district physicians: First District, Dr. C. E. Wamsley; Second District, Dr. F. A. Clark; Third District, Dr. W. A. Krieger.

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The malady is so insidious in its onset that it is difficult to state absolutely what are the earliest premonitory symptoms. The first thing usually complained of by the patients is some gastro-intestinal disorder; this may be loss of appetite, burning sensation in epigastrium, excessive desire for food or drink, or more often diarrhea with more or less stomatitis and salivation.

Soon after these digestive disorders manifest themselves, or coincident with them, the patient detects a disinclination to any exertion, becomes irritable and sleepless. Duties that were formerly dispatched with a feeling of pleasure, are now looked upon with a dread; and procrastination takes the place of habits of promptness; so that the personal appearance of the victim, or the aspect of the home and children, if the sufferer is a woman, indicates neglect; all of which is evidence of the psychic depression that forms later a prominent figure in the clinical picture of the disease. After these symptoms have persisted with usually increasing severity, in some cases for weeks, in others for months, the characteristic symptom of the disease almost invariably appears, namely: erythema on the hands and arms not covered by the clothing. The Skin Eruption.-This may be either dry or

wet.

Dry Form. The eruption appears usually in the early Spring months, and, while it is the most characteristic objective feature of the disease, it is subjectively one of the least important, as very few of the patients suffer any physical discomfort from it other than a burning sensation, complaining principally of the unsightliness. The eruption commences as an erythema, suggesting sunburn, on the backs of the hands and extensor surface of forearms, extending up the arms to the point that the sleeves reach, and ends abruptly there, being absolutely symmetrical, if the sleeves are symmetrical, which is usually the case. In persons who do not "hold their hands," the eruption extends to the flexor surface in a characteristic shape; com

*Read before the Thirty-fifth Annual Meeting of the Mississippi Valley Medical Association, October 11-14, 1909.

mencing on the radial border it extends toward the ulnar by an oblique line, forming a patch of erythema on the flexor surface somewhat triangular in shape, the base of the triangle being the radius and the apex near the styloid process of ulnar. Patients who are well advanced in the disease and unable to work, and who "sit about" and "hold their hands," have the eruption on the flexor surface to the same extent as on the extensor surface. The erythema lasts for a few days and then commences to fade, and the skin to desquamate in fine scales, if the dermatitis has been mild. As the redness fades the site of the erythema assumes a somewhat cyanotic hue; this is gradually replaced by a characteristic light liver or chocolate color, which, if once seen, cannot be mistaken or confounded with any other skin disease. In negroes it is readily recognized by an increase of pigmentation, the site of the eruption appearing as though soot had been smeared on that part of the hand and arm.

The patients often make vain attempts to remove the dirty appearance of the hands with soap and water. After a time this eruption scales off and leaves the hands soft, velvety and glistening, quite a contrast to the dirty hands that they were the sorrow ful possessors of only a few weeks before; but, like Banquo's ghost, it has come to stay for a term -the erythema reappears and the eruption follows the same course as previously described. This may happen several times during the summer. As a result of these repeated inflammations the skin of the hands becomes thickened, hard, wrinkled and inelastic, and frequently deep fissures form on the fingers, notably the index finger, at or near the first joint. Portions of the body covered by the clothing subjected to pressure also show the eruption in some cases, the skin over the olecranon, trochanter, sacrum and knees being especially liable to become affected. The forehead, face and neck, are often the seats of the eruption. In those who go barefooted the feet and legs do not escape. The eruption commences in the Spring months and persists until July, August or September, and then disappears to make its appearance the following Spring. In some cases there is a mild relapse in October. The crowning characteristics of the pellagra eruption are symmetry and color.

After the discolored skin has been exfoliated.

there usually remains a fringe of dirty-appearing epithelium, a relic of the line of demarcation of the dermatitis. In some cases the sebaceous glands on and around the nose are hyperactive, there being a seborrhea. Purpuric spots are sometimes seen on the hands and face, a favorite site being under the eyes; here the spots have a crescentic shape and are symmmetrical. On the hands these spots are sometimes on the palmar surface.

Wet Form. This differs only in degree. Where the dermatitis is severe bullæ form, sometimes containing serous, serosanguineous or seropurulent fluid. When the bullæ break, large ulcers are left to

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