observing one which had just been taken from under the bark of the straw, through which there was no perforation over the fly, a small mite was observed crawling over the dead body of the fly. Placing the bodies of several flies under the microscope and using a 14-inch objective and a No. 5 eyepiece, it was found that on nearly all flies over which the bark was intact a small parasite could be detected, these mites varying in number from two to four mites to each fly. Upon furthering the observations it was found that the dermatitis lasted after the flies had been observed and exterminated.

The following experiments were carried out to prove whether it be the fly or the parasite that was the etiologic factor in producing the derma

titis:

Six live flies were taken, upon which no parasites could be found; these were placed under a watch glass and bound upon the right arm, leaving them in contact with the skin for three hours. Upon the left arm four dead flies, on which living parasites had been observed, were placed under a watch glass and left in contact with the skin for three hours, after which the glasses were removed and results awaited. The right arm showed nothing. Upon the left arm there appeared within twelve hours four small wheals, the character and evolution of which are later discussed. To further the experiments, some fresh lesions of patients were scraped and the scrapings examined microscopically and two of the mites were found in the scrapings.

Symptoms.-Itching is the most prevalent and first symptom to attract the attention of the patient. It is most persistent and intense during the after part of the night. At about the time the itching is most intense there appears an urticarial eruption, accompanied, in severe cases, with general systemic symptoms, such as rise of temperature from 99 to 102; in one case the temperature rose to 103.8; the pulse rate is accelerated to 100, or as high as 119, in one case to 130. Intense headache, anorexia, nausea, in some cases vomiting, and a mild form of diarrhea. In severe cases some complain of general joint pains and backache; in these cases the urine was examined and albumin in small amount was found, but no casts or blood. When the acute symptoms disappeared so did the albumin.

Many patients who suffer from mild cases complain of nothing aside from the intense itching. If all straw is removed from the beds and house the symptoms will subside in one or two days and completely disappear in a few days more.

The Eruption.-If the term urticaria be used, the lesions may be divided into the following classes:

1. Urticaria papulosa

2. Urticaria vesiculosa
3. Urticaria pustulosa

4. Diffuse urticarial erythema

The third class of cases may be confused with varicella.

The lesion which is typical of the disease is the urticaria vesiculosa. The urticarial lesion varies in size from that of a split pea to a penny; it is surrounded by a pinkish halo, varying in intensity of color from a pale pink to a most bright pink. The "hive"-like lesion is at first blanched, but later becomes a rose-red color. It

is elevated about 1 or 2 mm. above the skin surface, and is surmounted by a small vesicle containing a whitish fluid, marking the place of inoculation. The vesicle is about 1 or 2 mm. in diameter and elevated about 3 mm. above the surface of the urticarial lesion.

As the lesion grows old it goes through a process of evolution: (1) it is blanched and a central vesicle; (2) it is rose-red and the vesicle may become a pustule; (3) it generally recedes to the skin level with scab formation, due to scratching; (4) it leaves a brownish or greenish-yellow or purple spot on the skin surface. In debilitated patients the markings look not unlike faded indelible pencil marks. (This was noted in a patient suffering from pulmonary tuberculosis.) These discolorations may last for several weeks.

The anatomical location of the lesions is generally the back, sides and abdomen, and less frequently the arms and legs. The neck has very few lesions; the face, hands and feet have very few or none.

The number of lesions depends upon the number of parasites, ranging in number from very few to thousands; in some cases the back and abdomen have been almost a solid mass of lesions -new lesions on the top of old lesions, so having lesions in all stages of development.

The pathology of the disease can probably be explained by a toxic substance being injected into the skin by the pediculoides.

DIAGNOSIS

1. History of persons coming in personal contact with straw, either in mattresses, under carpets or handling it, or by individuals contaminated with the parasite; this straw must be infested with the Pediculoides ventricosus.

2. Hive-like wheals surmounted with a small whitish vesicle and surrounded with a pinkish halo, the lesions being more abundant upon the back, sides and abdomen.

3. The finding of the Pediculoides ventricosus in the scraping of fresh lesions.

4. In severe cases, malaise, anorexia, general joint pains and backache, nausea, sometimes vomiting and enlargement of the superficial lymph glands, all of which are in direct proportion to the number of lesions.

Differential Diagnosis.—Urticaria, the erythemas, scabies, varicella and in rare instances variola.

Complications. The most frequent complication is a pruritis; the next is probably a dry eczema. Several cases of acute weeping eczema have been noted. Local abscesses may develop, due to secondary infection inoculated by the patient scratching.

TREATMENT

I. Prophylaxis.-1. By discarding the use of straw containing the larvae of the wheat straw

worm.

2. By thoroughly disinfecting the straw mattresses and straw in use by subjecting it to steam or strong sulphur fumes in a tightly closed roomfor ten hours. Formaldehyd may be used for the same purpose.

3. If possible, by the eradication of the wheat straw worm by burning of the stubble and rotation of crops, but this cannot always be done.

II. Medicinal Treatment. 1. Medicinal treatment is useless unless the cause is removed. All cases will recover in a few days if the cause is removed.

2. Where the wheals are fresh and the itching is intense, a great amount of comfort can be obtained by prescribing the alkaline bath, which helps to neutralize the toxic substance of the bite, which is probably highly acid. The alkaline bath is made by the following method:

To six gallons of water placed in a tub, dissolve one of the following:

Skin grafting within and about the orbit. presents at times some difficulties which it is almost impossible to overcome. The irregularity of surface about the canthi and the inaccessibility as well as mobility of the stump after enucleation are obstacles which have taxed the ingenuity of the most skillful to overcome.

To accurately fit and retain in position the thin epithelial graft used to cover the denuded surface is frequently difficult to accomplish. In the hands of the writer the following method has given almost uniformly good results. Over the part to be covered, whether within or without the orbit, is laid a piece of sterile gutta percha tissue and an exact pattern made of this surface by the use of small scissors. This pattern is now removed and laid aside for future use. Next a piece of gutta percha tissue two or three inches square (for convenience of handling) is laid in a bowl of normal salt solution. The Thiersch graft is cut in the usual way but is allowed to remain upon the razor blade and transferred directly to the gutta percha tissue. To affect this the tissue. is removed from the salt solution and spread evenly on a sterile towel. The upper surface of this tissue must be kept quite moist to facilitate the even application of the graft. The razor blade carrying the graft is dipped gently into the normal salt to loosen the adhesion between them preparatory to the next step. The graft is now applied, raw surface up, to the tissue by holding the edge with a small spatula and gradually drawing the razor backward and dislodging it. The

spatula is now brought into play and all wrinkles carefully smoothed. Should any difficulty be experienced a few drops of water sufficient to float the graft may be dropped upon its surface. The gutta percha tissue should now be lifted slowly by taking hold of one end and the excess of water on its surface allowed to drain away slowly. This will cause the graft to become intimately adherent to the surface of the tissue and permit handling without any fear of wrinkling or dislodgment. With a pair of small and sharp scissors the tissue and the adherent graft are cut at the same time to correspond to the size and shape of the pattern previously described. In case great accuracy is demanded the pattern may be placed beneath the tissue while this shaping is proceeding. The graft thus shaped, together with its companion piece of gutta percha, is now placed face down upon the surface to be covered and pressed into place with the spatula or any convenient instrument. Here the two may be left in contact or if desired the tissue may be removed by gently insinuating the edge of a spatula. It is surprising to see with what ease this may be done even in the deep recesses of the orbital cavity. In case of skin grafting within the orbit the writer has tried all the accepted methods but finds the following to give the best results in his hands. After the graft has been forced into position the gutta percha is allowed to remain and form a smooth surface between the graft and the retentive apparatus without danger of disturbing the raw surfaces. A splint is now formed by tak

FOLLOWING close after the report of the Carnegie Foundation concerning the low standard and general inefficiency of some of the Chicago medical colleges come exposures by Chicago daily papers concerning the manner in which many medical stúdents have obtained their credentials for entrance to medical schools. It seems to be conclusively proven that any person, whether possessing educational qualifications or not, has been able to buy a certificate, signed by a principal of a high school, stating that the owner is duly qualified in educational requirements to enter medical colleges demanding a high school education as a requirement for admission. This exposure, together with the evidence which warranted the Carnegie Foundation in intimating that certain Chicago medical colleges are associated with the State Board of Health in fraudulently turning out and licensing doctors, shows

ing a piece of "white wax" as found in the shops, but which I am informed is a mixture of wax and paraffin, dropping it into a vessel of hot (not boiling) water until thoroughly softened, then molding it roughly into the shape of a large almond and dropping it into cold water to harden. This should now be trimmed and shaped by a knife to fit the orbit. In my own cases I have made the lower edge rather sharper than the upper to provide a sufficiently deep sulcus for the retention of the artificial eye. This splint is now again dipped quickly into quite hot water to soften the surface only, which is now smoothed and polished by the naked fingers to get rid of rough places which might tend to detach the graft. After being hardened by being plunged into cold water it is inserted. A pad and light bandage is applied over both eyes for two days. Each day the eye is dressed by removing pad and gently washing the edges of the lids and allowing some of the normal salt solution to flow into the orbit, but without removing the splint. On the third day the splint is removed but the gutta percha tissue is not disturbed, and the eye irrigated with normal salt and the splint re-inserted. This is repeated daily until the fifth day, when the gutta percha is removed and the splint permitted to rest in direct contact with the skin. The patient is then instructed to take care of the eye himself by removing the splint daily and irrigating with sterile normal salt. The splint is to be worn day and night for three weeks and then the artificial eye inserted.

that the whole system of medical education and licensure in Illinois is rotten and that it is time for a house cleaning.

It is reported that the governor of Illinois, when asked to remove the secretary of the State Board of Health for inefficiency and questionable practices, said that it was not politic for him to do so because the secretary had too much influence with members of the legislature. If the daily papers of Chicago keep up the editorially pungent criticism of the political system which permits the existence of a traffic in medical diplomas and high school certificates it may be possible that the governor of Illinois will find it politic to change his attitude. Chicago should wipe out of existence the medical diploma mills, and one of the first steps in the purification process is to secure a new state board of health.

At all events,