A CASE OF GASTROSCHISIS OR FISSURA ABDOMINALIS.* BY JOSEPH H. PETERS, M.D., HAMILTON, ONT. THE specimen presents the condition known as gastroschisis, or fissura abdominalis. The abdominal organs have no covering, except the peritoneum and the chorion and amnion continued from the placenta. There is a hernia of the liver and intestines, if not more of the abdominal organs, into the sac so formed. The pubic bones do not unite in the middle line. There is complete absence of the anterior wall of the bladder, and one can see its posterior wall continuous with the skin. Just posterior to the bladder will be noticed a projection of mucous membrane, which is found to be the rectum slightly prolapsed. The genital organs are completely absent with the exception of a rudimentary scrotum, which is cleft, each lateral half being attached to the corresponding nates. It will be noticed that the right leg is rotated inwards through an angle of 180 degrees, so that the foot looks directly backward, There is a spina bifida in the lower dorsal region. It will be remembered that in the process of development, the visceral arches (splanchno-pleures) grow forward, and for the most part coalesce in the middle line. The neural arches unite behind in a similar fashion. Non-union sometimes occurs and gives rise to various forms of clefts, such as those illustrated by this case. The incomplete closure is said to be caused by the abnormal protrusion of the viscera, preventing closure in front. "The cause of such protrusions may be dropsical accumulations, more especially in case of the thorax and abdomen, but it may be due to interference, by adhesions, or otherwise, of the amnion or allantois."-Coates. The child was alive at birth. *Read at the Ontario Medical Association, Toronto, June, 1904. Selected Articles. • PROGRESS IN THE TREATMENT OF ECZEMA. BY PROF. KROMAYER, BERLIN. THE province of eczema treatment shares with the remaining provinces in therapeutics, the questionable lot, that at brief intervals new remedies or novel compositions are ever being advanced and recommended as particularly effective in their action. In spite of these recommendations, however, but few remedies have been proved to represent real progress. The majority have met with a well-merited fate: in a short time they have become forgotten and been replaced by new ones. As against all these passing appearances, which prove the need of a new system of treatment, there stands fast, like a rocher de bronce, the old method of the Hebra school: Hebra ointment, tar, sulphur and soft soap (sapo viridis). Not that I mean to say, there has not been considerable progress made in the treatment of eczema since Hebra's time, quite the contrary; but despite such progress, the Hebra treatment in all essentials has maintained its position; it constitutes, as it were, the foundation upon which later improvements have been built up, without, however, rendering the foundation either unnecessary or superfluous. If, therefore, the progress which has been made in eczema treatment is to be rightly judged, we must go back to this foundation and get a clear idea of the principles upon which the Hebra treatment is based; and it is, of course, a matter of indifference, whether Hebra himself worked according to these principles, or whether he, our most genial clinical dermatologist, created the treatment, as a poet his song, without any theoretical speculations. At all events, I am unable to discover in Hebra's works any theoretical expositions on the point. Nevertheless, such are not to be dispensed with, if we wish to arrive at a proper understanding of the treatment of eczema. There are three principles underlying the treatment of eczema: 1. Removal of the irritation of the skin.-All inflammatory processes which have not yet brought about any considerable alteration in the histological structure of the skin, are again reduced to the normal (acute eczema). 2. Removal of the chronic inflammatory processes (which have led to deep-seated alterations in the histological structure) by means of a reducing agent (chronic eczema). 3. Destruction of the tissue-changes which do not return to the normal, either through removal of the irritation of the skin, or by means of a reducing agent (chronic eczema, obstinately complicated with acute, inflammatory outbursts). If we consider these three indications which come in question in the treatment of eczema, and the progress which has so far been made, we shall not only obtain a clear opinion of them, but also be able to judge their value in the treatment of eczema itself. 1. Indication of the removal of the irritation of the skin.For this indication we find Hebra employed: water dressings, dressings treated with ointment, and dusting with powder. An essential improvement has been the introduction of ointments, which, as is well known, were first recommended by Lassar; whilst the mulls treated with ointment, as proposed by Unna, have not been able to maintain a permanent position, and painting with gelatine, as recommended by Pick in the treatment of eczema, has been given up after a very short time. Ointment, as prototype of which I may cite Lassar's (zinc oxide 10, amyl 10, vasel. 20), protects the skin better, not only from external injuries, by reason of its very suitable consistency, but it is also far better adapted to absorb the secretions, so that the ointment treatment must be regarded as a great advance. Furthermore, the ointment is perfectly adapted for absorbing the medicaments in solid, soft or liquid form, so that it likewise forms an extremely convenient method of application for all medica ments. 2. The second indication, removal of chronic inflammatory alterations (inflammatory infiltrations), is effected, according to Hebra, essentially by means of tar, soft soap and also red or white precipitate-ointment. Strange to say, Hebra thinks little of sulphur in the treatment of eczema. To understand this, it is necessary to make a further division of "chronic eczema," under which we generally understand two altogether different conditions: 1. Acute eczema, which has persisted for a considerable time, and by frequent recurrences has caused chronic inflammatory infiltration of the skin, whereby the latter has become thick, red and swollen. 2. True chronic eczema, which from the commencement appears as red, scaly papulæ, and which is variously designated seborrheic, psoriatic, or parasitic eczema. Whereas the first group of eczemas is, it is true, but little, if at all, accessible to treatment with sulphur, the latter is one of the chief medicaments for the group of so-called "seborrheic " eczemas. Tar, on the contrary, has its domain in the first group of chronic eczemas. This is a distinguishing feature in the application of tar and sulphur, which should be clearly understood, since other medicaments in their action are grouped around these two remedies, and it is in this direction that much progress has been made in therapeutics. As tar, owing to both color and smell, is disagreeable to the patient, many attempts have been made to find a substitute, but without complete success. The derivatives of tar: phenol, naphthol, salicylic acid, greatly allay irritation, and in this respect render admirable service also in eczema, especially in a cooling ointment of the following composition: R Naphthol, Acid. Carbol., Acid. salicyl Lanolin, Vaselin. alb. amor., ..aa. 0.5-1.0 .aa. 30.0 Nevertheless, there is not the reducing action on the inflammatory infiltrated connective tissue. The same must be said of tumenol, which is likewise only a good palliative for the itching irritation. The experiments hitherto made with a view to improving the tar itself have also been but partially successful. The preparations from pit-coal tar, by their number alone, show that they have not fully met the reasonable demands made of them liquor carbonis detergens, liquor anthracis simplex, tinctura lithantracis (Leistikow), solutio lithantracis (Sack), liantral (Troplowitz). Recently, a really great advance in the purification of tar, and thus in the tar treatment, appears to have been made, Veith having succeeded in distilling both from pit-coal and wood tar, a colorless product, anthrasol (Knoll),* which, according to my observations (extending over a period of nine months), proves admirable in its purely tar effect. The absence of color is not only agreeable to the patient, but also no small advantage to the physician, since he can observe the action of the tar with much more exactitude, and can far more readily remark any irritation on the just commencing redness, not hidden by any brown color. *A. Sack, M.D., Ph.D., and H. Veith, Ph.D., Munchener Med. Wochenschrift, 1903, No. 18 Dr. Sack, Alleg. Medic. Centralzeitung, 1903, No. 44. Report of the Eighth Congress of the German Dermatological Society, Sarajevo. Monatshefte fur prakt. Dermatologie, Vol. 37, No. 9, p. 390. Dr. Veith, Therapie der Gegen wort, 1903, No. 2. Karl Hercheimer, M.D. (Senior Physician. Station for Skin Diseases, Municipal Hospital (Frankfort-on-Main). Deutsch. Medic. Wochenschrift, 1904, No. 5. With the second group of chronic eczemas (seborrheic and psoriatic), the therapeutic progress which has been made since Hebra, has been much more considerable; here pyrogallic acid and chrysarobin have made a triumphal entry. With them or their derivatives, especially eugallol, with its pronounced action, cures in these forms of eczema can be effected so quickly, that sulphur would appear to be altogether left in the shade. And yet sulphur cannot be altogether dispensed with: it works much slower and more quietly, but, on the other hand, it has not the disagreeable properties of the two new medicaments, viz., their poisonous character and tendency to slightly irritate. A special province remains for it, viz., that of seborrhea, pityriasis, acne. The following preparations exhibit essentially the action of sulphur: ichthyol, thiol, thiocol, but without having any essential advantages over sulphur itself, and thus not constituting any appreciable progress in the treatment. 3. The most difficult is the third indication, in which case Hebra has recommended liquor potassæ and soft soap. It is here generally a case of extremely irritating eczema, which has persisted for a long time, failing to give way under the ordinary treatment adopted for the removal of the inflammation, since the tissue-changes have already progressed too far. Even the reducing treatment with tar and its substitutes cannot here be usefully employed, as they are liable to cause further irritation. For this obstinate eczema, which is exceedingly difficult to treat, and in which the red, infiltrated, edematous skin usually exhibits numerous superficial or deep-rooted vesicles, running places and scurf, Hebra reserved as ultimum refugium liquor potassæ, with which in 30 per cent. solution he cauterized the whole of the eczematous surface, and thus simply destroy the, for the most part, altered and inflamed tissue. Such cauterization must be undertaken several times, at intervals of one week, before it is of any definite effect, as, even after the cauterization, new inflammatory outbreaks take place. One of the chief advantages to be noticed immediately after the cauterization is the disappearance of the tormenting itch, since the liquor potassæ destroys the covering of the vesicles, so that the inflammatory secretion can escape and run over the surface of the skin. Since this cauterization, however, is attended with no inconsiderable pain, Hebra, before having recourse to this extreme measure, first employed soapy ablutions, by means of which he likewise disturbed the covering of the vesicles, naturally without producing so intense a cauterizing action. So excellent the prescriptions of Hebra are in themselves, they have one drawback, which was acknowledged by him himself, viz., that the application is by no means easy, and that a |