152 NINTH REPORT. 



cases was one in which a boil appeared on the anterior border of the left arm 

 pit and was fully developed when I first saw the patient, an adult man. In- 

 cision and careful antiseptic dressing were practiced, but in two days a second 

 boil appeared in the lower portion of the axilla, accompanied by enlargement 

 of several contiguous glands. In spite of careful surgical treatment the in- 

 fection of the glands had progressed until two had suppurated and been in- 

 cised; then a well developed axillary adenitis with the usual mass of tender, 

 indurated, confluent glands developed, and it was clear that the issue was a 

 total extirpation of the infected mass or intervention with an artificial auto- 

 inoculation. The first dose of a stock staphylococcus aureus opsonogen 

 brought the adenitis to a check and three glands progressed to suppuration, 

 l)ecame superficial, fluctuated, and were easilv evacuated. A second dose 

 after six days, this time of the autogenous aureus opsonogen, promoted the 

 resolution of the infected glands, and at the end of the second week when 

 the third and last dose was given the whole indurated mass had melted away 

 and a complete and perfect recovery was effected — all of this with the patient 

 reporting personally for treatment, and losing but three days in his employ- 

 ment. 



Staphylococcic Psoriasis. — Before dismissing this necessarily hurried ac- 

 count of staphylococcic infections I wish to recount one of my latest exper- 

 iences which is so remarkable in its results as to call for a special and de- 

 tailed account, although it comes in a group of results all of which are truly 

 astonishing judged by any previous therapeutic standard. I refer to a case 

 of what was designated by Dr. A. P. Biddle of Detroit, who had the woman 

 under treatment twelve of the eighteen months of the disease, as psoriasis, 

 but which the bacteriologic analysis showed to be a most extraordinary 

 staphylococcus dermatosis, and which one dermatologist has defined as a 

 seborrhoeic eczema. At the time I first saw the patient the disease involved 

 at least one-third of the entire cutaneous surface of the body, and was of so 

 aggravated a type as to make of her a physical and nervous wreck. The 

 immense confluent lesions on the arms, legs, breast, back, sides and buttocks 

 'were slightly raised above the unaffected skin, of a dull red color and cov- 

 ered with large, thick scales, remindidg one of a piece of plate gelatin. Each 

 night, and often twice daily, the woman annointed herself with olive oil and 

 went through the trying operation of pulling off the scales, which she as- 

 serted would cover a newspaper, and which often left bloody, denuded sur- 

 faces exposed. A constant sensation as of a recent burn was suffered, and 

 often an intolerable itching so that sleep of not more than hour's duration 

 had not been possible for months ; and with no relief during the day it is little 

 wonder that the victim was on the verge of complete collapse when I first 

 saw her. Movement of the arms or walking were most painful to her be- 

 cause of the cracking and erosion of the crusted limbs. Besides these con- 

 fluent areas there were numerous discrete lesions on the limbs, trunk, face 

 and scalp. The remaining skin was dry and harsh and did not perspire. 

 The hair was coarse, dry and lusterless. 



With the evident subacute inflammatory nature of the affection as a ray 

 of hope I excised completely with asceptic precautions, one of the discreet 

 lesions on the arm and placed it on glycerin agar. The next day I was 

 rewarded by a pure culture of the staphylococcus aureus against which I 

 found the patient's opsonic index low. An opsonogen from this culture was 

 at once prepared and inoculated. That same night the patient slept two 

 hours consecutively and the skin broke out in a mild perspiration. The 

 next day the burning abated at intervals and the itching lessened. At the 



