Solution Manual for Lakeside Company

Case Studies in Auditing 12th Edition

by Trussel
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Solution Manual for Lakeside Company
Case Studies in Auditing 12th Edition by
Trussel

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Case 1 - Exercise 1
Abernethy and Chapman
Fraud Risk Factors

Client:
Prepared by:
Date:

List the fraud risk factors that the CPA firm might encounter if they accept this audit
engagement. Be sure to include a discussion of all items that will probably require
special attention during the audit. For each of these fraud risk factors, indicate how
the auditor should follow up on each potential problem if the engagement is accepted.
Use the following format:

Fraud Risk Factors Auditor Follow Up

Another random document with
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 Prognosis. The prognosis varies, according to the determining
cause. In cases of accident and in temporary agalaxia, it is sufficient
to change the food in order to restore the secretion. Cooked food and
warm drinks, with an allowance of roots such as turnips or
mangolds, have excellent results. Where restoration of the secretion
is delayed the use of what are called galactogogues has been
recommended, comprising fennel, carraway, cummin, aniseed,
juniper, sulphur, etc., mixed in equal parts and given in doses of 6 to
8 drachms per day for a cow.
They act principally through the stimulating effects of their
aromatic principles.

MICROBIC CHANGES IN MILK.

LACTIC FERMENTS.

Microbic changes in milk are much commoner than changes of a

chemical nature. Milch animals differ very markedly one from
another, and, according to circumstances, give milk of ordinary
composition, milk of a very rich character, or watery milk; but the
most important changes in composition are those due to microbic
agents.
During the milking, and according to whether this is performed in
a low, dirty byre, in a clean, roomy byre, or in the open air, various
numbers of germs obtain entrance to the milking vessels, and
develop there with extraordinary rapidity. The milk may even
become infected by non-pathogenic germs while still within the
udder, in the sinus and galactophorous canals. The cleanliness of the
milking vessels also has a considerable influence on the number and
variety of the microbes which may eventually germinate in the liquid.
Among the microorganisms usually found in milk there are some,
however, which always preponderate and play the part of organised
ferments, viz., the lactic ferments and the organisms which cause
coagulation of the casein; these may be regarded as normal
constituents. The others are more or less foreign, and may cause
important changes in the milk or cream.
 The lactic ferments are numerous, comprising the lactic bacilli of
Hueppe and Grotenfeld, the micrococci of Hueppe and Marpmann,
and the bacilli and micrococci of Freudenreich. These different
agents act on the lactose of the milk, decomposing it into carbonic
and lactic acids, which coagulate the milk.
Another group of microorganisms which were well studied by
Duclaux comprises those acting on the casein, among others
Tyrothrix tenuis, filiformis, turgidus, scaber, virgula, etc.
These organisms secrete principles having similar effects to those
of rennet, and are capable of coagulating enormous quantities of
milk. After a certain time, they also secrete a second diastase, viz.,
casease, which acts in the ripening of cheese.
Clotted Milk.—This term is used in dairies to indicate milk which
coagulates in lumps immediately after being withdrawn from the
udder, or which coagulates spontaneously a few hours later.
The change may be of a chemical nature, depending on conditions
of keep or feeding. More frequently, however, it is related to a latent
non-pathogenic infection of the udder, or to immediate infection of
the milk after removal by lactic ferments contained in the milk
vessels or the atmosphere.
It is necessary, according to circumstances, either to modify the
diet or disinfect the milk vessels, and immediately pasteurise the
milk.
Milk without Butter.—Less commonly the diseased condition is
indicated by marked diminution in the quantity of cream.
Churning only produces a poor kind of butter, particles of which
do not readily cohere. This peculiarity is due to the presence of
microorganisms, which have not yet been fully identified. It can be
prevented by disinfection of the milking vessels, as well as of the
dairy itself, and by the use of centrifugal separators.
Putrid Milk.—This milk is characterised by its odour. It cannot
be used for making butter. In fact, as soon as the cream separates,
little bubbles of gas form at various points and break, leaving small
cavities. These little separate cavities reunite very rapidly, and the
cream becomes reabsorbed as fast as it is formed. Afterwards oily
drops formed of butyric, capric, and caprylic acids appear in the
depressions and give the milk a repulsive odour (rancidity).
 This change is seen during mammitis, but most commonly results
from uncleanliness in byres and dairies. In the latter case
putrefaction occurs about twenty-four hours after milking, and is due
to the growth in the milk of Bacterium termo, lineola, etc. These
organisms are present in the dust which falls into the milking pails in
the byre; when milk so contaminated is stored in the dairy the
changes occur.
Putrid odour may also be due to the presence of ammoniacal gas in
the byre, or to special toxins liberated by microbes which have found
their way into the milk. It is most marked during the warm seasons
of the year.
The occurrence of putrid milk can be prevented by disinfecting the
dairy and the milking pails daily for a certain time.
Mucous, viscous, or thready Milk.—These terms are applied
to a condition which usually appears twenty-four or thirty-six hours
after the milk has been withdrawn. The milk seems thick and
viscous, and can be drawn out into threads like mucus. It sticks to
neighbouring objects, and adheres to milk vessels like molasses. It
coagulates imperfectly on standing, gives little cream, and even this
cream only furnishes a mawkish, ill-flavoured butter.
In certain parts of Switzerland the production of mucous milk is
favoured, because it is employed in making cheeses.
The change is due to the presence of various microorganisms.
Those which have been best studied are Schmidt-Mülheim’s
micrococci, the Actinobacter polymorphus of Duclaux, the Bacillus
lactis pituitosi of Löffler, the Bacillus lactis of Adametz, the
Streptococcus hollandicus, and, finally, three others which are much
commoner, Guillebeau’s bacillus, the Micrococcus Freudenreichii,
and the Bacterium Hessii. These microorganisms act on the lactose,
decomposing it and causing the formation of a kind of filamentous
mucilage, which can be isolated by the addition of alcohol.
The mucilaginous change in milk can be prevented by ordinary
methods of disinfection.
Red Milk.—Milk which becomes red some hours after
withdrawal, or within forty-eight hours after milking, should be
distinguished from milk which on withdrawal from the udder is
tinted red in consequence of hæmorrhage within the udder itself.
When the milk is of a hæmorrhagic tint the blood corpuscles are
soon deposited on the bottom of the vessel if the milk is allowed to
remain undisturbed.
The tint which the milk assumes is due to the growth of
chromogenic organisms, the best known of which are as follows:—1.
B. prodigiosus, which produces large red patches on the surface. It
grows readily on potato and gelatine, which it liquefies. 2. The
Sarcina rosea, which develops first of all in the cream and
afterwards invades the milk. It grows in sterilised milk, on alkaline
potato, and on gelatine. 3. The Bacterium lactis erythrogenes, which
liquefies gelatine and produces a reddish coloration. Casein can be
precipitated and peptonised by means of its cultures. It develops in
the milk below the cream, the serum alone becoming red, and only
when shaded from the light.
Blue Milk.—In this case the milk appears normal when
withdrawn, but some days afterwards shows blue patches, which
gradually increase in size, and by uniting produce a distinct blue tint
at the surface.
This change is connected with the presence of the B. cyanogenus.
The organism grows in sterilised milk, but in this case merely
produces greyish patches, the blue tint only occurring when a certain
quantity of lactic acid is added or when the ordinary lactic ferments
are present.
Yellow Milk.—A yellow tint occurs in ordinary milk and cream,
particularly in certain breeding districts—in Normandy, for example,
where the butter produced is greatly valued on account of this
appearance. Pathological yellow milk is the result of the growth of B.
synxanthus Schröter, which secretes a substance resembling rennet,
curdles the milk, and finally dissolves the clot, at the same time
producing the yellow colour.
Bitter Milk.—Milk which is of a normal character on being
withdrawn from the udder may acquire a bitter taste some hours
later. At rest, this milk produces a small quantity of yellowish, frothy
cream. The organisms which produce the change have been studied
in Germany, Switzerland, and Auvergne. We may mention
Weizmann’s bacillus of bitter milk, Conn’s micrococcus of bitter
milk, and Duclaux’s Tyrothrix geniculatus.
 Medicated Milk.—Medicated milk may be divided into two
kinds: Firstly, medicated milk proper, which differs from normal
milk inasmuch as it contains a certain proportion of drugs, which,
when swallowed by milch cows are partly eliminated through the
udder. When taken by a young animal or child such milk has a
distinct therapeutic effect, depending on the principles employed.
It does not appear, however, that up to the present any very great
success has followed this system. It is possible to increase the
richness of the milk in phosphates, but as regards mercurial or
iodine preparations the failure has been complete.
Secondly, fermented milks, which in addition to their nutritive
action are made more digestible.
Fermented milk is easily digested, and is better borne by the
weakest stomachs.
In human practice the fermented forms of milk are two, viz.,
kephyr and koumiss.
Kephyr is prepared in Afghanistan and Persia from camel’s milk,
but for some years past it has been made in England with cow’s milk.
A certain quantity of cow’s milk is placed in a bottle and the ferment,
consisting of kephyr grains, is added. The lactose is converted into
carbonic acid and alcohol in consequence of the action of certain
lactic microbes.
This milk after ingestion does not require to be coagulated and
then digested before absorption, a fact which considerably
diminishes peptic digestion.
Koumiss is a milk preparation resembling kephyr; it is made by the
Kirghizes with mare’s milk according to the same principles, but the
ferment employed gives more alcohol.
Preservation of Milk.—On account of the importance of
preserving milk for use in large towns, in hospitals, and in the army
during war, the question of its preservation has long been studied.
Chemical Processes.—The principle of preserving milk by chemical
action consists in preventing, or at least retarding, the changes which
inevitably follow exposure to the air. For this purpose, chemical
substitutes are added which in themselves have no injurious action.
Those most commonly employed are:—
 Carbonate of soda 45 grs. per quart.
Bicarbonate of soda 45 grs. „
Boric acid 15 to 30 grs. „
Salicylic acid 12 grs. „
Borax 60 grs. „
Lime 20 grs. „

The results obtained are of comparatively little value; the milk only
keeps for a few hours, or at the most for three or four days.
Cold.—Refrigeration, which is so valuable in preserving all kinds of
animal products for long periods, has also been used for preserving
milk. Unfortunately, although cold impedes the development of
bacteria, it also has the grave inconvenience of causing the cream to
separate from the milk, and it being impossible to mix them again
satisfactorily, milk preserved in this way is more or less unfit for
consumption.
Heat.—The principle of preserving milk by heat is based on the
destruction of the microorganisms at a high temperature. In this
respect again, one meets with obstacles, for, if the heat be applied
direct, some of the principles of the milk are converted into caramel,
and if the temperature rises beyond 157° Fahr. (70° C.) the
composition of the milk is changed.
Preservation by Oxygen.—Within the last few years the use of
oxygen at a pressure of about two atmospheres has been
recommended. When the milk is to be used it is only necessary
slightly to relieve the pressure and allow the oxygen to escape, the
liquor which remains having all the characters and qualities of fresh
milk. The method appears excellent, but is too costly for every-day
use.
Pasteurisation.—The pasteurisation of milk aims at destroying the
greater proportion of the ferments above mentioned. The milk is
heated at atmospheric pressure, and is kept for a time at a
temperature of between 150° and 157° Fahr. (65° and 70° C.). It
preserves its properties and composition, but sterilisation is not
complete, and the milk cannot be kept indefinitely.
 Concentrated Milk.—Concentrated milk is obtained by prolonged
heating to 157° Fahr. (70° C.) in a vacuum, when it becomes syrupy
by evaporation and its composition is not greatly modified. It is then
drawn off into bottles, which are hermetically sealed and subjected to
a higher temperature to complete the destruction of all the germs.
Condensed milk keeps for a very long time. To prepare it for use it is
mixed with a certain quantity of water, and then yields a liquid
similar to normal milk.
Sterilisation.—Sterilisation necessitates the use of special
apparatus in which the milk is heated in a water or steam bath
sheltered from the action of the air, the temperature rising to 212° to
240° Fahr. (100° to 115° C.); all the ferments are destroyed, and the
milk will keep indefinitely, but its composition is slightly modified.
Diseases Transmissible to Man through the Medium of
Milk.—Tuberculosis.—The history of tuberculosis contains
numerous facts proving the possibility of contagion by milk from
cows suffering from tuberculous mammitis, though it seems
necessary that the milk should be taken for a certain time to produce
these effects.
Foot-and-Mouth Disease.—Observations recorded by veterinary
surgeons prove that this disease affects the teats. It may be
transmitted to man. The milker may be directly inoculated, but the
milk is the ordinary vehicle of contagion. Chauveau saw an epidemic
in a school at Lyons where milk was obtained from cows suffering
from foot-and-mouth disease. In a similar way 205 persons were
inoculated at Dover in 1884, and suffered from vesicles about the
mouth.
Although foot-and-mouth disease is extremely benign in men, it is
well to take every precaution against it.
Gastro-Intestinal Infections.—Cases have been recorded of gastro-
intestinal infection in young animals and children in consequence of
consuming milk which had undergone abnormal changes. Milk
containing various kinds of microorganisms may at first produce
lactic indigestion and afterwards diarrhœic enteritis.
 CHAPTER VII.
MALE GENITAL ORGANS.

The scrotum, the vaginal sheath, the testicles, the vas deferens, the
vesiculæ seminales, the prostate, and Cowper’s glands may all
become the seat of disease.
The scrotum and testicles seldom reveal more than mechanical
injuries of external origin, producing wounds and cuts and, in the
case of severe contusions, hæmatoma of the scrotum, of the vaginal
sheath, and of the testicles. Inflammation of the testicle, that is to
say, traumatic orchitis, is rare; on the other hand, Moussu has
several times seen tuberculous orchitis, for which he has operated.
This, however, was in the boar. These different lesions, the last
named excepted, usually heal with rest and the application of
antiseptic dressings, anodyne and resolvent lotions.
Breeders seldom retain more entire animals than are strictly
necessary for reproduction. The others are castrated, and this alone
explains why the treatment of genital diseases in male animals of any
species is rare.

TUMOURS OF THE TESTICLE.

Of the genital diseases which possess real clinical interest the most
important are tumours of the testicle. These occur not only in male
animals, but also in those which have undergone the operation of
bistournage.
It might à priori be believed that in an animal of the latter class
the testicle had been completely destroyed, not only from the
physical, but from the pathological point of view. This, however, is by
no means the case, and Cruzel has described, under the erroneous
designation of sarcocele, tumours of the testicle which develop in
oxen of various ages.
Moussu has had a similar experience with animals of from four to
six years of age which had been carefully operated on.
 These tumours, the origin of which is unknown, develop at the
expense of the rudiments of the atrophied testicle. They vary in
character, and Moussu has only observed tumours of a type different
from that of the testicle itself, containing tracts of carcinomatous,
sarcomatous, and fibrous tissue. They also appear to vary greatly in
gravity, for, although the cases seen by Moussu had become
generalised in a few months, Cruzel states that these tumours may
remain stationary for several years.
The symptoms
consist in progressive
enlargement of the
scrotal region and the
appearance of a tumour
surrounded by
œdematous or lardaceous
tissue.
The tumour, which is
confined to one side,
increases in size, is
bosselated and adherent
at points to the surface of
the skin, while it is
insensitive or only
slightly painful to the
touch.
In a few months it may
increase to the size of a
child’s head. The animals
have difficulty in moving
Fig. 239.—Upper surface of the neck of or lying down, the hind
the bladder and origin of the urethra in limb on the affected side
the ox. 1, Bladder; 2, vesiculæ seminales; is abducted, and the
3, vas deferens; 4, principal portion of animal usually lies on its
the prostate gland extending beneath chest and abdomen. The
the sphincter; 5, sphincter; 6, patient rapidly loses
aponeurosis of the sphincter, clothing flesh, although the
the upper portion of the urethra and the appetite remains good.
flattened portion of the prostate. (After When the growth is
Barrier.) removed, it is easy to
prove that the tumour has
developed in the
atrophied mass of testicular tissue, and that it remains suspended
from the end of the cord.
The diagnosis of tumour of the testicle is extremely easy, for the
condition cannot be mistaken for a hæmatoma or for a scrotal
abscess.
The prognosis necessarily depends on the nature of the tumour,
but as it is impossible to determine this point before extirpation, the
prognosis should always be regarded as very grave.
Treatment. Whatever the nature of the tumour, ablation is
advisable. If it is of a benign character, recovery may be complete
and permanent, but if it is malignant, generalisation will rapidly
ensue. Before interfering surgically, however, it is essential to
examine the inguinal, pelvic, and sublumbar lymphatic glands, to
make sure that they are not affected. If they prove to be already
invaded, an operation should be avoided.
Even despite such precautions and the apparent absence of any
glandular infection, operation may be followed by generalisation in a
few months, although for a short time the condition may seem to
have greatly improved. No special indications need be given beyond
those suggested as necessary in dealing with all kinds of tumours,
whatever their nature.
The skin should be freely divided, that the tumour may be
thoroughly dissected out and no fragments be overlooked. The mass
of the tumour having been dissected free, the écraseur is applied to
the pedicle or the cord. Enucleation of the tumour may be very
difficult on account of the presence of numerous ramifications or
attachments, but the closest attention must be given to removing
every fragment if a fresh local growth is to be avoided. In the event of
fragments being left, a fresh growth is certain to occur.
Generalisation, which may extend to all the viscera (lymphatic
glands, liver, spleen, lungs, pleura, peritoneum, heart, etc.), is
indicated by rapid wasting, fever, acceleration of breathing, digestive
disturbance, and sometimes coughing, etc.
 Local new growths assume the form
of ulcerating swellings. In practice, if
the general condition can be improved
for a short time, it is advisable to
slaughter the animal.

ACCESSORY GLANDS OF THE

GENITAL APPARATUS.

(PROSTATE, VESICULAR
SEMINALES, COWPER’S GLANDS.)
Inflammatory or other diseases of
the above glands are most frequent in
entire animals. As a group they are
uncommon, and are still ill-recognised
and ill-described, being seldom
identified except on post-mortem
examination.
The cause of inflammation of the
prostate, of the vesiculæ seminales,
and of Cowper’s glands is probably an Fig. 240.—Roof of the neck
ascending infection of the urethra and of the bladder and first part
neighbouring channels, a fact which of the urethra (internal
explains the comparative rarity of such surface). 1, Orifice of the
conditions in castrated animals. ureter; 2, urethra at a point
The pathogenic germs penetrate beyond the urethral valve;
from the urethra into the excretory 3, submucous erectile
ducts of the glands, obtain a lodgment tissue; 4, urethral
in the culs-de-sac of the glands sphincter; 5, vesiculæ
themselves, and thus produce simple seminales; 6, veru
or suppurative inflammation. montanum; 7, orifices of
The symptoms may easily be the vesiculæ seminales; 8,
mistaken, to some extent at least, for orifice of the vas deferens;
those of acute cystitis or cystitis due to 9, orifices of the prostate;
the presence of a calculus, and it is 10, urethral valve, showing
only by rectal examination that the on its free margin the
diagnosis can be made. point-like openings of the
 The first symptom is defective ducts of Cowper’s gland.
micturition, which occurs in jets, is (After Barrier.)
intermittent and painful, and
sometimes
causes slight
groaning. It is
accompanied
by vesical
colic,
spasmodic
lifting of the
hind legs, and
more or less
unsuccessful
expulsive
efforts.
These
symptoms are
of reflex or
mechanical
origin, and are
due either to
direct
compression
of the urethra
Fig. 241.—View of Cowper’s gland and of its by an
compressing muscles. (After Cocu.) 1, Cowper’s hypertrophied
gland; 2, compressing muscle; 3, accelerator urinæ and inflamed
muscle turned back to expose the gland; 4, gland, or to
sphincter of the urethra. spasm of the
vesical
sphincter. The urine passed, unlike that in cases of acute cystitis or in
cystitis due to calculus, is of a normal character. Rectal examination
usually reveals distention of the bladder, and hypertrophy and
exceptional sensitiveness at certain points.
If the painful and hypertrophied area is over the neck of the
bladder, this indicates that the lobes of the prostate are affected. If,
however, the affected parts are situated on the sides of the neck and
along the posterior pointed end of the bladder (Fig. 239), the
vesiculæ seminales are affected; finally, if the painful points are
directly above the ischial arch and below the sphincter ani, Cowper’s
glands are the seat of disease (Fig. 240).
To diagnose these conditions requires very close and careful
examination. They may easily be mistaken for acute cystitis, though
the character of the urine should suggest doubts and lead to rectal
examination.
Although they do not endanger the animal’s life, these conditions
give rise to such serious inconvenience as often to render entire
animals useless for stud purposes.
Local treatment is impossible, and the practitioner is restricted
to the use of anodynes, balsamic preparations and diuretics. The
treatment, in fact, differs little from that of cystitis. In cases of
suppuration of Cowper’s glands, the abscess usually forms just below
the anus and close to the median line. Thus the diagnosis may be
confirmed by capillary puncture, the part being laid open if
necessary.
 SECTION VIII.
DISEASES OF THE SKIN AND SUBCUTANEOUS
CONNECTIVE TISSUE.

CHAPTER I.
ECZEMA.

Under the name of eczema may be grouped a series of cutaneous

diseases characterised by pruritus, by a discharge from the skin, or
simply by epidermic proliferation, without any apparent parasitic or
accidental cause.
These diseases have been referred to a special constitutional
condition termed a diathesis, although during the last few years we
have come to recognise certain microbic and toxic influences in their
production. In the ox eczema assumes different appearances.
Accordingly, the disease has been divided into the acute, chronic,
sebaceous, and toxic forms.

ACUTE ECZEMA.

Causation. In the ox, as in all other species, the determining

cause is to be found in bad hygienic conditions, improper feeding,
and in a special individual condition of the animal affected, that is to
say, a diathesis.
 Symptoms. During a preliminary period, which might be termed
a prodromic period, only general symptoms can be detected, such as
fever, loss of appetite, digestive disturbance, constipation, etc. Local
signs are still absent, or at least are not noticeable, and are only
represented by congestion of the skin.
The second phase is characterised by a papulous eruption which is
difficult to detect, inasmuch as it occurs in the depths of the coat.
Nevertheless, the skin is distinctly sensitive, and at numerous small
points the hairs appear to stand upright.
The third phase consists in the development of more or less
confluent vesicles, with exudation and discharge. The disease is not
really visible externally until after the hair has become agglutinated
by the discharge. This discharge is seldom as abundant as in eczema
in the dog or horse. It is produced slowly and dries rapidly.
As the crusts fall, carrying with them a portion of the hair, the
general symptoms disappear, but the sites of these vesicular patches
now show cracks extending as deep as the dermis and often
complicated by secondary infection involving suppuration, adenitis,
abscess formation, or diffuse subcutaneous suppuration.
Acute eczema is generally confined to the limbs. It may develop
fully in from twenty-four to forty-eight hours. The acute stage is
attained in a few days, and the condition disappears in two to three
weeks provided it does not assume the chronic form as the result of
complications.
Diagnosis. The absence of parasites enables the condition to be
distinguished from phthiriasis and acariasis, whilst the history
prevents its being confounded with toxic eczema.
Prognosis. The condition is troublesome rather than grave.
Suppuration is often persistent, and despite careful attention the
discharge may only diminish slowly, while the disease is always liable
to return.
The treatment is local and general. Local treatment consists in
emollient and antiseptic washes and the application of drying
powders. The former comprise glycerole of starch, bran water, boric
ointments, camphorated vaseline, iodine and glycerine. At a later
stage the skin can be washed with decoction of oak bark or a weak
iodine solution, followed by the application of talc or starch powder.
As far as possible this external treatment should be supplemented by
the frequent use of mild purgatives and various diuretics, which
seem to have a special action on the arthritic diathesis.

CHRONIC ECZEMA.

Comparatively few cases of chronic eczema have hitherto been

described in oxen, and the details given are extremely meagre.
Chronic eczema may assume that form from the first or may succeed
acute eczema. The causes are probably the same in both conditions.
The symptoms appear to be those of the acute form, but are
much less severe. They consist in papulation, a miliary vesicular
eruption, pruritus, and the formation of crusts and epidermic scales.
In a case seen by Mégnin the crusts separated and fell away,
leaving bare spots. The disease re-appeared for several years in
succession. The spots finally remained bare, but showed no
thickening of the skin and no microscopic changes.
Diagnosis. Microscopical examination is necessary to distinguish
this disease from scabies or ringworm.
The prognosis is grave, because large areas of the skin may be
invaded in succession.
Treatment. As in acute eczema, the condition is improved by the
prolonged administration of small doses of salines and diuretics.
Arsenical preparations are also valuable, but should only be
employed for two or three weeks together, with intervals of equal
duration. The dangerous complications which sometimes result from
accumulations of this drug in the system are thus avoided.

SEBACEOUS OR SEBORRHŒIC ECZEMA.

Whilst the two preceding forms of eczema result from vascular

disturbance of the skin or dermis that now under consideration
seems due to vascular and secretory troubles in the accessory
structures of the skin, and more particularly in the sebaceous glands.
Fig. 242.—Sebaceous eczema, first stage. Depilation of the extremities.

Symptoms. The disease develops slowly. At first circular or

elliptical patches of skin, distributed regularly over the body, more
especially round the natural orifices, become deprived of hair. The
surface of these patches is covered either with thick crusts of a
peculiar greyish-brown tint which display numerous superficial
cracks, or parts normally free from hair exhibit shining epidermic
crusts arranged in layers, which are shed on the slightest touch.
This depilation has a strong tendency to spread, and so at first it
often resembles ringworm. It results from changes in the hair
follicles, with atrophy of the papillæ and complete loss of hair. The
changes in the skin, however, are little marked. The skin itself is but
slightly thickened and preserves its usual suppleness, while the
subcutaneous tissue is not œdematous.
Fig. 243.—Sebaceous eczema, second stage. Partial alopecia.
Fig. 244.—Sebaceous eczema, third stage. Total alopecia.

The hairs, however, when examined microscopically are found to

be thickened at their roots, though otherwise throughout their whole
length they remain normal. The condition is a consequence of
disturbance in the circulation and nutrition of the papilla and the
root of the hair.
Finally, the congestive process extends to the sebaceous glands,
the secretion of which it modifies, and sets up seborrhœa, which is
responsible for the formation of the crusts and epidermic scales
above-mentioned.
The pathogeny of the disease is difficult to explain, but the stages
in the clinical development are as follows: the skin undergoes
repeated attacks of congestion, followed by seborrhœic folliculitis,
epidermitis and loss of hair.
The diagnosis is easy, the absence of ringworm being proved by
the absence of the spores of trichophyton and by the non-contagious
character of the discharge.
 The prognosis is not grave from the point of view of general
health, the chief functions being perfectly regular, but it is otherwise
as regards possible terminations, viz., partial or total loss of the coat,
which may be irremediable.
Treatment. It is difficult to lay down a really satisfactory method
of treatment, because the exact cause of seborrhœa is still unknown.
As it is probably to be sought in some individual constitutional
peculiarity, the feeding and method of life should be changed and the
skin stimulated by washing with lukewarm water and soap and by
dry friction. Locally, if the alopecia threatens to be permanent
stimulating applications may be tried. These comprise lotions
containing alcohol, solutions of chloral, salicylate of soda, etc., and
they should be applied with smart friction.
The sufferers should not be used for breeding purposes.

ECZEMA DUE TO FEEDING WITH POTATO PULP.

Among the forms of eczema due to toxins, several varieties may be

recognised. Some result from the administration of drugs such as
iodine, others from special forms of food. The only one of clinical
importance is that following the consumption of excessive quantities
of potato pulp.
Causation. The disease is seen in all districts in which potatoes
are employed for the manufacture of alcohol and starch, more
especially in Germany. The disease seems to be a direct consequence
of feeding with residual products of distilleries and starch
manufactories.
Spinola states that 160 lbs. of potato refuse per day to 1,000 lbs. of
body weight would certainly produce eczema: 60 to 80 lbs. only
produce it in rare cases and 20 to 40 lbs. are harmless.
There is a further point to consider as regards the variation of
potato pulp in toxicity. Potatoes yield a more or less active residue,
according to the year in which they are grown, their state of
germination, and the variety to which they belong. Raw or cooked
potatoes may produce eczema if given in large quantities or for long
periods.