In nine cases out of ten, eczema can be cured by local treatment without alteration in diet or internal drugs. Bat Mr. Hutchinson always advises the avoidance of sugar, fruit, and milk, and very often gives salines, and in acute cases, even tartarized antimony. The prohibition of milk has caused surprise, as it is regarded as the mildest and least irritating of foods. The testimony of not a few patients, however, has convinced him that it often makes the skin itch, and aggravates eczema. The influence of fruit, especially strawberries and raspberries, and all kinds eaten with cane sugar, is very great in causing irritability of the skin. It is doubtful whether they ever cause eczema, but they cause scratching, and this brings out eczema. The main agents in the production and perpetuation of eczema are scratching and rubbing. The patient who has strength of will to abstain usually recovers; no treatment will cure those who cannot. It is often of little use to insist on its avoidance unless a substitute is provided, it is here that tar solution is useful. It abates irritability. A good bathing gives relief as efficiently as a good scratching, and is not followed by reaction. One reason that eczema is so difficult to cure in infants is that they cannot be restrained from tearing the skin, and often undo in a few minutes the effects of a week's treatment.

Weak tar lotions may be used without much regard to stage. In a few cases, however, of very acute inflammation, it is preferable to use lead lotion for a few days, and to add tar only when the congestion is a little abated. The cases, however, are very few in which Mr. Hutchinson omits tar, even at the beginning. Very often he prescribes liquor carbonis and liquor plumbi diacetatis in equal proportions diluted as above directed.

Arsenic rarely does any good, and often irritates. Weak sulphur baths, as at Harrowgate and Aix-la-Chapelle, often cure chronic cases, chiefly those of dry eczema, but he has seen severe cases from both places not only uncured, but apparently made worse.

A Case of Malformation of the Finger-Nails with Eczema of the Fingers.-(Presented by Dr. Klotz at New York Dermatological Society.) A boy, 3 years of age. Dr. Klotz stated that he presented the case principally because its history seemed to throw some light on the origin of some eczemas of the nails and fingers. The boy's mother reports that last December she noticed a blister filled with pus at the base of the nail of the left

forefinger. Owing to her confinement she could not pay much attention to the child, but before she left her bed in January she noticed that a number of other finger-nails had become affected in a similar manner. Soon afterwards the tips of the fingers became red, covered with small vesicles, which opened, and then the skin showed thin scales or crusts. Later on patches of a similar character began to appear on the forearm, the legs, and since about two weeks, on the face. The nails of most of the fingers on both hands show a sharply defined depression at their base, redness, swelling, and abrupt ending of the soft parts around the nail without the usual flat processes of the horny epidermis overlapping the nail substance. The body of the nail is mostly smooth and well-shaped except that of the left fourth finger, on which the process started. There the entire nail has lost its smooth, level surface and is divided up into a number of small prominences. It can be safely concluded that if the eczema of the fingers will be allowed to continue much longer, the nails themselves will be more prominently affected and will apparently take part in the eczema.

Dr. Allen said that when, at a recent meeting of the Society, he had shown a case of this character, one of the members took exception to the term "eczema of the nails." Since then, the speaker said, he had seen a case in which an eczema of long duration, in a young child, was limited to one hand; all of the nails of that hand were altered at the matrix, and, commencing about the middle, the nails curl upwards. They are not thickened and filled in, as in psoriasis, but simply grow in an upward direction, almost at right angles to the plane of the nail.

Dr. Morrow said the nails in the case shown by Dr. Klotz did not present the features which he was accustomed to associate with eczema of the nails. In the majority of those cases the trouble is more apparent at the free border of the nail and the lateral margins, more especially the former. The condition in Dr. Klotz's case resembled a dystrophy which might be associated with an eczematous condition of the fingers, but which was of neurotic origin. In cases where there is any interference with the nutrition of the nail, the presence of transverse furrows, as in this case, was frequently noticed. The case was certainly not a characteristic example of eczema of the nails.

In true

Dr. Johnston said he agreed with Dr. Morrow. eczema of the nails the furrows usually run in a longitudinal

rather than in a transverse direction, as in this case, and the nails are apt to be split. The speaker said he regarded both the eczema of the hands and the affection of the nails in Dr. Klotz's case as evidence of a trophoneurosis, the two conditions being coexistent rather than dependent one upon the other.

Dr. Fox said that, strictly speaking, there was no such thing as eczema of the nails. In the case shown by Dr. Klotz there was simply a malnutrition of the nails resulting from the eczema of the fingers. The curling upwards of the end of the nail, without the formation of any chalk-like deposit underneath, is probably the result of the transverse furrows which may occur from onychia or malnutrition.

Dr. Klotz, in closing the discussion, said he agreed with Drs. Morrow and Johnston that the case was not originally one of eczema of the nails. The disease began as a pyogenic infection of the matrix at the base of the nail, the eczema appearing later. If the eczematous process of the fingers were allowed to continue, the nails, as the result of impaired nutrition, would gradually develop these features which usually are described as eczema of the nails. The speaker said his object in showing the case was to demonstrate what he had maintained at one of the previous meetings of the Society that these conditions of the nails were originally the result of an infectious inflammation of the surrounding skin and other soft tissues.

PATHOLOGY AND BACTERIOLOGY.

Under charge of ERNEST S. PILLSBURY, M. D.,

Professor of Bacteriology and Pathology, College of Physicians and Surgeons of San Francisco.

Adaptation of Pathogenic Bacteria to the Different Species of Animals.-Medical science and medical art are concerned chiefly with the phenomena of human disease, but to learn even the simplest fact, recourse to animal experimentation has been necessary at every step. It is necessary not only to study the micro-organisms, but the host into which they enter. If we glance at the infectious diseases which we share with animals, or in which they enter as a necessary factor, we find four groups: 1. Diseases common to man and certain animals, and presumably transmissible from animals to man, and vice versa. (Bubonic plague, tuberculosis.) 2. Diseases

common to both, but not known to be transmitted. (Actinomycosis, tetanus.) 3. Diseases transmitted from animals to man, but not, as a rule, from man to man. (Anthrax, glanders, rabies, vacinia, foot and mouth disease, meat-poisoning, pus-infections.) 4. Certain specific symbiotic relations requiring two hosts for the complete life-cycle of the micro-organism. (Malaria, trichinosis, tape-worm.)

The range of infectiousness varies considerably and arbitrarily without any at present assignable reasons. The rat, which is, generally speaking, quite resistant, is very sensitive to bubonic plague, while the guinea-pig, which is susceptible to most every thing, is much less sensitive to this bacillus than the rat. The range of infective power seems, to a certain extent, to coincide with the readiness with which the bacteria can be artificially cultivated on various media. Thus, the plague-bacillus, the colon-derivatives, the septicemia group, and anthrax have a wide range, while the bacteria of leprosy, syphilis and gonorrhoea do not attack animals. This may be due to absence of a suitable soil.

Another interesting fact is that certain bacteria, causing disease among different species, have certain affinities which force us to classify them together, and which enable us, at the same time, to clearly separate them from other pathogenic groups, as the human, bovine and avian tubercle bacilli and others. This brings out two facts of bacterial adaptation: 1. The direct passage of infection from animal to man, and from one animal to another; and 2, the adaptation of the same stock to different species leading to modifications of this stock into recognizable varieties.

Virulence is a variable term and might mean an increase of effect towards other species of animals with an increase or diminution towards the same species. No general scheme will fit the increase, decrease or fixation of the virulence of pathogenio organisms by passage through series of animals. The reappearance of the plague after an interim of months is ascribed to the new generation of susceptible rats, but this explanation may not be true of all diseases. If pathogenic bacteria have but one habitat the probabilities are in favor of a gradual mitigation of that type of disease as in leprosy, syphilis, and tuberculosis; but if bacteria have another habitat to recruit their virulence we may expect to have epidemics of such

diseases. It is not improbable that the process of making pathogenic bacteria is now going on in the animal world—to be noticed only when these bacteria have been transported to a species which may happen to be susceptible.-THEOBALD SMITH, M. D., in Philadelphia Medical Journal, May 5, 1900.

Hospital Notes.

CALIFORNIA EYE AND EAR HOSPITAL.

By REDMOND W. PAYNE, M. D.

Burgeon to the Hospital; Consulting Ophthalmologist to the Southern Pacific Hospital; Professor of Clinical Ophthalmology and Otology, College of Physicians and Surgeons, San Francisco.

Traumatism Producing Retro-Bulbar Injury to the Optic Nerve.-Six weeks ago the patient, a man 45 years of age, was struck with some heavy weapon upon the external angle of the orbit. The soft tissues at this point were lacerated for about an inch down to the bone. The bony walls of the orbit, however, seemed to be intact, and there was apparently no fracture. Severe swelling of the lids and surrounding tissues followed. One week after the accident I saw the case and at this time the swelling had gone down considerably, so that the lids could be opened.

Examination of Eye.-The eye was absolutely blind. There was no perception of light from any direction. There was marked chemosis of the conjunctiva. The iris appeared normal, but did not react to light. Its associate reaction, however, was normal, when light was reflected into the uninjured eye. The cornes, vitreous and pupil were perfectly clear. The fundus appeared perfectly normal, there being no change either in the papilla or in the vessels. There was no pain in the eye at any time. Motion of the eye was good except as embarrassed by the swelling of the lids and conjunctiva, and there was only a slight amount of tenderness by pressing the eyeball backward.

Probable Site of Injury.-At the first examination all the findings pointed to an injury of the optic nerve at some point behind the globe. It was thought at that time that the injury was probably at a point between the optic foramen and the entrance of the central retinal artery into the nerve, and if our prognosis were correct, we expected that a descending degenera