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Causative factors in the development of hypertension are numerous; however, one common denominator in the hypertensive state appears to be sympathetic predominance over the vasoconstrictor mechanisms responsible for maintaining arterial blood pressure. Today, there are available a number of therapeutic agents that are capable of lowering the blood pressure by "blocking" the flow of nervous impulses over the sympathetic nervous system. The majority of these drugs are impractical for routine use, because of the development of tolerance or the presence of untoward side-effects or because they are destroyed in the gastrointestinal tract and must, therefore, be given parenterally. Despite this fact, great impetus has been given to the search for more effective agents that can be administered orally and that will lower the blood pressure on a long-term basis and thus arrest the progression of the disease. Frequently, original reports on potential hypotensive drugs are enthusiastic, yet, when the drugs

From a chaotic group of hyperkinetic manifestations Friedreich separated an entity which was characterized by rapid, lightning-like twitchings of the muscles, or myoclonia. This syndrome, now known as Friedreich's paramyoclonus multiplex, he ascribed to abnormal irritability of the cells of the anterior horn. In 1891 Unverricht1 demarcated still another nosologic entity of myoclonic phenomena associated with epilepsy. He described several cases from the previous literature and added observations on a family composed of 5 sisters. These patients were afflicted between the ages of 6 and 13 years, first with generalized convulsions, followed in a few years by the onset of myoclonia consisting of irregular, arrhythmic lightning-like jerks of muscle groups without movements of the extremities. These affected both upper extremities first and involved the face last. Sleep abolished the movements; external disturbances, psychic upsets and volitional muscular effort increased them. Unverricht, too, expressed the belief that the myoclonia is

LICHEN MYXEDEMATOSUS. PRESENTED BY DR. JAMES F. MADISON AND DR. JOHN R. HASERICK. HISTORY: This 40-year-old white female was in good health until the fall of 1959 when her earlobes became "sensitive" to touch, and she noted redness of the bridge of the nose and coarsening of the skin over the glabella. During the next 8 months, the patient developed transient flushing on the thighs, followed by the appearance of asymptomatic flesh-colored papules on the knees elbows, arms, earlobes, cheeks, forehead, nose, and dorsa of the wrists and fingers, in that order. In July of 1960 the patient noted persistent erythema of the face, sparing the periorbital skin and giving the appearance of having been sunburned while wearing dark glasses. Beginning in October, 1960, the patient experienced mild swelling of the fingers, stiffness of the knees and ankles, soreness in the tibiae and heels, and numbness and cyanosis of the

Because of the present extensive use of metrazol (pentamethylenetetrazol) in the treatment of the psychoses, and since it is clinically administered for cardiac and respiratory collapse, it was decided to report the serious complication of status epilepticus which occurred in the course of treating a psychotic patient. REPORT OF A CASE F. R., a white youth aged 18, was admitted to the Kankakee State Hospital on Jan. 5, 1935. The patient's maternal uncle, H. M., had been an inmate of this and other institutions for many years, with an illness diagnosed as paranoid dementia praecox. The patient's brother, D. R., had been confined here in 1929, and in various other sanatoriums; his illness was diagnosed as "mental deficiency with psychopathic tendencies"; he is at present in an institution for the criminally insane. Other than the aforementioned cases, the family history was negative for mental disease. No history of a convulsive

LETTERER-SIWE DISEASE (ACUTE DISSEMINATED HISTIOCYTOSIS X). PRESENTED BY DR. A. E. WALKER, DR. J. J. STEWART, AND DR. P. J. CRONE. HISTORY.— A 6-month-old white male infant was first seen at the age of 2 months with a reddish, blistering, seborrheic eruption on the scalp, face, neck, chest, arm folds, palms, the plantar aspect of the feet, and groin. Several nonpainful ulcers of the mouth also were present. The eruption appeared shortly after birth as discrete, firm nodules on the plantar and palmar areas. The eruption gradually spread, but the child gained weight, increased in size, and appeared to be healthy until approximately 3 months of age, when he suddenly became easily irritated, developed anorexia, skin pallor, and a hacking cough. This was followed by the onset of a fever, drainage from the right ear, and a marked enlargement of the right side of the neck. PHYSICAL EXAMINATION.— This

PEMPHIGUS FOLIACEUS. PRESENTED BY DR. WILLIAM E. CLENDENNING. A 50-year-old Negro man was admitted to University Hospitals on June 1, 1959, with a threemonth history of a severe, progressive vesicular and bullous dermatitis. The eruption began in the left inguinal region and subsequently became generalized. Initial examination showed a generalized eruption of which the primary lesion appeared to be a vesicle on an erythematous base. Initially the contents of the vesicles were clear but rapidly became turbid. The vesicles extended in arciform and gyrate fashion eventually forming large plaques covered with a thick scale. Nikolsky's sign was negative. There was a musty, foul odor.Initial biopsies revealed subcorneal vesicles filled with acute and chronic inflammatory cells. A diagnosis of subcorneal pustular dermatosis was considered, and the patient was given short trials of Kynex and sulfapyridine without improvement. Further biopsies showed acantholysis of the granular layer more consistent with pemphigus foliaceus