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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

A CASE FOR DIAGNOSIS. PRESENTED BY DR. GAMMEL. M. B., a German laborer, aged 40, who said that he had not had any venereal disease, presented a paper-like thickening and bluish discoloration of almost the entire glans penis, together with several small areas of telangiectasia. The condition was said to have begun on the prepuce two years previously. The preputial area had improved, leaving the glans involved. There had been no irradiation of any kind. DISCUSSION Dr. Cole: I have seen about six such cases and feel that the condition corresponds to kraurosis vulvae and may possibly lead to malignancy. I would treat it by electrodesiccation.Dr. Netherton: One part of the lesion resembled an early basal cell epithelioma. A CASE FOR DIAGNOSIS. PRESENTED BY DR. COLE AND DR. DRIVER. J. R., a man, aged 50, presented a generalized eruption which was said to have started three years before presentation

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,

Recent advances made in the study of the functional activity of the liver, by means of various tests, have stimulated the interest of the entire medical profession. Of particular note, perhaps, has been the use of dyes which are eliminated solely by the liver through the bile passages. The dyes used for this purpose include phenoltetrachlorphthalein, rose bengal, bromsulphalein, indigo carmine, methylene blue, congo red and others. Of this number, phenoltetrachlorphthalein and rose bengal have been more thoroughly investigated and have lent themselves to clinical use.It is but natural that the syphilologist should be among the first to determine the efficiency of these tests because of the frequency of hepatic complications seen in the syphilitic clinic. Rosenthal1 reports that cases of jaundice were eight and eight-tenths more frequent in the syphilitic clinic at Johns Hopkins Hospital than in the medical clinic during the same period. In this work

A Case for Diagnosis (Linear Nevus?). Presented by Dr. R. E. Barney.Mrs. R. F., a white woman aged 27, states that her father informed her that he had noticed a dime-sized pitted area on the flexor surface of her right wrist at birth. This area had increased in size, gradually extending up the arm.Involving the flexor surface of the right wrist, chiefly on the ulnar aspect, is an area half the size of a palm in which the skin shows a noninflammatory stippling. The process extends up the ulnar aspect of the forearm in a ½ inch (1 cm.) band to the junction of the middle and upper thirds.A biopsy specimen taken from the area on the wrist showed a moderate degree of hyperkeratosis, with flattening of the rete pegs. There was atrophy of the papillary layer of the corium and moderate fibrosis of the reticular

Localized Scleroderma. Presented by Dr. W. R. Hubler.A. E., a white woman aged 68, presented from the department of dermatology and syphilology, University Hospitals, has had a small white area with a slight red flare in the umbilicus and another over the right tibia for nine years. For three years numerous pruritic blebs have been appearing on the lesion on the leg, which has slowly increased in size. The patient traumatized this area two months ago, and a small ulcer has developed. Dyspnea and edema of both legs have been present for ten years.There is a large palm-sized slightly raised plaque on the anterior surface of the right leg showing pigmentation, depigmentation and atrophy. Portions of the area are red. There is a fixed nodular feeling to the lesion, and some deep-seated translucent nodules are seen. A sharply marginated dime-sized ulcer with a purulent base occupies the center of the lesion. There

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

A CASE FOR DIAGNOSIS (TUBERCULOSIS VERRUCOSA CUTIS? VERRUCA VULGARIS?). PRESENTED BY DR. C. L. CUMMER AND DR. C. G. LAROCCO. T. M., a Negro aged 27, presented from the department of dermatology and syphilology of St. Vincent Charity Hospital, has an irregular scar situated in the median line about 2 cm. above the tip of the nose. At the upper pole is a verrucous lesion about 1 cm. in diameter, surrounded by a slightly elevated border.The patient states that he had had a wart or mole on the tip of the nose for several years. In August 1940 he scraped it, as a result of a fall. This was followed by a scar and the appearance of the growth.The Wassermann reaction of the blood was negative, but because of a positive Kline reaction of the blood antisyphilitic treatment was administered and resulted in no change in the lesion.

TERTIARY SYPHILIS OF THE SKIN (GUMMA OF THE LIP). PRESENTED BY DR. MAX E. KRAUSE AND DR. E. B. HEISEL. J. J., a Negro aged 50, presented from the department of dermatology and syphilology, City Hospital, complains of a progressive, painless enlargement of the lower lip of two months' duration. He was seen first in the syphilis outpatient clinic in January 1939, at which time he had a positive serologic reaction of the blood for syphilis. He did not return for further observation until November 1941.He presents a diffusely enlarged, everted lower lip, which is approximately twice the normal size. The right three quarters of the lip is composed of a firm, nontender, flat mass, 2 by 6 cm. The left one quarter of the lip is soft and elastic. The vermilion border is smooth but considerably enlarged. There is no break in the mucous membrane, but there is