The favorite sites for eczema are the flexure surfaces, but no area of the body is exempt. Itching or burning is always present, and is most intense in the papular type. Eczema in this country is the most frequent of all skin diseases, being about onethird of all cases.

The causes of eczema are at the present time regarded as being constitutional and external. Hebra and the Vienna school believed at first that eczema was a local condition, but later in his life Hebra changed his views, and accepted the constitutional causes which were made so prominent by the French school. While this view is generally accepted, and while the pathological changes have been carefully examined with the microscope, still the specific constitutional disturbances which cause these pathological changes and an eczematous eruption are questions of speculation. However, in a brief statement, the constitutional causes may be given as any general conditions, temporary or persistent, which interfere with proper nutrition and excretion, and bring about impaired vitality. Experience has taught that gouty and rheumatic subjects are especially liable to eczema, and that in these cases excessively acid urine and defective kidney action are very important factors. Digestive debility and constipation should be given high places as conditions leading to specific causes of eczema in both adults and children.

The External Causes of Eczema: Heat rays, extreme cold, sharp winds, soap and water, dye stuffs, chemical irritants, drugs and trade articles, should be regarded, in my opinion, only as exciting causes acting conjointly with a favorable constitutional condition. For instance, two women may wash clothes with the same soap and water, and one would have eczema on the hands and the other would not. It is true that there is a difference in their skins, but it is more probable that the general conditions were more favorable to eczema in one than in the other, and that the irritating effect of soap and water was all that was needed to excite the skin to an eczematous action, just as a hot bath sometimes causes the macular eruption of syphilis to appear.

Unna and others have attempted to show that eczema is

caused by micro-organisms; that they pass down through the epidermis and cause the inflammation and edema observed, but this notion has not been accepted, and at present the authors themselves have modified their views.

The treatment depends upon the cause. Eczema developed by external causes is relieved usually by withdrawing the cause and applying a bland protective dressing. The constitutional disturbance is not so great as to cause the eczematous process to continue. The general treatment as to drugs, diet, etc., in cases of much constitutional disturbances, must depend upon the judgment of the physician. The local treatment in all cases should depend upon the subjective and objective signs.

Itching or burning usually demands attention in local treatment, and carbolic acid, menthol, thymol, resorcin, salicylic acid, are the remedies usually adopted.

The objective signs indicate the extent of the pathological changes with which we have to deal, and enable us to select the remedy, its strength and method of application.

In the acute stages of eczema there is inflammation, slight exudation, with burning or itching, and to meet these conditions soothing applications are demanded, and I would prefer a cooling lotion, never heat; and the calamin zinc oxide lotion would be, as a rule, my first choice, dabbed on alone, or applied on wet cloth, laid on, and kept wet with the lotion. Carbolic acid, one or two grains to the ounce of liq. calcis, and sweet almond oil, equal parts, applied on a cloth, is also good. Boric acid lotion, or lotio nigra, applied and allowed to dry, and followed with zinc oxide in ung. aquae rosae, will agree with many acute cases. The idea is not to stimulate, but to cool the surface and allay the itching, and reduce the slight inflammatory process.

It is not the nature of true eczema to be pustular and ulcerative, but these conditions occur through infection, so, in the majority of cases, it is essential to apply some mild antiseptic in conjunction with the other remedies. This point should always be kept in view.

A case moderately inflammatory, with distinct infiltration in the corium and thickening of the epidermis, will probably need

slightly stimulating applications, but it is always advisable to begin the treatment with the mild applications used in the acute stage until the nature of the skin is ascertained, and later cautiously add the stimulants. These stimulants promote absorption of the serum (which was described in the pathology as being in great excess, and bathing and soaking the cells), restores the cells and tissues to normal activity and the formation of a healthy epidermis. Tar, resorcin, salicylic acid, ichthyol, and hydrarg. ammoniat. in ointments or solutions, are the stimulants to use. I would recommend, in many cases, the conjoint use of a lotion and ointment, while other cases would respond more rapidly to an ointment alone; for instance, a mixture of one or two drams of liq. carbonis detergens to one pint of calamin zinc oxide lotion, is one of the most reliable lotions; or boric acid lotion applied and followed with ammoniated mercury or tar ointment; or the ointment may be used alone.

In sluggish, inflammatory cases, with pronounced infiltration and epidermic thickening, the same remedies will be demanded in stronger preparations.

Thickly indurated and verrucous patches are to be reduced and thinned by the application of sapo viridis, caustic potash, and salicylic acid, in conjunction with the plans above mentioned. Water and soap act like poison in many cases of eczema.

A few weeks ago a gentleman of 61 years of age came under my care suffering with eczema of four years' duration. It was located on both legs, surrounding the lower third, on the fore arms, and in patches on the hands. The type on the legs and forearms was chiefly papulo-vesicular, but was papulo-squamous on the hands.

The eruption appeared during the summer. He received treatment at that time in New Orleans, and since has been treated by physicians in California, Michigan, and other States, but his trouble remains with him.

He complained of constipation. His urine was excessively acid. Otherwise his general condition was normal. I directed him to take Kutnow's Powder, and to drink more water, and change his diet to some extent. This was not sufficient to pro

duce good bowel action, and I ordered, in addition, cascara sagrada, ext. nux. vom. and belladonna, which acted well. At first I ordered an ointment of acidi carbolici gr. v., zinc oxide, dram I., ung. aquae rosae q. s. ounce I, to be applied to the affected parts, spread on absorbent cotton or cloth, and lightly bandaged; no water and soap to be used, but to cleanse with oil olivae, containing a little salicylic acid. This relieved the itching, and gave him comfort, but the healing was slow, which was really to be expected in a case of such long standing. I then ordered him to apply constantly calamin zinc oxide lotion on a wet cloth, and to keep his feet elevated as much as possible. This gave more satisfactory results, and within a short time the epidermis had taken on nearly a normal appearance, and the infiltration was greatly reduced. To the papulo-squamous lesions on the hands I applied pure liq. carbonic detergens with good results.

If time permitted more cases should be reported to furnish the details of treatment.

In this brief discussion I have only attempted to give the types of the disease and types of treatment. Eczema presents such a variety of clinical conditions (all the types in varying stages may be found in one case, and in addition pustulation and ulceration), that the successful treatment, constitutional and local, of many cases would demand a far wider practical view of the disease and of the detailed methods of treatment than here presented.

Abstracts.

HYDROGEN PEROXIDE.

HOW BREAKAGE OF BOTTLES CAN BE REDUCED

TO A MINIMUM.

The greatest obstacle that lies in the way of producing a sound container for liquids occluding gases under high pressure, as, for instance, solutions of hydrogen peroxide, is the fact that no process for making unbreakable glass has yet been discovered.

Up to the present, the ordinary amber glass bottles have been found totally inadequate and untrustworthy, though a device patented by Charles Marchand goes far towards overcoming this delinquency.

This device practically reduces the danger of bursting of the bottles to a minimum. As long as the bottles having this device are kept in stock standing up, the pressure resulting from shaking, high temperature in course of transit, etc., will not rise much above four or five pounds to the square inch; and, therefore, though occasionally a bottle may crack or burst, it is not due to pressure, but to the inherent imperfection of the glass arising either for a lack of homogeniety, or else imperfect annealing, or both, to which we have already referred.

The worst feature of this unreliability in the bottle is, that there is no way of detecting it. A bottle may be submitted to a pressure of a hundred pounds to the square inch, without betraying signs of weakness, yet even with nothing in it, it may burst or crack within an hour.

The only remedy in these conditions as to the bottles, and that is not absolute, is in changing the material from which the containers are made, and substituting for the unreliable amber glass, a good article of flint glass. While, as we have intimated, this does not absolutely remove the danger of loss by explosion or cracking, it greatly reduces it, and when the flint glass container is closed by Marchand's Safety Valve Stopper, danger is re