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There have been between 230 and 250 reports of poikiloderma atrophicans vasculare (Jacobi).Cockayne quotes Oppenheim to the effect that the disease is familial, but adds, "The evidence for this statement is scanty." (p. 363.)In June, 1906, Petges and Cléjat reported their case of "sclérose atrophique de la peau et myosite generalisée," and at the Ninth Dermatological Congress at Berne, September, 1906, Jacobi presented his case of poikiloderma atrophicans vasculare. In 1909 Professor Zinsser reported familial cases, two brothers, affected with a disease closely resembling the pictures as described by Jacobi, with the skin manifestations, the dystrophic nails, and the leukoplakia of the mucous membranes.In the comprehensive report of Oliver on the condition, his patient ended with mycosis fungoides, as did the patient of Weiss and that of Wile. Civatte's patient had been diagnosed as having parapsoriasis by Brocq, as having poikiloderma atrophicans vasculare by

Pruritus ani and/or pruritus vulvae is a common disease which frequently taxes the therapeutic ingenuity of the physician. Patients are frequently annoyed to the point of exasperation by the intolerable itching, which results in loss of sleep, nervousness, irritability and loss of efficiency. The prognosis is often unfavorable, and recurrences are frequent.The causes are numerous, and many times complex, and fall within the separate fields of internal medicine, gynecology, proctology, neurology and dermatology. However, almost invariably these patients possess symptomatic manifestations that bring them under the care of a dermatologist.Against a background of rather unsatisfactory therapeutic results in many cases, there came to our notice in 1943 a preparation, coparaffinate ointment (ointment iso-par coparaffinate®), for which were claimed a number of properties which would, if satisfactorily demonstrated, counteract the objective and subjective symptoms in many cases of pruritus ani and, perhaps, of pruritus vulvae.The active ingredients of

This is one of a series of articles written by eminent clinicians for the purpose of extending information concerning the official medicines. The twenty-four articles in this series have been planned and developed through the cooperation of the U. S. Pharmacopeial Committee of Revision andThe Journal of the American Medical Association.—Ed.In syphilis there is an active, motile organism which requires moisture and tissue for its further spread and vitality. It is well known that Spirochaeta pallida dies within one-half hour if exposed on a dry surface; e. g., a glass slide. On the other hand, if anywhere on the body the organism gains entrance into the skin, through a bruise, a cut or a crack, an infection will probably occur. Of this there is not absolute surety, for it is possible that certain individuals may have some resistance to the disease, perhaps enough at least to word off an

None of the mercurial preparations used, at present, in the treatment of syphilis are perfect. In the laudable quest for better ones Parke, Davis and Company submit a new mercurial preparation for which several claims have been made. The evidence from the literature that they submit in its favor is of little or no value, since, in practically all cases reported, the patients received arsphenamin as well as Mercurosal. In the first place, they claim that they have a preparation which can be used either by the intramuscular or by the intravenous route. This, of itself, would be advantageous in certain cases in which it would be found impossible to use one of these routes. Secondly, they affirm that the drug has no deleterious effects on the vessel walls. To quote their own words, "Following a long series of intravenous injections in dogs, there was no appreciable effect on the

In December 1942 the Council on Pharmacy and Chemistry was approached by Col. Otis O. Benson Jr., M. C., representing the commanding general, Army Air Forces, Matériel Center, Wright Field, Dayton, Ohio, in regard to the most effective protective substance for the prophylaxis of sunburn. The problem was as follows:The Matériel Center would like information on the most effective protective substance for the prophylaxis of sunburn. In essence, the problem is as follows:Men marooned on life rafts or in the desert following airplane crashes for various reasons seem to lose a good deal of their clothing and are subject to severe solar exposure.It has been definitely established that a protective substance (cream or ointment) to be stowed in life rafts and other emergency equipment in military aircraft is required, when the aircraft is operating in the southwest Pacific and Mediterranean theaters.The requirement per

In 1896, Marcuse1 first called attention to the dangers incident to exposure to the roentgen ray—the production of an alopecia and of a dermatitis "resembling sunburn." In the short space of twenty-eight years, how much valuable knowledge has been discovered concerning this wonderful physical agent? Incidentally, how many workers have learned to their own cost the dangers ensuing from being fully exposed to its unseen rays? In the early days, many a martyr to science was known, and the result was a long list of fatalities extending from 1898 to 1912. As the result of education and prophylactic measures, this list has since rapidly declined. Nevertheless, in the last few years, with the increasingly wide use of the roentgen ray by many physicians and dentists for picture work, for fluoroscopic work and for treatment, the question arises whether it will not be well to sound a new warning on

Intravenous injections of suspensions of finely divided mercury were made by Fuerbringer 1 in 1880 for the purpose of studying the fate of mercury in the tissues of animals. With the aid of acacia and glycerin, he prepared a stable suspension in which the mercury globules were smaller than the blood corpuscles. However, such injections of suspended metallic mercury do not appear to have been tried clinically until recently, when a proprietary preparation of this character was introduced, originally under the suggestive name of "lueside," which has been changed to "mercodel." The manufacturers claim that this produces very striking therapeutic results, with absolute safety, without injury to the vein; in fact, without any objectionable features. Since this method of introducing mercury for therapeutic purposes is a distinct novelty, the claims require careful control; a task that was assigned to us by the Council on Pharmacy and Chemistry, to which the

Since the earliest times, mercury inunction has been used for the treatment of syphilis. The drug, however, has always been employed in the form of an ointment of the metallic mercury. Recently Wile and Elliott1 and Schamberg, Kolmer, Raiziss and Gavron have suggested the use of an ointment made of calomel; this, for several reasons: The blue ointment is very uncleanly; it leads to discovery, and it frequently sets up an irritation of the skin. As calomel is more cleanly, and as the latter four authors felt that it is fully as well absorbed through the skin as the ordinary blue ointment, they suggested that it be used for inunction purposes in a formula consisting of:The arguments of these writers seemed convincing, and we commenced using calomel inunctions, especially in private practice, in the spring of 1917. Since then the use of the calomel rubs has become so

A disease known as climatic bubo has been, in part at least, recognized for the past seventy-five years. It was supposedly tropical in character, running a very chronic course with more or less suppuration of the affected inguinal lymph nodes. It was supposed to follow venereal exposure, especially to Negro women. The lymph node symptoms did not show up, as a rule, until an entrance for the infective agent was no more to be found. The cause was unknown. As long ago as 1865, the French clinician Trousseau1 gave a very good description of it:I must not forget to say a few words about a lymph node infection which I have often observed in the young Creoles, and more particularly in the Creoles of Réunion and Maurice.... In adolescence, and more in the boys, we see the superficial and deep nodes in the groin swell up on one

Every physician devoting his life work to a specialized line of endeavor is bound to have more or less correspondence with various colleagues and lay persons in regard to problems arising along that line.It is not often, however, that the same specialist goes to the trouble of collecting and analyzing this correspondence.This has recently been done by Stokes and Ingraham1 in two related publications, the one that is of particular interest here being entitled "Two Thousand Questions the Doctor Asks About Syphilis." In the period from July 1928 to July 1938 nine hundred and fifty-five letters have been answered either by them or in the Queries and Minor Notes of The Journal. In the case of the latter, they have been answered anonymously by various correspondents. The total number of questions answered by Stokes and by the correspondents was 2,115. Statistical break down of the 2,115 inquiries

Intramuscular bismuth therapy against syphilis ranges between the extreme of very slow absorption from the oil suspensions of compounds that dissolve very slowly in water, such as the subsalicylate, and the other extreme of the relatively rapid absorption from watery solutions. With the watery solutions an effective concentration of bismuth in the blood and tissues is reached in a short time, perhaps after a single injection. As the excretion of these solutions is also more rapid, their action is relatively brief and they must be administered more frequently. The oil suspensions have the advantage that they may be given at longer intervals. They tend to become cumulative when injected once a week. The effective concentration in the blood is therefore approached more slowly, probably only after from two to four weeks. These extremes are bridged by a variety of bismuth preparations, such as oil suspensions of more soluble compounds and the oil-soluble compounds. It occurred to us that it might be advantageous to approach the problem in a different way, namely by an interlocking sequence of watery solutions and salicylate suspensions, adjusted to build up an effective concentration rapidly by use of the watery solution and a continuous concentration meanwhile by use of the salicylate suspension, the injections of the watery

DISCRETE KERATODERMA (MICHAEL). PRESENTED BY DR. GEORGE H. CURTIS AND DR. E. W. NETHERTON. H. N. W., a white man aged 38, has had lesions on the dorsa of the hands for eight years. There have been periods of improvement and exacerbation. During the exacerbations the lesions are thickened and tend to become fissured. They have never been pruritic and are not affected by the seasons, nor do they improve when he is away from work for from a few weeks to a year at a time.There are a number of dry brownish red and fairly well demarcated plaques on the dorsa of the hands and knuckles. They vary from 1 to 3 cm. in diameter, the smaller lesions being roughly circular and the larger ones irregular in shape. The surfaces vary from slightly scaly to mildly verrucous. The lesions on the knuckles show a tendency toward fissuring. The

Occasional reports have appeared in medical literature on ectodermal defects or ectodermal dysplasias. Some of the anomalies have been of the anhidrotic type. Rarely has there been any suggestion of possible concomitant mesodermal involvement. A case of such involvement as well as of an osseous aplasia is presented here, with a discussion of the salient characteristics and unusual relations. REPORT OF A CASE M. E., a white woman aged 26, unmarried, an office worker, had had a disturbance of the skin since birth. FAMILY HISTORY.— The father, 52 years of age; the mother, 45 years of age, and two sisters, 19 and 10 years of age, were living and well. There had been no other pregnancies. There was no history of a similar condition in any known member of the family, nor was there a history of insanity, cancer, tuberculosis, congenital heart disease or epilepsy. PAST HISTORY.— The patient's health

A CASE FOR DIAGNOSIS. PRESENTED BY DR. H. G. MISKJIAN. R. D., a youth aged 17, has a remarkably symmetric eruption, on each side of the nape of the neck. It started about two years ago in the form of a small red pimple on the left side and gradually spread. About a year later it appeared on the right side. It has been in its present condition for about a year.On both sides of the back of the neck, about 5 cm. from the midline, there is a linear eruption, composed of small, red, raised, hard papules. They are contiguous but not confluent and appear like beads on a string. The eruption forms a curved line, more or less paraboloid on the right side. On the left side it is irregularly curved with a looplike annular lesion in the middle. There are, in addition, some stray papules around

The trivalent arsenical preparation meta-aminoparahydroxyphenylarsine oxide was studied originally by Ehrlich and Bertheim and later by Voegtlin and others. Ehrlich and Hata1 found its therapeutic index to be less than that of the arsphenamines. Voegtlin2 considered arsenoxide for clinical use in the treatment of syphilis but hesitated because its margin of safety as established by the chemotherapeutic index appeared to be somewhat lower than that of arsphenamine. The attention of chemotherapeutists was again called to arsenoxide as the result of the experiments of Tatum and Cooper.3 These investigators found that the therapeutic index and other properties were such as to make the drug more promising than any other single antisyphilitic agent. Gruhzit,4 in studies on experimental trypanosomiasis and syphilis, found that arsenoxide was well tolerated and possessed a therapeutic value at least as high as that of neoarsphenamine.Mapharsen is meta-aminoparahydroxyphenylarsine oxide hydrochloride, generally known by

INTRODUCTION As one glances through various foreign dermatologic journals or foreign medical weekly publications, one is surprised at the advertisements for various proprietary medicines or patent remedies. As a rule the remedy has a suggestive designation and its formula is essentially secret. The reader is forced to accept the information and claims as stated in the advertisement unless he is in a position to carry on his own investigation. All too often the sole recommendation which is included in the advertisement is that the remedy has been used in Professor So-and-So's clinic and that he endorses it; why he endorses it is another story, generally not divulged. WHAT IS THE STATUS IN THE UNITED STATES? Dr. George H. Simmons,1 editor emeritus of The Journal of the American Medical Association, said that as early as 1879 the American Medical Association adopted preambles and resolutions strongly condemning the use of secret

The clinical efficiency of treatment with bismuth compounds in syphilis has been sufficiently demonstrated by all the available methods— by the clinical progress, by the disappearance of spirochetes from the lesions and by the reversal of the Wassermann reaction. However, these methods are not sufficiently sensitive to distinguish sharply the optimal conditions for the use of this treatment, such as the concentration and duration that may be required and the relative efficiency of different preparations. This limitation of clinical experience is reflected in the multiplicity of preparations, dosages and instructions for spacing of injections. It may be presumed that compounds which differ in solubility differ also in rapidity of absorption, and therefore of excretion, and in promptness and duration of action. If continued action is essential, as seems probable, too rapid absorption would necessitate frequent injections and very slow absorption would not only delay the effect but tend to produce

Mercury has been used by the inunction route in the treatment of patients with syphilis almost since the first authentic reference to the disease. Mercurial ointments have been used in the treatment of persons with diseases of the skin since time immemorial; what then could have been more natural than that some investigator should have employed it experimentally when syphilis first appeared on the medical horizon? Thus one finds that among the earliest writings on syphilis the use of mercurial ointments is recommended. For example, among the ten incunabula on syphilis reviewed by Singer,1 Schelling (1495), Grunpeck (1496), Torella (1497), Widman (1497) and Steber (1498) emphasize the value of this medication; though Leonicenus rather discredited its value. Naturally, these early writers had little rime or reason to their methods of therapy.The Spanish syphilographer, Almenar, in 1501, seems to have been the first physician to employ a rational method

At the annual meeting of the Cleveland Dermatological Society held in October, 1926, a case was presented for diagnosis in which the patient showed a peculiar scarflike, pigmented eruption of the neck, an acrocyanosis of the hands and feet with hyperhidrosis of the palms and soles, a dystrophy of the nails and a leukoplakia-like eruption of the tongue and hard palate. The history and description are given subsequently. REPORT OF CASES HISTORY.— The father, mother and three sisters were living and well. No one in the family had had the same condition as the patient, and he knew of no other relatives who had this trouble.The patient, a man, aged 20, had had the ordinary diseases of childhood— measles, mumps and varicella. He had been troubled as far back as he could remember with what had been called undernourishment or malnutrition. He was in a severe automobile accident at

Étienne François Geoffroy, a Paris physician famous during the first third of the eighteenth century, in his "Tractatus de Materia Medica"1 gave an interesting description of the method of mercurial inunction employed at that time, which differs especially in dosage from the present method. The patient was seated near a fire, and the parts to be anointed were rubbed until they became red and hot; the parts were then rubbed with the mercury ointment, the patient being removed a little farther away from the fire, so that the ointment would not become too much softened. On one day, the feet, knees and thighs were rubbed; on alternate days, the nates, wrists, arms and forearms. The inunctions were repeated daily or on alternate days, according to the constitution of the patient, until an abundant flow of saliva appeared. This method is not much different from the present practice. At this

The efficiency of mercurial medication must depend in a great degree on the concentration of mercury in the body; this, in turn, depends on the balance between the absorption and excretion of the mercury; this, again, can be learned only through chemical analysis. The importance of such chemical studies is evident; but the difficulty of exact determination of small quantities of mercury in the excreta has naturally resulted in limiting these studies. There are only a few series of quantitative observations, each limited to a few cases, and usually confined to the urine. These are much more difficult to analyze, but they play a not inconsiderable part and, what is most serious, a variable part in the excretion. Moreover, some if not most of the analytic methods contained inherent faults, and it was difficult to judge how far these might have influenced the results. Although these results were not worthless,

It is only since 1921 that bismuth has been employed in the treatment of syphilis. Yet if one were to judge from the amount of journal space devoted to this one phase of antisyphilitic therapy, one would be inclined to think that its use was as old as that of mercury. One need only recall how numerous are the different bismuth preparations already on the market.These preparations, following the classifications of Levaditi,1 can be roughly grouped under four main heads: I. PREPARATIONS CONTAINING METALLIC BISMUTH "Neo Trepol" containing 96 per cent. of pure bismuth (finely ground up and divided) serves as an example. II. ORGANIC SALTS OF BISMUTH Examples of this class may be enumerated as follows:The sodium and potassium bismuth tartrate (trepol) and other examples of this salt on the market containing from 50 to 60 per cent. of bismuth.Bismuth salicylate with 50 per cent,

Several very complete reports on the toxic effects of arsenical preparations used in the treatment of syphilis have been made in the past few years, notably the Medical Research Council Survey of Great Britain,1 the report by Phelps and Washburn2 on cases observed in the venereal disease service of the United States navy, and Kerl's3 article in the Jadassohn Handbuch.Nevertheless, if one scans the literature from day to day and from month to month, one still notes the frequent observation of further arsenical reactions supervening in the treatment of syphilis. Either past experiences have not taught us sufficiently to prevent these occurrences; or there is still something to learn along these lines, or, finally, arsenical reactions must be looked on by the medical man as phenomena bound to happen sooner or later in many cases, and this despite every precaution. This is the excuse that we

Paul Ehrlich worked for years synthesizing an arsenical compound to cure syphilis. The therapia magna sterilisans, he thought, had been achieved with his six hundred and sixth preparation, arsphenamine (introduced as salvarsan), to be injected intramuscularly, one injection sufficing. Relapses as well as reactions disclosed differently and he synthesized another arsenical, neoarsphenamine, and later still others. When none of these worked he and his collaborators suggested use of more than one injection. Every physician agreed to the effect of the trivalent arsenical salts on Treponema pallidum, but it required trial and error as well as evaluation of enormous amounts of case material before medicine finally awakened to the profound effect of these compounds on syphilis. Injections of the arsenical were at first widely spaced between other forms of therapy—mercury. Later a physician here and there had the temerity to use injections perhaps once a month, later once a week. It

The extragenital chancre is by no means an uncommon sight — to the dermatologist, at any rate — and I feel a hesitancy in reporting to this section such a short series of cases. However, the affection is rather rarely encountered by the general practitioner and, consequently, the diagnosis is deferred, as a rule, until the appearance of the secondary symptoms, a time when much damage often has been done both to the patient and to his family. DEFINITION By the term "extragenital chancre" I mean the primary invasion of the Spirochaeta pallida on other parts of the body than the genitalia — hence the frequently used term "syphilis insontium." This type of syphilis has been known since the earliest times, and authentic epidemics of innocent syphilis have been reported as early as 1577 in Austria, 1592 in Switzerland and 1596 in Germany. Most of the earlier ones were due

ETIOLOGY OF CHROME DERMATITIS AND ITS FREQUENCY IN INDUSTRYCHROME compounds (chromic acid, chromates, and bichromates) are exceedingly active chemically and are powerful skin irritants. Their extensive uses in manufacturing processes are many and varied. Chief offenders are the alkaline chromates—potassium, sodium, and ammonium bichromates.Chromium compounds affect the tissue proteins, forming with them chemical compounds, as in the tanning of hides. In strong enough concentration they corrode the skin and mucous membranes.Strong solutions not concentrated enough to corrode the skin may produce a toxic dermatitis. In still weaker concentration, the chromates may sensitize the skin and cause an allergic dermatitis.1Engelhardt and Mayer2 conclude that chrome dermatitis has become much commoner since the photographic method was adopted in the printing trade. They found it in 1 of every 4 of a group of 114 lithographers who handled chromium salts.The frequency of sensitization to

HURLER'S syndrome, gargoylism, lipochondrodystrophy, or dysostosis multiplex was defined by Washington as. . . a disease of congenital origin characterized by chondrodystrophic changes in the skeleton with a tendency toward the deposition of a lipid substance in the tissue, particularly in the brain. On pathologic examination, changes resembling those of amaurotic idiocy are found. The condition appears to combine certain features of Morquio's Disease with some features of Niemann-Pick's Disease. Clinically, it is characterized by dwarf-like stature with marked shortening of the trunk and neck; enlargement and often distortion of the skull with depression of the bridge of the nose and coarseness of facial features; limitation of motion of joints and kyphosis; protrusion of the abdomen with hepato-splenomegaly; clouding of the corneae and mental deficiency. The last two are often absent.1REVIEW OF THE LITERATURESince as far back as 1865, a number of such syndromes have been described, characterized

NONLIPID granular cell tumors are usually considered to be myoblastomas, and in the following review this term will be used freely. However, identity of all these tumors is still open to question. We present 3 cases exemplifying this problem.In 1926 Abrikossoff1 reported a tumor of myoblasts occurring chiefly in relation to striated muscle. He thought it might be due to degenerative lesions following injury or inflammation. In 19312 he further elaborated his ideas on myoblastic myomas, as he called them, feeling that perhaps they were made up of embryonal elements—primitive myoblasts. He divided them into four different types, of which the first three are all granular cell and benign: (1) round, egg-shaped or elongated myoblasts, 20 to 25 microns in length, showing granules but no longitudinal or cross striations; (2) growths in which some of the cells may show longitudinal or cross striations, and (3)

SINCE October 1943 treatment with sodium penicillin has been carried out in a total of 182 cases of pregnancy complicated by early syphilis at the Cleveland City Hospital and the University Hospitals. Although total doses of penicillin increased as time went on from 60,000 to 9,600,000 units, in the bulk of the cases (86 per cent) at least 2,400,000 units were given in divided doses every three hours for from sixty to one hundred and twenty injections. The results of treatment are measured in terms of the efficacy of penicillin in protecting the fetus or, better, in curing the fetus of the maternal infection.In this study there were 5 cases of primary syphilis, 63 cases of secondary syphilis and 114 cases of early latent syphilis. Excluded were all cases of patients thought to have had adequate treatment who were re-treated for protection of the fetus, and all late latent

At 5 a. m. on April 22, 1915, the Germans released about 180 tons of chlorine gas from 5,730 cylinders on a front of 6 kilometers. Results were disastrous to the English and French colonials. About 5,000 men were killed and many more were incapacitated. Fifty guns were lost, and the Allies were forced to abandon their position. This first surprise gas attack on an unprepared foe showed the possibilities of this mode of offense either in actual warfare or in civil strife.1In connection with industrial medicine, opportunity has been afforded in a plant in northern Ohio for a study of a few of these products. As the manufacture of chemical agents used in war at one time or another has resulted in a series of untoward dermatologic episodes, we were called in in the hope, first, that they might in part be prevented and, second, that they

INFLUENCE OF THE VEHICLE ON ABSORPTIONIn our previous papers on inunctions the excretion and absorption of mercury after simple and those after clean inunctions have been compared,1 and the advantage of massive weekly inunctions has been demonstrated.2 In the first article of the present series3 the relation of the concentration of the mercury in the ointment to absorption and excretion has been shown. The function of the oleate and the effect of the size of the particles as found in ointment of colloidal mercury was discussed, while the relation of the vehicle to the absorption of mercury with a petroxolin base was only touched on. It appeared desirable to make a more extensive investigation of this subject since the vehicles of the mercurial ointments of the various pharmacopeias differ considerably, partly in the emulsifiers which are used to extinguish the mercury and partly in

When mercury is administered to a patient, a part generally remains unabsorbed, at least for a time; that which is absorbed circulates through the blood, lymph and tissues, and is then either excreted or deposited and stored in the tissues. This stored mercury may remain in the body for indefinite periods without producing any perceptible toxic or therapeutic effects, for soon after the active absorption of the drug has stopped, but while comparatively large quantities of mercury are not being excreted, the toxic phenomena disappear and the therapeutic effects decline, so that another course of administration must be started to maintain the antisyphilitic action. It may be suggested that the stored mercury has already combined with the tissue proteins, perhaps in insoluble form, so that it does not react further and is therefore really inactive. However this may be, it seems that the actively circulating mercury is chiefly, if

Mercurial inunctions have been used from the earliest days in the treatment of syphilis. They are efficient and secure an adequate excretion of mercury when they are properly performed. Nevertheless, they have the objection of being uncleanly, of occasionally leading to irritation of the skin, and likewise of leading to disclosure of the condition. Therefore, if another more cleanly and yet equally efficient preparation of mercury could be found, it would be most valuable.As long ago as 1905, Neisser and Siebert1 suggested such a preparation entitled, ``Kalomel Salve," or ``Unguentum Heyden.'' It consisted of a colloidal mild mercurous chloride made of 75 per cent mild mercurous chloride and 25 per cent albumin, with a mercury content of 66 per cent. The dose to be inuncted was 10 Gm. They reported that usually after the fifth day mercury was found in the urine. In experiments on

Our attention was first called to the possibility of unequal amounts of bismuth in measured doses of oily bulk bismuth suspension when working with tartroquiniobine. This is a suspension of the iodobismuthate of quinine and of sodium potassium bismuth tartrate in camphorated oil and has a metallic bismuth content of 6 cg. per two cubic centimeters. Because of the time required when doses are put up in separate ampules, as well as because of the expense, we used this preparation in 25 cc. amounts put up in wide-mouthed shallow bottles. The bottles were thoroughly shaken before the dose was removed; moreover, the suspension contained several glass beads to assist in more thorough mixing. At the bottom of the bottle we were occasionally surprised to find a heavy, thick, reddish deposit. This disturbing factor led us to examine several other bulk products that we were using, the potassium bismuth

An American dentist, Guilford,1 first reported a case of congenital ectodermal dysplasia of the anhidrotic type. The man, aged 48, was edentulous and had almost complete absence of taste and complete anosmia. He was hypotrichotic and never perspired. At almost the same time Atkinson2 presented before the Philadelphia Medical Society a man aged 40 who had never had teeth or any distinct growth of hair on the scalp except the downy hairs which are seen in early infancy. He was also destitute of the sense of smell and almost of that of taste. His skin appeared to be unprovided with sweat glands, as he never perspired, and when working actively he was obliged to wet his clothes in order to moderate the body heat. He could sleep in these wet clothes in a damp cellar without catching cold. His jaws presented the appearance seen in persons who have

FACIAL GRANULOMA WITH EOSINOPHILIA. PRESENTED BY DR. H. N. COLE, DR. J. R. DRIVER AND DR. H. N. COLE JR., CLEVELAND. H. A., a white man aged 54, has noted an asymptomatic lesion on the left cheek for the past three and one-half years, which has been slowly progressing in size. He denies any previous skin disease, or taking any medication internally.Physical examination revealed an essentially normal condition except for a well circumscribed, slightly raised, moderately firm lesion on the left cheek, 6 by 8 cm. in diameter. The surface of the lesion was dry, smooth and slightly erythematous.The reaction to the Kline test was negative. Results of examination of the urine were normal. The hemogram revealed 16.5 Gm. of hemoglobin and 5,200 white blood cells, with 67 polymorphonuclear leukocytes, 27 lymphocytes, 2 monocytes and 4 eosinophils. A test with old tuberculin in a dilution of 1: 10,000

In 1913 Ito, working with Carl Bruck at Neisser's clinic, devised a specific intradermal test for chancroid —Ducrey bacillus infection. The diagnostic value of this test was later confirmed by Reenstierna, working with a serum containing antibodies of the Ducrey bacillus. Today this test is spoken of as the Ito-Reenstierna reaction.Ito, for his cultures, used 24 hours old streptobacillus colonies from two Besançon blood agar tubes. The bacilli are suspended in physiologic solution of sodium chloride with the addition of 0.5 per cent phenol and heated at 60 C. for two hours. Reenstierna employed unheated material in the presence of phenol for fourteen days in the icebox. Frei1 in his survey of the entire subject up to 1927 says that he employed the water of condensation. He also states that it makes little difference what method of preparation is employed.The antigen is employed as an intradermal test,

Mercuric salicylate was first recommended as a syphilitic remedy in 1887 by Silva Arranjo of Brazil. Because of its comparative painlessness by intramuscular injection, its use spread rapidly, so that it has probably been more widely employed than any other preparation of mercury. Moreover, it has been a comparatively safe remedy as compared with other salts of this metal. Study of the 108 fatalities reported as resulting from the use of mercury from 1883 to 19011 shows that 7 of the deaths were from soluble injections and 78 from insoluble injections of different mercurials. Mercurial oil was the cause of 31 of these, mild mercurous chloride of 8, and although mercuric salicylate was probably used far more than any other, it was the cause of only ten deaths. Lomholt says that during his experience two deaths have resulted from the use of this salt. In our clinic at Cleveland

As was pointed out in the first paper of this series the quantitative excretion of mercury is an important index of the concentration of active mercury in the tissues, and should therefore furnish data for the rational administration of mercury. A number of studies on this subject have been published, but they are not conclusive, mainly because the material was not sufficiently extensive to judge and to take account of the natural variability. Some of the studies also disregard the feces, a factor which might be important; and some of the analytic methods appeared rather questionable, at least theoretically.We found the subject difficult; but with the collaboration of the staffs and resources of the chemistry department of Adelbert College, the department of experimental medicine, the school of pharmacy, the departments of dermatology and syphilology of Lakeside and City Hospitals and the department of pharmacology, we have been able to

Not long ago a man training for the medical profession merely served as an apprentice to a practitioner. Still later a course of lectures was required, and somewhat later two and even three courses were demanded. Only within the past thirty-five years or more have medical schools required three years and later four years of study from a man desiring to practice medicine.From apprenticeship under a family physician, it was only a step to practice in the hospitals, and though hospitals have been established institutions for centuries, their desirability as places for study have been properly recognized only during the past thirty-five or fifty years. At present, there are clinical clerk services in hospitals, and most states require hospital training for men desiring to practice within their boundaries.During the last decade of the last century, institutions first demanded higher preliminary training of medical students; as a result of

From t́ime immemorial it has been known that workers in copper dust or alloys rich in copper are liable to have green stained hair and greenish deposits on the teeth and gums. Kaber and Hanson1 tell us that they even have a greenish tint to their perspiration, which may persist after a thorough bath, while the skin may actually be bronzed. However, with the exception of the involvement of the gums and perhaps pyorrhea, both of which are rare, the effects of the copper on the health are remote. Oliver,2 likewise, in his book on dangerous trades, does not consider working with copper as dangerous an occupation as working with brass. Rambousek3 says that the symptoms which have been described by some workers as those of chronic industrial copper poisoning are really due to a mixture of other poisonous metals with the copper, especially lead and arsenic.

My attention was especially called to this rare condition by two cases observed and studied. At the time, I supposed it was an exceedingly rare complication of early syphilis, and this idea was rather confirmed by questioning colleagues as to their experience. However, I was surprised indeed on looking up the literature to see that it is by no means an uncommon condition, and we must now add our affirmation to that of Kuh,1 page 386, "If one studies the literature one can hardly draw any other conclusion than that the importance of syphilis in the etiology, not only of acute myelitis but also of chronic myelitis, has been underestimated." Quite early, Ricord,2 Caizergue,2 Juillard2 and others described this condition. Euhlenberg,2 Fournier,2 Erb,3 Gowers4 and other authors have also written quite extensively on the subject. Leyden,5 in 1874, reported cases presenting

HISTORY Fumigations in the treatment of disease have been used since the time of Hippocrates. They were highly recommended by Celsus, Galen and others. Probably one of their first uses was in the treatment of scabies; therefore, it was only natural, when the skin manifestations of the new disease syphilis appeared in Europe that fumigations should have been mentioned as being employed to treat it. According to Astruc, to whose admirable book1 we are indebted for much of our information regarding syphilis in early times, fumigations were first used in the treatment of syphilis by Angelo Bolognino, professor of surgery at the University of Bologna, in 1506. Jacques Catanee2 also used them about the same time. Massa2 speaks of them in his book on the treatment of the "Malady of Naples." Later, Matthiole,2 in 1535, recommends them; likewise Fracastor, in 1546; Gabriel Fallopius, in 1560, in

"Doctor, I am suffering from eczema"—most often pronounced with the emphasis on the second syllable. What physician has not heard this expression hundreds of times, and how often even the best physicians and dermatologists have been at their wits' end before seeing the last of the patient! That the condition is common goes without saying, and even in dermatologic practice, where more careful elimination of related conditions would be achieved, one finds that the percentage of eczema and dermatitis is very high in comparison with the number of dermatoses diagnosed. Moreover, even in the practice of the general practitioner, the problem of eczema and dermatitis comes up so often that I feel that it would be well worth a little consideration; at least, that is my excuse for presenting it for study.The word eczema is an old term. As early as 1800, Robert Willan defined it as "a condition

From a careful study of seventy cases and from a review of the literature, Ziegler,1 in 1911, felt that one fourth of all cases of Hodgkin's disease, at some time or another in the course of their trouble, showed evidence of skin involvement. Bunting and Yates2 quote Westphal as finding 15 per cent of his cases with skin lesions.To me, these percentages seemed rather high until I began to go deeper into the subject and look more particularly for these manifestations. After about two years of careful observation of such cases, I feel that these writers are probably correct in their figures. It is my belief that all too frequently cutaneous lesions of lymphogranulomatosis are not noted because they have not been sought after, and it is my object to call the attention of the medical profession to this interesting and as yet not generally recognized series of

In October, 1926, a unique case was presented before the Annual Meeting of the Cleveland Dermatological Society by Drs. Cole, Rauschkolb, and Toomey.1 This 20-year-old man of Jewish extraction stated that as far back as he could remember he had had a peculiar condition of his nails and an unusual pigmentation around his neck. He complained that his hands and feet perspired very freely and he often had large blisters over his heels. His father, mother, and three sisters were living and well.At that time, the entire tongue had a thickened, whitish appearance, with a large ulcer in its center. Later, there was a large leucoplakic spot on the hard palate. The nails were dystrophic in type, and some of them were almost entirely absent. The skin of the neck down to the clavicle showed fine dark reddish-brown papules, arranged along the somites of the skin.

FROM October 1943, 730 patients with early syphilis have been treated with penicillin at the University Hospitals and City Hospital in Cleveland. In addition, a number of patients with syphilis of the central nervous system have been treated, but their cases have not been incorporated in this report. Moreover, many of these patients have been retreated since and a good many a second time, with progressively larger doses of penicillin as indications warranted.ROUTINE IN USE OF PENICILLINAll the patients studied were given careful physical examinations on admission and thereafter as indicated. With any open lesions, dark field examinations were made every few hours at first—as many as were necessary to study the disappearance of treponemas. Serologic examinations of the blood were made frequently.At the University Hospital progressive dilutions are made on serums showing a reading of 1 plus on the Kline diagnostic test and 3