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In the course of various investigations carried on with the financial assistance of the Interdepartmental Social Hygiene Board, we made a series of fifty-three tests with luetin purchased in the open market. This test is more generally depended on than many realize; hence the importance of investigating the quality of the luetin available at this time. As a member of the California State Board of Medical Examiners for the last eight years, I have taken part in several hundred oral examinations given old licensed applicants from every state in the country. This has furnished exceptional opportunities to gage the opinions of the rank and file of the medical profession, as well as that of the numerous so-called "drugless" cults, regarding various medical matters. The handling of the syphilis situation as a public health problem is complicated by the fact that increasing thousands are depending on half-educated, insufficiently trained practitioners of

The subject of this report had severe onychauxis of all the finger and toe nails. The administration of thyroid extract over a period of six months was followed by disappearance of the condition. The photographs taken before and after this treatment illustrate very well the transformation that occurred. A brief history of the case follows: CASE REPORT A married woman (88128, Skin Clinic), aged 49, called, September, 1920, presenting severe onychauxis of the finger nails and, to a less extent, of the toe nails. The process started on the fingers in June, 1920, and in September on the large toes, extending fairly rapidly to the other toes. The patient presented a condition of general dryness of the skin, with scaly, itchy areas on the outer arms and thighs, left elbow, left knee and the umbilicus. She also had severe pruritus vulvae. The skin generally was pasty and coarse, with dilated pores and hypertrichosis. The patient perspired easily. Physical examination disclosed nothing except a few enlarged cervical glands and evident lack of care of the teeth. The thyroid was not enlarged, but was palpable.

Several observers (Pollitzer, 1 Lane 2 and Hazen 3 ) have presented interesting statistical studies of the incidence of common diseases of the skin occurring among patients seen in private practice and at the dispensary. Goodman 4 has published a study covering almost 1,000,000 dermatologic diagnoses made in private and clinic practice. These figures include the findings of previous observers and may be considered as accurate owing to the large number of cases studied and the length of the period covered. The tabulated results in each case reveal a strikingly close correlation between the individual diagnoses and the numerical sequence of the survey despite the age and class of the patients. The present study, utilizing the figures of, and attendance at, our health service, represents 5,354 new diagnoses made from January 1928 to January 1936. The student group constituting the material of the study was composed entirely of men students in

In 1914 and 1916. 1 I reported a case of rhinoscleroma with the history and photographs of the patient during the periods before and after successful roentgen treatment. This was the first case reported in California, and the one presented in this paper constitutes the second. In an interesting article on rhinoscleroma, Figi and Thompson 2 reported three cases observed in the Mayo Clinic and suggested that the disease should be called "scleroma" because "in a large proportion of cases the infection is by no means limited to the nose." The absence of outer nasal lesions in the case reported in this paper led my associates and me to overlook the diagnosis for a time. A member of our staff, Dr. Esteban Reyes, of San Salvador, called attention to the fact that in the district from which our patient came, there were many cases of rhinoscleroma without external lesions.

For several years I have advised patients with mycotic infections of the hands and feet to apply ordinary vinegar twice daily as a cleanser. This has proved to be a useful auxiliary to other treatment. It also has served as a valuable prophylactic measure in the "after-treatment" of such conditions. Last year Dr. John C. Belisario, of Sydney, Australia, told me about his successful treatment with citric acid. His patients were advised to rub the raw surface of a lemon cut in half into the affected areas. Last summer, while at sea, I had an acute vesicular attack on one sole and one palm. For less than a week I rubbed in lemon several times daily, allowing it to dry. Aside from a temporary smarting and some "stickiness" for a while, the treatment was not disagreeable. The lesions disappeared in a week, the process ending in peeling. A subsequent recurrence

There have been many articles on the subject of panniculitis in medical literature. Numerous cases have been reported in which fat and muscle were involved but few in which fat alone was the seat of this painful, inflammatory process. This condition is characterized by the appearance of painful nodules in the subcutaneous fatty tissue, sometimes having the clinical aspects of erythema nodosum and resulting in localized destruction of fat with replacement by fibrous tissue and production of nodules either plainly visible or, if not visible, easily felt. Weber and Gray 1 in 1924, Weber in 1925 2 and Christian 3 in 1928 published cases similar to the one that we record here. REPORT OF A CASE History .— Mrs. K. S., aged 41, a Canadian nurse, retired, who had served during the World War, complained that frequently since 1918 painful nodules had appeared on the outer parts of

The date of accidental inoculation and the course of events in this case being definitely known, it is felt that a report would be of interest. CASE REPORT An intern, aged 25, while assisting at an autopsy on a patient with tuberculosis on July 8, 1929, pricked his left index finger (flexor aspect) with the knife. Two weeks later, he noticed a nodule the size of a pea at the site of the injury. He incised the nodule, but there was no pus. Within a few days, painful axillary (left) adenopathy developed. The epitrochlear glands did not become involved. The axillary glands slowly enlarged, and five months later became soft and fluctuating. The primary lesion constantly remained nodular and never became verrucose or pustular, but a very small amount of serum could be readily expressed. There had been no rise in temperature. At the time of examination, the

To the Editor :—In the September 1935 issue of theArchives(vol. 32, p. 468) I reported a case of dermatitis herpetiformis in a male student at Stanford University in which the lesions disappeared after an attack of German measles and again after fever therapy in the form of hot baths. At the time I was skeptical as to the effects of the fever therapy and suggested that the disappearance of the lesions possibly was influenced by rest from college work, change of environment and life in the open air at the seashore in Mexico. Then I did not know that the patient was taking a solution of potassium arsenite steadily and having his prescription refilled regularly. He had been told to take it no longer than a month. He wrote me stating that all of his summer vacation he had remained well. When I saw him after

The application of cold produces effects varying naturally with the skin's resistance, the temperature of the agent used at the time of contact, the amount of pressure applied and its duration. These effects are useful in a variety of dermatologic conditions. The local action of solid carbon dioxide has been well known for many years. Since 1906, when I was working in Dr. George Henry Fox's clinic (the Vanderbilt clinic) under Jackson and saw various uses to which solid carbon dioxide was put, I have been using this agent. At that time, to increase the cold, ether was added. Liquid air, being twice as cold, proved somewhat more useful than solid carbon dioxide, but it has always been difficult to obtain and to keep. For the past few months I have been using a new agent in this field, a freezing gas consisting of butane, isobutane and propane. When sprayed

We believe lichen planus to be a distinct disease, and we also believe it to be a constitutional disease with manifestations on the skin and mucous membranes. Lichen planus almost always occurs in its chronic forms, and as such its constitutional symptoms are frequently so slight as to escape detection. In the acute cases, however, the general constitutional symptoms become salient and form an important part of the clinical picture, of which the following is an example: HISTORY OF CASE Patient. —An obese, pulpy-looking Mexican woman, aged 40, and engaged in general housework, entered the University of California Hospital, July 8, 1908, with a very itchy tormenting eruption. She said that before its appearance she had worked very hard for some time and that for several months she had not menstruated. History. —Previous to this her menstruation had been normal, and she had enjoyed

Examination of excessively long nails reveals more or less separation from the nail bed. When the skin and nails are inclined to be dry this separation sometimes extends back almost halfway to the lunula. Since women have been cultivating long tapering nails and shellacking them with varnish of various hues, many cases of this condition are being encountered. The shellac dries and greatly hardens the nails, tending to make them form hard, rigid transverse arches and separate mechanically from the distal part of the nail bed. This tendency to separate is increased as the nails grow longer and pressure on the ends, which is exerted by many contacts during a day's activities, produces more leverage. As the shellac is removed frequently with acetone, this oil solvent adds its drying effect to that of the former. Frequently dry epithelial scales and other material accumulate under the nails, simulating onychomycosis, and sometimes

Case 1 (Serial No. 4266). —Leukoplakia of tongue and palate in an Irish painter, aged 68. The dorsum of the tongue is almost entirely occupied by a very thick hyperkeratosis (Fig. 1). There is a similar process on the hard palate. The lesions have existed for over thirty years. The patient has cerebrospinal syphilis (of the meninges), diabetes mellitus and chronic nephritis. These diagnoses have been established by complete physical and the usual laboratory examinations. Case 2 (Serial No. 26856). —Tuberculosis verrucosa cutis and epithelioma simulating blastomycosis in a Chinese laundryman, aged 55. For five years a slowly spreading granulating area has existed on the dorsum of the left hand (Fig. 2). The patient has been applying various kinds of Chinese remedies. Occupying most of the dorsum of the left hand there is a well-circumscribed "granulating" mass. Elevated about 3 mm. and slightly detached from it, a similar smaller lesion

I have reported two cases of rhinoscleroma in California previously,1and Bingham and Cutler2described a third. So far as I know, these are the only cases to have been reported in this state, although there may be many more undiscovered cases in this part of the country, for lesions are seen occasionally in the mouth only. It is possible that among the Mexican and Central American population there may be many "carriers." The subject of the present report lives in a district of the San Joaquin valley where there are many laborers from Mexico and Central America, but she stated that she had never seen any one with lesions like hers or like those in my collection of photographs. She was presented at a meeting of the San Francisco Dermatological Association in April 1936. REPORT OF CASE Mrs. B., an American housewife aged 29, was

At the meeting of the American Dermatological Association in 1922 I reported two cases of cutis verticis gyrata 1 and exhibited the scalp of the first patient in a Kaiserling preparation. In the first case there was no history or evidence of trauma, infection or past inflammation. Complete removal of the involved area followed by skin grafts produced excellent results. The second case presented typical lesions in the occiput of four years' duration. The process was gradually becoming more accentuated. Chronic inflammation associated with severe seborrheic eczema seemed to be the main etiologic factor. There was no history or evidence of traumatism. Lesion in author's third case. My third case, a photograph from which is shown, is that of a man 25 years old, an American baker. In the upper occipital region he presents lesions typical of cutis verticis gyrata. His head is of the dolichocephalic type. The pronounced ridges

I have had numerous examples of vocational dermatoses under observation in my private practice and also through the courtesy of the California State Industrial Accident Commission. The observations here reported are based partly on this experience. Many dermatoses are due principally to external influences and are aggravated and perpetuated largely by external causes. The occupation and habits of the individual naturally have an important influence on the course of these eruptions. It must not, however, be forgotten that there are often underlying conditions rendering the skin more sensitive and thus more easily injured. Cutaneous medicine embraces such a wide field, including as it does syphilis and diseases of the mucous membranes, that a brief paper could not possibly cover the subject. SYPHILIS In the case of syphilis, which is involved to a great extent in the diagnosis, prognosis and treatment of many dermatoses, it will be seen that the field

Cutis verticis gyrata has been well described by various authors since the first report by Jadassohn at the Ninth German Dermatological Congress in Berne. A recent interesting report and review of the literature by Wise and Levin 1 describes the first example of the anomaly observed in America. As far as I know, the cases that I am presenting constitute the second and third reported in this country. The condition is characterized by the appearance of deep furrows and convolutions in the upper posterior portions of the scalp more or less resembling cerebral convolutions. By many it is regarded as a congenital tendency to furrowing which becomes pronounced later in life. My first patient comes in this category. Some believe that the process is usually intensified by local inflammation. My second patient comes under this classification. Through the courtesy of Professor Lesser, I had the privilege of seeing a case

My experiences in treating a large number of cases of psoriasis locally with the mercury quartz lamp during the last few years have convinced me that this therapy constitutes a relatively satisfactory and cleanly method. While it is not invariably successful, I have often observed that psoriasis lesions clear up more effectively than under any other form of treatment except roentgenotherapy. For various reasons, I prefer the former; I believe that recurrences are delayed longer after successful ultraviolet light treatment. It seems to me to be safer and more desirable when the scalp is involved, although I realize that it is stated on very good authority that roentgenotherapy is safe and effective. I now have a patient with psoriasis in my care suffering from alopecia due to roentgen-ray treatments administered by a local expert for the eradication of psoriasis lesions of the scalp. The lesions have been eradicated, and so

Jacquemet and Goubeau's article 1 on the therapeutic uses of carbon tetrachlorid in cutaneous medicine first called my attention to its possibilities. For the past two years I have been using it as an external application, with satisfactory results. It is inexpensive, and when used with full knowledge of its possible depressing effects, is a comparatively safe remedy. Carbon tetrachlorid, or tetrachlormethane, is obtained from carbon disulphid and chlorine gas by heat (C Cl 4 ). Thorpe 2 discusses its chemistry. According to Jacquemet and Goubeau, 1 it is "a colorless liquid of a density of 1.6 with an agreeable odor (when pure) similar to chloroform (C HCl 3 ). It is a solvent of iodin, camphor, rubber, greases, and essential oils. It is miscible with alcohol, benzol, and petrol.... It has anaesthetic properties." Its successful internal use is noted in the treatment of uncinariasis in which as much as 3 c.c.

So many cases of disability reported to be due to sensitization to turpentine and paint have been brought to the notice of carriers of insurance that the question has become rather acute in California. Dr. Morton Gibbons, medical director of the Industrial Accident Commission of California recently appointed a Reference Board, consisting of Harry E. Alderson, chairman, Douglas W. Montgomery and Hiram E. Miller, to formulate answers to certain questions related to cutaneous sensitization. This action was taken partly on account of a case which had recently been appealed and partly because the commission desired to have an authoritative opinion to guide them in the handling of other cases. The case in question was that of a man who had worked as a painter for six years before having any skin trouble. At the end of that time he developed severe dermatitis venenata of the parts exposed in