eee er OL etek, ee 
356 
June 3.—Several of the vesicles observed yesterday aré now slightly clouded. 
Many macules have developed vesicles and certain vesicles have increased in size. 
Lesions numerous on back. : 
June 4.—A great number of the vesicles have become clouded and are no longer 
tense. Few new lesions have developed except a number on the hands. Soft 
palate presents three grayish erosions. Several lesions on the face have been 
ruptured. One present in the scalp. : 
Beneath a small collodion dressing on the chest is a group of clear vesicles 
following the outline of the collodion. 
June 6.—Many of the vesicles have dried up and are represented by thin crusts. 
Others persist as flaccid vessicles containing cloudy whitish fluid. No new lesions 
have appeared since June 4. One lesion on trunk presents a depressed thin 
central crust and an elevated pustular edge. 
June 7.—Only three unruptured vesicles left on body. Many have disappeared 
or are represented by pale spots in the skin. In some cases where the remains 
of the vesicle have been removed there is a small, round, red area representing a 
defect in the epidermis. Around this is a pale, translucent zone, representing the 
new epithelium growing in to replace that destroyed in the lesion. 
June 8.—Healing has proceeded still further, Many of the crusts have been 
removed leaving white, rounded areas. 
Lesions were excised from the eleven cases at various stages from the 
earliest reddening of the skin through their entire development until 
healing was well advanced. The technique of incision is as follows: A 
fairly large-sized scalpel, which must necessarily be sharp, is all that is 
absolutely necessary, although a pair of mouse-tooth forceps can be used 
- to advantage in certain instances. The fixing fluid should be already 
prepared and at hand. ‘The skin is first washed with alcohol and sponged 
lightly with a piece of gauze or absorbent cotton to render it clean. The 
skin adjoining the lesion is pinched up between the thumb and forefinger 
so that the lesion is situated at the summit of the elevation. By holding 
the knife nearly flat with the surface of the skin, one cuts with a sawing 
motion beneath the lesion which, when removed, should be placed im- 
mediately in the fixing fluid. In certain cases when the skin about the 
lesion is not sufficiently loose to be pinched up by the fingers, elevation 
may be accomplished by seizing the skin near the lesion with the mouse- 
tooth forceps and then exicising. It is essential to work with a very 
sharp knife, otherwise the lesion is liable to become mutilated and the 
patient caused unnecessary pain. I would recommend this method for 
general purposes of diagnosis of superficial skin lesions, for the following 
reasons: It causes a very superficial injury amounting to scarcely more 
than a slight abrasion, which under ordinary conditions heals rapidly. 
By the thinness of the slice of tissue almost perfect fixation is obtained. 
By this method, in which the lesion itself is neither seized with forceps 
nor manipulated in any way, the topographical relations are undisturbed. 
The only objection to the method is that it can not be done without a 
certain degree of pain, for the injection of a solution of cocaine so 
distends the tissue that it may be impossible to acquire any conception 
of the original process which was present. The method of freezing the 
— 
bythe 
ee yo 
vs 
