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WITHIN the past few years so many important contributions have been made in the field of radiation physiology that one need hardly apologize for the sketchiness of any short paper intended to summarize the state of affairs. In the discussion which follows there are sure to be regrettable omissions and instances of misplaced emphasis. Fortunately, in addition to the hundreds of papers reporting original research work, there have been some excellent reviews. Especially easy of access is the chapter on the physiological effects of radiant energy by Shields Warren 1 in the Annual Reviews of Physiology for 1945, which gives an excellent idea of the state of our information in that year. There is a comparable article in the Annual Reviews of Physiology for 1950 by Abraham Edelmann. 2 These two reviews have been invaluable in the preparation of this paper. Both afford keys not only to original reports but

During the course of management of subsiding acute and subacute dermatoses and dermatitides need has been felt for a paste which could be removed with water rather than with oil. It seemed especially desirable for use between wet dressings and soaks in fairly acute eruptions, for which a lotion was considered too drying. It is probable that such a preparation has already been described, but a review of many of the popular dermatologic texts and peridoicals has not shown this. In this investigation a number of water-soluble vehicles were tried, but the combination which has functioned most satisfactorily as a paste and which still can be removed by warm or cool water or solution is the following: The proportion of emulsion base can be increased or decreased if an alteration of the consistency is desired. Haldane's emulsion base is a pleasant, creamy white water-washable base, produced by several manufacturing pharmacists.

IN A PREVIOUS paper 1 we made observations on the thresholds of various types of injury to the skin by varying the intensity of a stimulant while keeping constant the site, skin temperature, and blood flow. In the present paper we wish to report on some factors determining the type and severity of reaction, when the injury is to a fixed degree of heat. Clinically, it seems that injuries tend to heal at unequal rates at various sites, an impression we here put to experimental test. We also have examined some factors likely to be responsible. METHOD As in our previous work, we used the Guillemin instrument 1 designed for heat conduction by an electrode with a face of 25 sq. mm. and simultaneous indication of temperature and electrical energy necessary to obtain and maintain any given temperature. The subjects were normal volunteers and patients in bed with various

BROCQ, 1 in 1898, described this condition minutely, named it, and outlined his treatment. His masterly description has not been improved to this day. In 1915, Adamson 2 drew attention in the English literature to Brocq's work and placed this disease in a classification. In Volume 1 of theArchives of Dermatology and Syphilology, two papers are devoted to "Neurotic Excoriations." In one, Pusey and Senear 3 discuss Adamson's paper very completely and mention the fact that scant attention has been paid to this subject in the American literature. In the paper by MacKee, 4 Cases 5 and 6 which he presents were probably excoriated acne and not neurotic excoriations, judging from his description of the disease and the excellent response to therapy. Following these papers, there is a paucity of reports on this disease. Excoriated acne is described in most of the standard dermatological textbooks published in England

IN A PREVIOUS paper 1 I described the way in which the experimental incubation of staphylococci on the skin gave rise to a variety of poral lesions which, in the case of the sweat pores, resembled bullous impetigo and miliaria rubra. Brief mention was made of the fact that these same experiments gave rise to follicular lesions, namely, follicular impetigo (Bockhart), acneform pustules, and abortive furunculosis. 2 My purpose in this paper is to describe and discuss these follicular lesions in more detail. PROCEDURE Staphylococci grow abundantly on nutrient agar containing 8% by weight of sodium chloride ("salt agar"), whereas bacteria of most other genera are inhibited or destroyed. 3 This selective property of salt agar was used to induce pure staphylococcal infection of the skin in the following manner. (Fuller details are given in the earlier paper. 1 ) Nine normal volunteers were selected, and to each

IN A PREVIOUS paper 1 it was reported that incubation of pure cultures made from thin saline suspensions on Levine eosin-methylene blue agar containing 0.1 mg. of aureomycin per cubic centimeter at 37 C. in 10% CO 2 makes it possible to distinguish Candida albicans from other related species within 18 hours. In the present paper, a similarly rapid identification of this fungus in cultures made directly from samples of human clinical materials is described. The effects of incubating such cultures in air and in CO 2 are compared. The 114 specimens used in this study were made from feces, mouth and vaginal secretions, skin, and nail scrapings collected in the clinic from 54 patients with suspected moniliasis or undergoing treatment for or after recovery from proved moniliasis. In many instances materials for culture were taken from several areas of the same patient on the same day. Two samples were

SINCE 1943, when Mahoney, Arnold and Harris first reported on the use of penicillin in the treatment of syphilis, many excellent papers have been presented dealing with the efficacy of various dosage schedules in the different manifestations of the disease. It is not our purpose in this discussion to add to these reports but rather to present information concerning a problem in the management of syphilis in northern Alberta and the manner in which it is being attacked. The syphilis rate amongst the white population in this province has recently been extremely low, varying from 0.7 per 1,000 in 1945 to a present rate of 0.3 per 1,000. Two spot surveys, one in 1921 and one in 1935, had disclosed no evidence of syphilis in the population of northern Alberta in excess of that in the inhabitants of the province as a whole. However, during the early days of World

TO THOSE of us living in that uneasy middle generation, forbidden to be modern and reluctant to be mellow, there is a growing feeling of guilt that we are in part responsible for what appears to be the inadequate training of the undergraduate student in the specialties of medicine. There is then, understandably, a great desire among us to reevaluate our concepts and our goals in the light of that some have been pleased to call "the changing order." Nowhere among the medical specialties is this desire greater than among the dermatologists, as witnessed by the discussions of Wile, 1 Cole, 2 Stokes, 3 Lane, 4 Cipollaro, 5 and those engaged in the organization and operation of the American Board of Dermatology and Syphilology. Within the many papers on medical education there is abundant evidence of a growing dissatisfaction with existing methods of instruction. * On the other hand, there

WHILE sarcoidosis has been receiving increasing attention in medical literature, there is still no agreement concerning its cause. It is the purpose of this paper to discuss some of the etiologic and immunologic concepts which have been advanced, in order to see what evidence there is for and against the various theories. By sarcoidosis is meant the systematized condition which goes under a variety of names, of which the three most prevalently used are Besnier-Boeck-Schaumann disease, lymphogranulomatosis benigna, and sarcoidosis. A local sarcoid reaction or sarcoid tubercle can arise as a result of a variety of stimuli and will not be further considered in this discussion except as a part of a systematized sarcoidosis. The major theories concerning the causation of sarcoidosis are the following: A. It is not an etiologic entity but can be caused by a variety of infectious agents, among them the tubercle bacillus, the spirochete of syphilis, the bacillus of leprosy, and others.

THE SUMMER of 1952 was a record year for elevated temperature and increased humidity. As a result of this climatic record, we observed an unusual increase in the cases of miliaria and its unusual complications. While prickly heat, or "heat rash," is generally recognized as a trivial dermatosis, actually it is occasionally accompanied or followed by dangerous sequelae and discomforting complications. Grulee and Rose1state the case: "While it does not lead to death, it certainly does prolong the state of malnutrition, and indirectly may cause a certain amount of infant mortality." Accordingly, this paper proposes to discuss briefly miliaria and two of its complications, namely: (1) the usual case of miliaria; (2) the moderately severe type of miliaria, and (3) severe complications of miliaria, namely periporitis staphylogenes, misnamed furunculosis, impetigo contagiosa, or pemphigus neonatorum. INCIDENCE Miliaria, in the hospital nursery and at the home, is

PATIENTS with therapeutically resistant acne vulgaris are still commonly seen. Occasional patients fail to show adequate response in spite of intensive treatment with dietary restrictions, local agents, removal of infectious foci, roentgen therapy, comedone expression, endocrinologic agents, vaccine therapy, and other acceptable remedies. Clinically, it has been shown that the administration of one of the sulfonamides or an antibiotic may cause decided improvement in some instances of pustular acne. 1 The decision as to which of these therapeutic agents the clinician should try first becomes rather significant. In an attempt to answer this problem, two of the methods for carrying out in vitro sensitivity studies have been utilized comparatively in this investigation. One of these is designated the paper disc method and technically is easily performed. The other method consists of tube serial dilution tests and involves considerably more time and effort in its execution. Only patients with the pustular

THE PROTEAN nature of infections due to the virus of herpes simplex has been repeatedly emphasized, and unusual clinical manifestations caused by this virus are being recorded with increasing frequency. 1 Herpes simplex infections occurring on the fingers or forearms, however, have been described only rarely, and their association with lymphangitis is even more unusal. 2 Furthermore, actual identification of the virus has been accomplished only in occasional instances. It is the purpose of this paper to report on two patients with recurrent herpes simplex infections on the fingers and one patient with recurrent herpes simplex infection on the forearm, in which lymphangitis was a prominent feature. Herpes simplex virus was isolated and identified from two of these patients. Virus studies were not attempted in the third case. METHODS OF VIRUS ISOLATION AND IDENTIFICATION The method followed in these cases for the identification of herpes simplex virus has been

Very often the diagnosis is made of "ringworm," "athlete's foot," dermatophytosis, etc., without the corroboration of a microscopic demonstration of the fungi assumed to be present. Conversely, many cases of fungous infection are undiagnosed because direct examinations are not made. This situation is attributable in part to the physician's inability or unwillingness to perform the requisite examination. Anything which makes this procedure more simple and convenient might induce more physicians to get into the habit of performing microscopic examinations for fungi. It is with this thought in mind that a simple modification of the usual technic is presented. The usual method of doing a direct examination for fungi consists in swabbing the skin with alcohol, scraping the suspected lesion with a scalpel, catching the scales on a glass slide (or on paper, and then placing the scales on a slide), adding a drop or two of potassium hydroxide solution

THE PURPOSE of this paper is to present observations suggesting that heparin possesses the ability to induce a remission in pemphigus. This disease, of unknown etiology, was first described in medical writings of the 17th century. Prior to that time there were no descriptions of disease states which might be interpreted as consistent with it. 1 At present four varieties of pemphigus are recognized: pemphigus vulgaris, the common form of the disease; pemphigus foliaceus; pemphigus vegetans, and erythematoid benign pemphigus (Senear-Usher syndrome). The acute pemphigus of butchers is now considered to be a fulminating rapidly fatal bacteremia, while pemphigus neonatorum is considered to be bullous impetigo. Pemphigus vulgaris is characterized by the development of successive crops of bullae, irregularly bilateral in distribution, usually erupting on normal-appearing skin or mucous membranes. At first the bullae contain clear serous fluid and are not surrounded by an inflammatory areola but later (24 hr.

Dermatitis due to nail lacquer is fairly common. A case was reported by Miller and Taussig in 1925 1 and in 1941 Osborne, Jordon and Campbell 2 analyzed a large series. They mentioned the commercial use of identical lacquers for coating such articles as leather hand-bags, purses, belts, glass beads, wooden and metal jewelry, hairpins, cigaret cases, vanity cases, pens, pencils, broom handles, buttons, straw hats and playing cards. The dermatitis is of the erythematosquamous variety, the upper eyelids, chin, front of the neck and ears being commonly involved, and occasionally the anogenital areas. Thus nail lacquer is an occasional cause of pruritus vulvae. In discussing the paper of Osborne and associates Dr. Ralph Hopkins mentioned the case of a woman who had used nail lacquer to "revive" an old set of earrings; dermatitis of the face and ear lobes had followed. Lacquers of various shades as well as clear

Recurrent erysipelas-like manifestations of the legs and their relationship to fungus infections have been thoroughly discussed and investigated. 1 McGlasson's la article focused attention on the phenomenon and its bacterial etiology. Sulzberger and associates, 1b Traub and Tolmach, 1c Waisman, 1f and Reiss 1g advanced the concept that some of the cases represent dermatophytids. The purpose of this paper is to focus attention on the ineffectiveness of antibiotics and to reemphasize the importance of fungicidal measures when the cause is mycotic. Reference to the use of antibiotics in active or prophylactic therapy of this condition has not been found. REPORT OF CASE Present Illness .—W. S., a 24-year-old white man, was admitted to Osaka Army Hospital on Feb. 1, 1952, with a diagnosis of recurrent cellulitis of the right leg. Approximately two hours before admission, the patient, who was well and at work, suddenly experienced a sharp chill followed by

ALTHOUGH cretinism is primarily a problem of endocrinology, hypothyroidism developing early in life produces a number of physical, physiologic, and pharmacologic changes of interest to the dermatologist. Many of these abnormalities respond promptly to thyroid therapy, but others apparently involve degenerative changes and are permanent in character. The material on which this paper is based consisted of eight sporadic cretins, two goitrous cretins, and four cases of childhood myxedema. In keeping with the usual sexual distribution, 11 patients were females and 3 males. Our youngest patient was 8 years old; the oldest was 47. Although 13 of the patients were white, with various European origins, the 14th was a Negro. All of the white patients were born in eastern Pennsylvania; the Negro girl was a native of South Carolina. Mentally, two were morons, five were imbeciles, and seven were idiots. All were patients at the Pennhurst State School for

IN TWO recent papers the entity of lymphocytoma of the skin was discussed for the first time in the American dermatologic literature.1The disease has been recognized for many years, however, both as lymphocytoma and as Spiegler-Fendt sarcoid, as reported by Lewis2and others. In 1943 the subject was comprehensively reviewed in a monograph by Bafverstedt.3This author, like Lewis, distinguished two clinical types: the isolated or regionally localized type, and the multiple disseminated type. Clinically, lymphocytoma presents a variable picture, with lesions usually on the face, characterized by small size, slow growth, absence or paucity of subjective symptoms, and no intrusion of cancerous change. Histologically, the lesions consist of a highly differentiated lymphoid tissue, with or without germinal centers. Pursuing a benign course, they may persist indefinitely or they may disappear spontaneously. As a rule they exhibit marked sensitivity to roentgen irradiation. The following case is

THE PRIMARY purpose of this paper is to present features of epithelioma adenoides cysticum which have not usually received adequate attention from dermatologists. From the earliest articles by Brooke 1 and others, 2 through that by Savatard 3 down to the most recent reports, the congenital defects associated with this disease have not been commented on or have received only brief mention. Recently we had the opportunity to observe a patient with lesions of epithelioma adenoides cysticum who also presented other developmental anomalies constituting a bizarre clinical picture. In addition to the cutaneous lesions there were partial agenesis of the corpus callosum (discovered at autopsy) and multiple dental follicular cysts. The latter proved to be the most serious condition, for a fibrosarcoma of the mandible appeared and metastases caused the patient's death. The patient also had mesodermal anomalies consisting of a bifid sixth rib and a fibroma of the ovary.

SOME will accept, some reject the following ideas, but most persons will reflect upon them and give them further thought. That is enough. During the last seven years much literature has accumulated on the treatment of early syphilis with penicillin. Generally speaking, the total dosage of penicillin has varied from a minimum of 300,000 units to a maximum of 10,000,000 units per patient. Published cumulative failure rates have varied from a minimum of 4 or 5% to a maximum of 50%. Practically all published data on failure rates have included cures listed as failures. Much stress has been placed by noted authorities on an intrinsic over-all failure rate of about 20% in the treatment of early syphilis with penicillin. With this conclusion, I am in complete disagreement, I contend that the failure rate is entirely too high. The purpose of this paper is to point out that the

ALTHOUGH nevi have been the subject of a great many papers, much interest, and many philosophical arguments since the earliest days of medicine, it appears that there are still "new" nevi which have escaped detection and description in the past. I have recently studied a singular case of the nevus-unius-lateralis type which proved to be a systematized basal-cell nevus. REPORT OF CASE O. J., a 69-year-old white man, was seen in the department of dermatology and syphilology of the University Hospitals on May 16, 1951, on referral from the department of surgery, where he was being treated for an adenocarcinoma of the colon. He was a small, emaciated man with a marked congenital dorsal scoliosis and peculiar smooth growths on the skin of the left side of the body, also present since birth. Examination of the skin showed bands of varying width on the left side of the chest

ANGIOKERATOMA corporis diffusum is only rarely described in the usual textbooks. This is not surprising, since only about 20 characteristic cases of angiokeratoma corporis diffusum have been observed since its first description in 1898. However, it would be wrong to consider this skin condition a dermatological curiosity. Investigations during the past few years have shown that in all probability this cutaneous anomaly will have to be considered as a sign of an internal disease unknown so far. It is by no means inconceivable that the rarity of angiokeratoma corporis diffusum (as far as I know, no case has yet been described in America) is due to the fact that remarkably few dermatologists seem to be familiar with this condition. The purpose of this paper is to draw attention once more to the skin disorder concerned. At the same time, a description of the internal anomalies which have recently been

THE USES of rubber have increased enormously since Goodyear, as the legend goes, tossed a piece of the raw material on a hot stove and was astounded at the bouncing result. By now rubber is indispensable for modern living and comfort, but, like many another invaluable thing, it has some hazards. One of these is its capacity to sensitize the human skin sometimes and then to provoke eczematous eruptions upon subsequent contact. Many sporadic cases of allergic eczematous contact-type dermatitis from rubber products and even some fairly large series of cases have been reported in the past. 1 The reasons for publishing this paper on the subject are as follows: 1. It seems to us that the absolute number of cases of sensitivity to rubber materials and of eruptions from them is growing huge. 2. So large a series as this is instructive of the variety of uses of rubber

GYNECOMASTIA is known to occur in conjunction with a variety of diseases, including testicular tumor, hepatic cirrhosis and hepatitis, bronchogenic carcinoma, lung abscess, carcinoma of the adrenal cortex, transverse myelitis, hyperthyroidism, and chronic ulcerative colitis. 1 In addition, gynecomastia is a common manifestation of puberty and starvation, and it can be produced by the administration of certain hormones, including estradiol, diethylstilbestrol (Stilbestrol), methyltestosterone, desoxycorticosterone acetate, adrenal cortex extract, and chorionic gonadotropin. 2 The purpose of this paper is (a) to report seven patients in whom gynecomastia developed in conjunction with generalized dermatologic disorders, (b) to discuss briefly the etiology of gynecomastia, and (c) to consider the significance of gynecomastia when it occurs in association with generalized cutaneous diseases. REPORT OF CASES Case1.— Generalized Atopic Dermatitis This patient, a white man, had atopic dermatitis during the summer months only when between the ages of 9 and

The purpose of this paper is to illustrate, by means of high-magnification photomicrographs, the characteristic type of cell found in lesions of a case of Kaposi's sarcoma (idiopathic multiple hemorrhagic sarcoma) and thus to attempt to throw some light on the controversial subject of the cell origin of this disease. We also wish to report the effect of cortisone and corticotropin (ACTH) on the clinical course in this case of Kaposi's sarcoma. REPORT OF A CASE J. I., a 71-year-old Italian man, was admitted to the Jewish Hospital of Brooklyn on Nov. 24, 1951, with complaints of swelling, itching, and inflammation of the legs of several years' duration. Twelve years previously, a small, itchy, purple-red papule appeared on the dorsum of the left ankle. This remained unchanged until four years later, when a number of small similar lesions appeared in the same area, with simultaneous increase in size of the

THIS PAPER reports the effect of roentgen rays on Microsporum audouini, under experimental conditions approximating those presented in a previous study on Microsporum canis. 1 The pertinent literature was cited in the latter publication. MATERIALS AND METHODS Two freshly isolated strains (JC and HM) were used. Six subcultures were prepared of each strain, two of which were irradiated on the day of inoculation; two seven days after inoculation, and two remained untreated to serve as controls. The irradiation was given through the glass wall of the medium container (½ oz. [15 cc.] perfume bottles), the filtration value of which was not known. Following are the technical data: Bracke-Seib Dermatron; two-valve tube rectification; Eureka tube type 13-; 85 kv.; 5 ma.; 25 cm. distance; 3 minutes 25 seconds; 340 r unfiltered. Three successive transplants from the irradiated colonies and their controls were prepared at intervals of three weeks. The

XANTHELASMA is generally considered to be the commonest external manifestation of essential hypercholesteremic xanthomatosis 1 (familial hypercholesteremia 2 ). Major interest in the xanthomatous lesions centers about their importance with respect to the presence or development of atherosclerotic vascular disease. The purpose of this paper is to report observations of 35 patients with xanthelasma, obtained mainly from the private dermatologic practice of one of us (N. N. E.). It was felt of particular importance to study the serum of such patients with respect to lipoproteins which appear to be in some way associated with atherosclerosis. METHODS The clinical status of these patients was carefully investigated and was supplemented by electrocardiograms and by the thymol turbidity and sulfobromophthalein (bromsulphalein®) sodium tests of liver function. All patients with nonxanthomatous abnormalities known to be associated with a disturbed cholesterol metabolism were excluded. Particular attention was given to the possible presence of manifest arteriosclerotic cardiovascular disease. Quantitative analysis of

DERMATITIS due to materials used in the manufacture of shoes has been reported from time to time. Burgess 1 reported four cases due to leather, canvas or fabrikoid® linings. Shaw 2 reported 22 cases due to such things as tanning chemicals, antimildew compounds, polishes and dyes. Gaul and Underwood 3 recently reported cases due to a wide variety of materials employed in the manufacture of shoes, and Robins 4 recorded cases of dermatitis due to substances used in shoes. No one has, however, stressed the importance of resinous linings as a cause of contact dermatitis. Perhaps the reason is that until recently artificial leathers were simple cellulose nitrate-coated materials. Since World War II a diverse number of resins have been employed as partial linings, particularly in women's shoes. The purpose of this paper is to indicate the importance of synthetic resins used as partial linings in

IN A PREVIOUS paper1we reported the effects of an artificially applied stress situation on the "alarm reaction" response of persons with the skin component of the eczema-asthma-hay-fever complex (atopic dermatitis). While the number of patients studied was small, there were definite indications of an abnormal response, as measured by the eosinopenic index and changes in the lymphocyteneutrophile ratio. Our results supported Selye's concept2that the allergic or atopic diathesis should be included in the so-called diseases of adaptation. This concept holds that these diseases may depend largely upon a derangement of the pituitary-adrenocortical response to stress, and, further, that as for "triggering" the alarm reaction, there is little or no difference between physical and psychic or emotional stress. In this paper we are reporting a continuation of our previous studies. Both our control and experimental groups have been considerably expanded. The alarm-reaction response, as

THIS REVIEW began initially 18 months ago shortly after I arrived in Brazil, the land of fogo selvagem, pinta, and South American blastomycosis. It quickly became evident that the majority of Brazilian medical writing on these subjects was in Portuguese, and a comprehensive knowledge of Brazilian Portuguese was necessary. After one year of study of the language and residence in Brazil I felt secure enough to embark on a study of fogo selvagem, a curious endemic bullous disease. I discovered that the works of Vieira, Orsini de Castro, and others were masterpieces. One could say, "Let's have all of them translated into English"; my reply is, "Who would or could finance it?" Joao Paulo Vieira has written some excellent reviews of pemphigus foliaceus, and if the writings of any one author should be translated into English it should be his papers on the subject. However, none of his writings, to my knowledge, has appeared in English since a translation of

THE IDEA of using procaine hydrochloride for the treatment of allergic conditions is not new. The drug has been used intravenously, with success in many cases, in the treatment of pruritus, 1 status asthmaticus 2 and serum sickness 3 for several years. A recent paper 4 briefly discusses the oral use of a procaine salt in the treatment of bronchial asthma in a person known to be sensitive to the drug when it is given parenterally. This communication is a preliminary report concerning the use of procaine hydrochloride with ascorbic acid by mouth in the treatment of various disorders, many of which have an allergic background. The pertinent data on 10 cases are presented in the accompanying table. Three representative case records are given below. REPORT OF CASES Case 6.— The patient was a white female nurse, aged 22, who sustained a laceration with a contusion of the left hand from

In recent years the busy dermatologist wishing to photograph clinical material in his office or clinic has often turned to a number of supposedly automatic and foolproof camera assemblies designed to eliminate the need for calculation of any kind on the part of the operator. The unsatisfactory materials with which so many dermatologic speakers and writers attempt to illustrate their work attests clearly to the inadequacy of any "automatic" device within the means of the average physician. There are several simple methods used by professional photographers which will prove far more satisfactory, both in cost of equipment and in final results. The purpose of this paper is to outline one such procedure, a technic known as "open flash," which is suitable for both black and white and color photography, produces excellent results with a minimum of equipment, and can easily be employed by the dermatologist as an office procedure. Open

The purpose of this paper is to report another case of Weber-Christian disease and to present what we believe to be the second case reported in a Negro.1In addition, the unusual feature previously reported2of progressive necrosis of the pannicula adiposa leading to spontaneous rupture and drainage of the subcutaneous nodules was also observed. Weber-Christian disease is of unknown origin, and it is not the purpose of this report to discuss the controversial theories as to its cause.3However, the sudden and often explosive character of the appearance of these nodules makes one postulate an allergic mechanism. Pfeiffer first described this condition in 1892, and Weber3elater reported a case in which he labeled the condition relapsing nonsuppurative nodular panniculitis. In 1928 Christian,4in his report of the third case, suggested adding "febrile" to Weber's definition. Since then it has been referred to as

SHORTLY after Roentgen discovered the rays which bear his name there appeared reports in the medical literature regarding the development of carcinoma as a consequence of radiodermatitis. With rare exceptions these reports have brought out a thought which has become almost accepted as a fact, namely, that such carcinomas are always prickle cell in type. It is the purpose of this paper to show that such carcinomas are not invariably of the prickle cell variety. In doing this we will summarize a few reports from the literature and report a number of cases in which the ensuing carcinomas were basal cell in character. HISTORICAL DATA Wilhelm Conrad Roentgen discovered "X rays" in November 1895 and announced his findings through the Physical-Medical Society of Wurzburg in December of that year. Almost immediately there were reports of erythema, dermatitis and deep ulceration from the use of these rays. In 1896 Marcuse 1 reported

IN A PREVIOUS investigation1on the local effect of intracutaneously injected cortisone we found that cortisone exhibited some local anesthetic action. Meanwhile, several papers have appeared on the local anti-inflammatory action of hydrocortisone.*Goldman, Emura, and Baskett3believe it possible that the antiinflammatory effects of cortisone may be due to hydrocortisone as a peripheral cortisone metabolite. This suggests an investigation of the analgesic properties of hydrocortisone as compared to cortisone. It was hoped that such an investigation would throw light on the mechanism of the therapeutic effect of cortisone and also that it would give us some clues as to the mechanism of peripheral pain. For this purpose it was thought worth while to compare these compounds in combination with procaine and antihistaminic agents. PROCEDURE In the studies reported here pain was produced by the intradermal injection of (1) thiamine hydrochloride, 100 mg. per cubic centimeter (Abbott)

THIS paper presents a compilation and brief discussion of superficial mycoses observed in three widely separated areas of the midwestern United States. It will be noted that the incidence of infection with the various dermatophytes is not the same as in other reported studies. During the period between July, 1949, and May, 1952, a total of 674 cases were observed. In each case the etiologic organism was cultured. These cases were seen in the Barnard Free Skin and Cancer Hospital, St. Louis, and in offices in Springfield, Mo., and Oklahoma City. MICROSPORUM AUDOUINI Of the 115 cases of infection with M. audouini 107 were reported from St. Louis. This disproportion cannot be easily explained, except that it may be said that the widespread epidemic of infections due to this organism did not extend into the southwestern states. In Springfield, Mo., the only cases of infection with M. audouini

CELSUS said, " alopekia spreads out in a pattern where is pleases; but ophiasis [so called from its resemblance to a snake] begins at the back of the head [ ab occipitio ]," and these are the two kinds of baldness ( area ). 1 Perhaps this constitutes the first description of alopecia areata, but it is certainly not a very good one, and it may be that Kaposi was correct when he said that Celsus actually did not describe it at all. 2 Celsus did very well, however, when he discussed treatment. He recommended scarification, painting with "resin of the turpentine tree," application of burned olive oil and "especially burned paper [ maximeque chartam combustam ]," and daily shaving. These suggestions have scarcely been deviated from, let alone improved upon, down to the present day. The reason for the persistent popularity of such measures seems to have been, in general, their apparent effectiveness. The majority

THE DEVELOPMENT of tumors on the dorsa of the hands in a patient following a severe sunburn was first reported by Poth 1 in 1939. Spontaneous involution occurred in approximately eight months. Two previous similar experiences had been noted by this same patient. In his paper Poth adequately reviewed the literature of actinic dermatoses, and Stillians, 2 in 1950, presented additional data on the effects of irradiation of the skin. The following case is presented in some detail because Poth 3 feels that it is the first case since his original report that parallels his case both clinically and histologically. REPORT OF CASE Mr. D. L. C., aged 75, was referred to the dermatology clinic of the Veterans Administration Hospital, Louisville, in February, 1950, because of multiple warty growths on the dorsa of his hands and wrists. The patient had been a blacksmith from 1923 to 1943

THIS PAPER is written mainly to reaffirm my belief in the efficacy of the antimonials in some cases of mycosis fungoides. This belief has been strengthened by the continued observation of the 3 out of 10 cases in which there was successful treatment with antimony potassium tartrate U. S. P. (tartar ametic), 1 from personal correspondence, and from results of cases published in this journal. REPORT OF CASES Cases 1, 2, and 3 of these aforementioned 10 cases, and that of another patient, W. F. (Case 4), were presented on March 20, 1952, at the Bronx Dermatological Society. Patients 1 and 2 were shown as being completely free of lesions for almost four years following treatment with antimonials, Patient 3 as displaying mild recurrences because of insufficient antimony potassium tartrate injections, and Patient 4 as showing complete involution of the lesions after treatment with lithium antimony thiomalate (Anthiomaline).

SYPHILIS is traditionally an infection which simulates the symptoms and physical observations of many other diseases. This paper reports a series of 10 cases in which the lesions of secondary syphilis resembled dermatophytosis of the feet. In two of these a local Herxheimer reaction occurred after the first therapeutic injection of penicillin. T. L. Chin1in China in 1932 reported three cases with dermatophytosis-like syphilitic lesions. In 1940 Thomas and Bluefarb2described six similar cases in New York, and L. Selmi3found one such case in Italy in 1941. Stokes4and his associates mention a patient with interdigital syphilitic condylomata in their textbook. Undoubtedly this small number of cases is not indicative of the incidence of such lesions but perhaps of the failure to recognize their syphilitic etiology. Of interest is the incidence of similar foot lesions in another systemic disease of spirochetal origin, yaws. Dr.

IN A PAPER recently published by Senear, Lewis, and Cormia, the statement was made that dermatology was at the crossroads; that it, in common with other medical specialties, had progressed a long way, but that it could not remain static, that its future must be one of expansion. I am in full accord with this statement; but I believe that with the type of men we now have in our specialty, we are bound to travel the right road. I am well aware that for some time past there has been a concerted but shortsighted effort on the part of some medical schools to make dermatology a very minor specialty. To overcome this trend, we must be alert. We cannot afford to cease fighting for what we believe is our rightful place, else we shall lose our identity as a specialty. During my lifetime I have seen many advances made

THERE IS no reported instance of treatment of systemic fungous disease in man with testosterone compounds. In 1953 Lamb and his associates 1 reported the cure of a mycetoma caused by an atypical Nocardia under treatment with large doses of pregnenolone acetate. Trial of this steroid in disseminated coccidioidomycosis has been unsuccessful. * The use of aromatic diamidines structurally related to synthetic estrogens is being thoroughly investigated by Curtis and his co-workers. 2 The present paper presents in vitro and in vivo laboratory studies of testosterone compounds as fungistatic agents and a report of the clinical trial of methyltestosterone and meth-dia-mer-sulfonamides (triple sulfonamides) in three cases of the deep mycoses. LABORATORY ASSAY OF ANTIMYCOTIC EFFECT OF TESTOSTERONE COMPOUNDS AND SULFONAMIDES In Vitro Assay of Testosterone, Methyltestosterone, and Testosterone Propionate .—In 1949 Reiss 3 demonstrated that testosterone, methyltestosterone, and other steroids and steroid-like compounds possess moderate fungistatic activity in vitro against Histoplasma capsulatum and other pathogenic fungi. Using a pour

RECENT reports1of infections with Candida (Monilia) albicans following the use of antibiotics suggest the desirability of a simple, rapid, and reliable method for the differentiation of this fungus from the common closely related nonpathogenic species of the same genus. The procedure now in use requires considerable laboratory manipulation extending over several days. The method here described is a combination of simple techniques already familiar in clinical laboratories. It yields readily interpreted results in 18 hours. The fungus can be identified either in pure culture or in mixed cultures made directly from feces, mucous membranes, or skin. This paper describes only the results obtained with pure cultures. Use of the method with clinical specimens will be reported in another communication. The culture medium is Levine eosin-methylene blue agar (difco®). To this is added a solution containing 10 mg. per cubic centimeter of

It is very often necessary to resort to destructive measures in long-standing, localized, pruritic, lichenified, and hypertrophic dermatoses that have not responded to conventional therapy, including x-ray treatment. For this purpose the most commonly used agents are phenol, trichloroacetic acid, solid carbon dioxide, and electrodesiccation. It is my aim in submitting this paper not to compare methods or to recommend the best one, but simply to introduce a new way of applying the electrodesiccation current. When desiccating tissue, the operator finds it difficult to cover much ground using the ordinary needle electrode. It has therefore occurred to me to use the ordinary straight-handled, metal, prostatic electrode. This is admirably suited for the purpose because of its blunt tip, anterior concavity, and posterior convexity. By manipulation the operator can obtain the desired concentration or diffusion of spark and will find the curvatures readily adaptable to all surfaces.

FOR A LONG time it has been known that contamination or infection with Candida (Monilia) albicans exists in many conditions, some of which are malnutrition, 1 diabetes mellitus, 2 pregnancy, 3 and idiopathic hypoparathyroidism. * More recently, it has been noticed in patients receiving antibiotic therapy.† Experimentally, however, chlortetracycline (Aureomycin) has been found not to influence moniliasis in animals by Kligman, 8 while it has by Morris. 10 Skinner, 11 after reviewing 303 papers on yeast, believed that observations on the nutritional and physical changes on the morphology of Candida had been excellent but that they had been unsatisfactory from a biochemical standpoint. Reiss 12 might have been answering this challenge when he found that estrogenic and androgenic hormones, except for diethylstilbesterol, did not inhibit the growth of C. albicans and that several hormones, particularly pregnanediol, enhanced its growth. The effect of some vitamins on the growth of

THE FIRST case of basal cell epithelioma of the sole described in this paper came to our attention in 1948; the second some three years later. The second encounter with this most unusual localization for a basal cell epithelioma prompted this report. It is felt that these cases are of interest not only because of their rarity but also because of the light they may shed on the disputations concerning the histogenesis of basal cell tumors. We inquired of a number of our colleagues as to their experience with basal cell tumors of the sole (or palm) and a search was made of the literature for earlier reports. Dr. Herman Beerman was good enough to tell us of a case he studied histologically some years ago. Dr. Hamilton Montgomery and Dr. Fred Weidman, however, were not able to recall any despite their vast experience. Statistics attest to the fact that

A CERTAIN percentage of infantile cavernous hemangiomas, if untreated, persist into adulthood. Since they respond well to irradiation during infancy and since later they may become very troublesome, I believe the physician should advise early treatment. Since the purpose of this paper is to show that persistence of hemangiomas is not uncommon and since types of therapy are adequately covered elsewhere in the literature, only indirect reference to therapy will be made. Furthermore, various types of vascular nevi will require varying forms of therapy. REVIEW OF LITERATURE Whether to treat or not to treat cavernous hemangiomas is a provocative subject. A thorough review of the literature only serves to point up the lack of harmony of concepts in types of therapy, the age at which treatment should be started, or whether hemangiomas should be treated at all. Lister, 1 who obviously included cavernous hemangiomas under the classification strawberry