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One of us1 has already briefly commented on the possibility of utilizing vital agents like yeasts and other micro-organisms as therapeutic agents against fungus diseases, particularly because they might insure against recurrence. Thus far only one species had been tested, "Johnson's Yeast," and while it inhibited fungus growth in vitro, it failed clinically. It is common knowledge, of course, that many saprophytic fungi which contaminate plantings inhibit or at least overgrow many of the ringworm species in the test tube. This phenomenon is so frequent and so striking as to lead to the perhaps fanciful hypothesis that there might be micro-organisms living on normal skins which were acting as omnipresent biologic protectors against ringworm and other infections.The present communication represents a further examination into the situation, this time so arranged as also to include the bacteria. On actual test, an organism was found on four normal skins which

The material was obtained from necropsy subjects—from the chest, anteriorly, of a man dying of erysipelas and the arm of a negress who had been vaccinated nineteen days previously. I have not attempted to compile a comprehensive list of suppurative conditions in which metaplasia may occur, because the application of the finding was not to those diseases, but to the morbid cytology of sweat glands.In both of these dermatoses, the inflammatory leukocytic exudate and congestion which are usual in severe acute inflammatory processes were present around all the appendages, and in the case of some of the sweat ducts and glands polymorphonuclears could even be found in the lumen. As regards the sweat duct cells, we are thus dealing reasonably with a reactive hyperplasia which is of the same order as that seen so often in the epidermal ones in chronic dermatoses and which was also present in this

TINEA CRURIS (DHOBIE ITCH). PRESENTED BY DR. BROWN. W. D., a white man, aged 28, presented a sharply marginated eruption with an elevated papular border, 8 inches (20.3 cm.) in width and 10 inches (22.8 cm.) in length, extending over the buttock. The condition was of five years' duration and started while the patient was in the United States Army. It was preceded by an eruption on the toes which in a month was followed by the development of a circinate lesion in the genitocrural region. It had been treated by roentgen ray for a considerable length of time, the patient being given one-fourth skin unit each week. DISCUSSION Dr. Weidman said that when there was considerable papular element present in these cases they were particularly refractory to treatment. A CASE FOR DIAGNOSIS. PRESENTED BY DR. GREENBAUM. A white man, aged 54, presented on the anterior surface of both legs

Although an uncommon condition, xanthoma tuberosum gives such a striking clinical picture and can be diagnosed so readily that unless there are additional features that reflect something of its cause, clinical reports alone are now passé. Necropsy reports are rare, but of these a sufficient proportion has disclosed analogous internal changes to indicate that in the future search for these should be made. In the first of our cases only the tendo patellae was affected in addition to the skin; but in our second case, the lungs, liver, skull, pineal body, pituitary and tuber cinereum were invaded, attaining, we believe, the high-water mark for extracutaneous xanthic involvement to date. Other features which threw sidelights on established or controversial phases of the disease were the association of xanthoma planum in Case 1, and of jaundice and hypercholesterolemia in Case 2. REPORT OF CASES CASE 1.— Russell G., aged 36, white, who

In recording these dermatologic states, I feel that a word of justification is appropriate, for, with only one minor exception, namely that of scabies, a knowledge of them can never be of any direct value in the practice of dermatology. The value of this knowledge lies in the relation of these conditions to the basic processes of dermatology; and involves that comparison of human diseases with those of the lower animals which is known as comparative pathology. The value of this line of attack on the hidden things of medicine is just becoming realized in general medicine, as is shown by the comparatively recent establishment of chairs of comparative pathology in some of our universities.A comparison is made of the differences and similarities in the manifestation of a disease in several animal species. Then, by analyzing these data (preferably from a series of cases), and taking into consideration known

By this time, the medical profession has become thoroughly aware of the danger which lurks in the surgical use of paraffin for cosmetic purposes, but, although by now almost an old story, the discussion pro and con still goes on. Thus, one of the most recent pronouncements is that of Davis,1 who concluded that for paraffinomas to develop in the skin there must be a predisposition on the part of the patient, since the majority of people into whose skins paraffin is injected do not develop paraffinomas. (The reader must keep in mind that we are speaking now of solid paraffin and not paraffin oil.) He concludes, on the other hand, that "the affliction is common enough to clothe the procedure of paraffin injection with a distinct risk," and that occasionally even epithelioma may develop. Oppenheimer,2 too, has voiced a condemnatory note. On the other hand, an Englishman,

To one who has done cultural work on both the Blastomyces and the Hyphomycetes it is easy to understand how isolated elements of the one may resemble those of the other. But when it comes to dermatologic examinations of scrapings, pus, etc.—tissue products in general—we have been in the habit of believing that the Blastomyces should appear as round cells unassociated with mycelia, more or less, and vice versa for the Hyphomycetes. This still holds good as a general rule, and may turn out to be an absolute one when we come to know more about the genuineness of the pathogenicity of these higher fungi.I have already cited an instance (illustrated) in which the scrapings from a case of ringworm of the nails showed bodies resembling Blastomyces,1 and in which the bodies were reproduced later by Penicillium brevicaule which was isolated in the cultures. Here a Hyphomycetes produced

It will be unnecessary to explain the need for the work above indicated to any one who has attempted the culture, particularly the identification of the ringworm fungi. For the sake of others, let it be said, first, that the proposition is very different from the cultivation of the bacteria, and that the difficulties are not along microscopic lines, but preeminently from the gross morphologic standpoint. Yet more precisely, we are not concerned so much with the matter of luxuriance of growth, for at present our fungi grow easily enough. Rather are we trying to coax out differential characteristics. It is with the latter phase that this paper has to deal; but before proceeding to our experimental work some preliminary considerations must be offered to make the work understandable.The problems before us can best be comprehended by keeping in mind throughout that the molds are plants. Much higher than

DURING the half century following Gilchrist's delineation of North American blastomycosis as an entity in 1896, it became firmly established by many observers that the disease exists in two widely divergent forms. In one, the skin alone is apparently involved in a chronically progressive, ulcerative, granulomatous, and cicatrizing process, which usually persists over many years without affecting the general health of the patient. In the other, the lungs are the primary focus, from which the disease as a rule soon becomes widely disseminated, usually causing death. Rarely has a combination of these two forms, or a transition from one to the other, been observed. It has been widely accepted that this sharp differentiation occurs because of variation in the portal of entry of the infection, direct inoculation of the organisms into the skin causing the chronic cutaneous type, and inhalation into the lungs resulting in the

MANY years ago, Mitchell stated picturesquely that when there were failures in the culture of scrapings from the toes, the attempts should be repeated "not seven times, but seventy times seven." Still, most texts treat only superficially or not at all of the necessity of using discrimination and care when selecting cutaneous scrapings for microscopic examinations and of collecting and planting an abundance of material when the cultures are essayed. Doubtless some dermatologists are aware of this, but many of them do not practice it. In any event, it is a common experience in the Laboratory of Dermatological Research at the University of Pennsylvania to receive a dozen or less particles of scrapings, perhaps crushed and adherent between two glass slides which are bound together with rubber bands, with the request that both microscopic examination and culture be performed. This is not serious in the case of material from lesions

FEW CASES of the rare disease dystrophia unguium mediana canaliformis have been reported. It was first described by Heller in 1928,1 who gave it its name. Since then, Wucherpfennig,2 Ledo,3 Pardo-Castello,4 Costa5 and Fowle and Wiggall6 have presented similar cases. The disease is characterized clinically by a canal which runs the length of the nail, from the root to the free edge where it becomes fissured. Thus far, the causative agent has not been determined.Treatment has had varying results. The disease in Ledo's case responded to roentgen rays; in Pardo-Castello's and in Costa's, it did not. Fowle and Wiggall reported that the disease in their case cleared completely in a year and a half after three carious teeth were extracted.This case is reported largely because it is a dermatologic rarity and because it demonstrates the clinical symptoms in such a classic form.

COMMONLY, Hodgkin's disease expresses itself on the skin in a nonspecific manner, such as by pruritus, urticaria and scaly erythrodermas. Relatively seldom do granulomatous lesions appear. In our case, five biopsies of specimens of the skin and two of specimens of the lymph nodes furnished an unusual opportunity for correlation of the reactions in these two tissues and for observation of the tissue processes from their beginning to maturity. Moreover, polymorphonuclear leukocytes were present in enormous numbers; the neutrophilic ones, which are so rare in this disease, bespoke an acute type of reaction, and the eosinophilic ones raised the question of whether eosinophilic granuloma of the skin was related. REPORT OF A CASE The patient was first seen at Grady Hospital on May 29, 1935, with a complaint of painful menstruation. The past history was essentially noncontributory and insignificant. The blood pressure was 160 systolic and 95 diastolic. The other

THREE other reports concerning eosinophilic granulomas of the skin appear concurrently with mine in this issue. In them collectively, a full perspective of the world's literature and the history of this disease can be gained, and accordingly these phases of the subject need not be repeated in detail. The same is largely true of the bibliography; the reader is referred to Lever's comprehensive one, which leads into the ten European reports. Incidentally, the reader will be impressed by the abruptness with which the subject has appeared in the American literature and the confusion which exists as to its pathologic significance. Accordingly, this communication can be confined largely to its reports of cases and emphasis on the pathology. PRIORITY AND NOMENCLATURE It is important to determine priority because it is necessary in the attempt to establish a definition for eosinophilic granuloma of the skin. According to the laws of priority in

Much has been done in recent years to clarify our views regarding that interesting and rather unusual group of conditions formerly known as purpura. Hemophilia, scurvy and other diseases displaying a tendency to hemorrhage have been weeded out of the group; the coagulation phenomena have been the subject of much careful study, and yet purpura remains an ill-defined borderline condition between internal medicine and dermatology, about which considerable confusion still exists. The case here reported represents a rare if not unique disease, but is presented not so much on this account as because it throws some interesting sidelights on purpura as a whole.REPORT OF CASEHistory.—Mrs. K., a schoolteacher, aged 25, of Irish and Scotch ancestry, seen Oct. 30, 1922, complained chiefly of spots on the skin and burning of the lower extremities. There was no history of any similar condition or undue tendency toward bleeding, on either

I wish first to touch on the injection of paraffin, a substance which, while not an oil, has a similar pathologic significance, besides being closely related chemically to liquid petrolatum. Furthermore, the more recent findings in connection with liquid petrolatum injections throw a side-light on the paraffin ones which justify this digression.PARAFFIN INJECTIONSEvery medical man is by this time aware of the untoward effects which sometimes follow the injection of paraffin for cosmetic or other purposes; so much so, in fact, that the term paraffinoma now has a familiar ring, and that the use of this substance in plastic surgery has been almost abandoned.Davis1 brings out that not every person thus treated develops a paraffinoma—that there must be a predisposition on the part of the patient; and, from this the final verdict for or against paraffin must depend on the frequency of the development of paraffinomas

We are restricted to the above title, because we cannot conclude within reason that the disease definitely conformed either to human measles or to scarlatina. As will appear later, the earlier phases resembled measles and the succeeding ones scarlatina, particularly in the extensive desquamation, which was the most picturesque feature of the case. The animal was tractable and easy to examine, and was the same animal in which scabies was described in a preceding paper.1 This is the chronology of the case:July 3, 1922: The animal's appetite became poor and the stools were loose.July 5: She became depressed, and the skin became warmer than normal. There were no râles in the chest, but noises indicating mucus in the nose could be heard—yet there was no discharge. There was no pharyngitis. A scattered, shotty, papular eruption was present over the more glabrous parts of the face, on the

We came upon this method of study during an attempt to demonstrate in cultures the same invisible and unstainable mucinoid coating on Torula histolytica1 that we saw in tissue, and which was only inferred to be there on account of the halo which appeared between the yeast cells and the surrounding tissue.For demonstrating the coating by the ink method, one must work fast because the ink dries rapidly. A loopful of India ink is placed on a glass slide, and a loopful of the solid (or pasty) culture material is quickly emulsified in it. A large coverslip is quickly applied and pressed gently, to make the emulsion spread over as great an area as possible. The drop must be small; othewise, too thick a film will result and the halo effect will be obscured. It is better that there shall be insufficient fluid to quite fill the space

In the August, 1925, number of the Archives of Dermatology and Syphilology1 we reported a case of multiple sarcoid-like granulomas of the skin of undetermined nature. The patient has since died. We herewith report necropsy findings and further laboratory studies which show that the eruption was of tuberculous origin. REVIEW OF REPORTED CASE The case was that of a negress, aged 23, who presented a widespread generalized papular, squamous, nodular eruption which first appeared in December, 1922. The lesions were psoriasiform and infiltrated; some were annular, and others followed the natural line of cleavage of the skin. In the course of twenty-one months, almost all of the lesions involuted, with scar formation, some with prior ulceration. The scars were soft and pliable, resembling the scars of syphilids.There were constitutional and objective symptoms of an infection, the nature of which was undetermined. Tuberculosis was rightly suspected, but not proved.

TO THE EDITOR:— The editorial in the April number of the Archives in regard to the "study of ringworm in America" has struck a responsive chord in the staff of this laboratory. It is most timely and likely also to stimulate others who have been prying into the edges of mycology, but who have received no encouragement because the importance of the subject did not appear to be as generally appreciated as it should be, and because they felt comparatively isolated in their work. The end-effect under these circumstances would be a decreasing interest in, and finally a cessation of, such investigation in many cases. We welcome the editorial, therefore, as calculated to reveal and focus these scattered activities in mycology and to open avenues of communication between them that will encourage and sustain the work in each center.The main purpose of this communication is to announce that this

The ophthalmologists are well acquainted with retention cysts of the glands of Moll. Duke-Elder's encyclopedic textbook of ophthalmology1 describes them as pinkish, transparent vesicles noted only in the ciliary margin of the eyelid. They develop slowly and may reach large size without any tendency to shrink or disappear. They may be unilocular or multilocular. Simple puncture of the cyst empties it, but recurrence is the rule. Excision or destruction by electrodesiccation is the only satisfactory type of treatment.During the last two years we have seen four patients with retention cysts of the glands of Moll. Recognizing that this gland belongs to the apocrine group of sweat glands, one would suspect that apocrine sweat-retention cysts could occur wherever apocrine glands are found. However, the medical literature is silent on this point.Our initial studies rapidly convinced us that apocrine sweat-retention cysts are actually common in apocrine

The fact that during pregnancy a hormone is eliminated in the urine naturally prompts thoughts to other secretions such as the saliva, sweat glands, etc. The last named are such remarkably efficient agents in preventing the elimination of certain body products and drugs1 that the opportunity must not be lost when presented to inquire whether this extends also to hormones, particularly since the presence or absence of this hormone has been made so unequivocal of late and been so whole-heartedly accepted as a diagnostic test for pregnancy.TECHNICPerspiration was collected in a rubber sheet from six colored women, all in the eighth to ninth month of pregnancy, by means of the electric light cabinet. A vulvar pad was applied to prevent possible contamination of materials by urine. Abundance of water was urged on the subjects, but no drugs were administered. As 100 cc. of perspiration suffices for a

Templeton1 and others2 have already indicated the value of high frequency currents in the treatment of various dermatoses requiring excision, and others have indicated the value of the so-called radio knife in such major procedures as amputation of the breast. The present communication, however, has nothing to do with such phases of the field. It is true that Templeton spoke of the usefulness of this modality in performing biopsies and exhibited several photographs. However, the attempt was not made in such presentations to distinguish between the value of the coagulating and cutting currents. It is to this particular phase that the present communication is confined.It has been the experience of doubtless many pathologists to have specimens submitted for histologic examination which have been removed by the coagulating current and in which the severity of the coagulative processes has been sufficient to compromise or even destroy the value

Discusses the role of industrial relations in keeping skilled workers. Shortage of skilled labor in the United States; Investment in technical and customer-service training; Need to emphasize lifelong learning to employees; Hippo Award given out at Americom.

To the Editor:—In The Journal, August 8, page 456, McNair critically reviews our report on the preventive treatment of ivy poisoning. As I directed the studies which, he says, should have been "more scientifically conducted," the duty is mine to point out wherein McNair has not quite grasped the situation.McNair is the author of a monographic treatise on Rhus dermatitis which covers all its phases and includes much original work; apparently he has not perceived the difference between the scope of a monograph and a report like ours, designed to be printed in a publication such as The Journal. Our communication reported our facts to the general medical practitioner, facts of which the doctor could avail himself in his approach to the problem of human welfare. Findings of more abstruse scientific interest could be pointed out only in passing. We did not pretend to exhaust all the ramifications—indeed,

In The Journal, Oct. 3, 1925, page 1066, an editorial appears entitled "The Synthesis of Cholesterol in the Body." It is indicated therein that feeding experiments have shown that cholesterol need not have its source exclusively in the diet.We submit further evidence on this point in the form of Dezani's work (Arch. di farmacol. sper.12:4, 1914). He fed measured quantities of cholesterol to white mice, and on analyzing their entire carcasses, found that the total amount of cholesterol therein was greater than what could be explained on the basis of that ingested.The subject of cholesterol synthesis comes to medical men by various avenues. Foremost among these are the various considerations associated with hypercholesterolemia, in connection with which certain tissue changes may come about or be experimentally induced. Some, notably the atheromatous aortas of rabbits, have been repeatedly and rather uniformly elicited, but others, such as xanthoma

To the Editor:—In The Journal, July 12, Harris and Hauser published their paper on "Bromide Intoxication," in which success therapeutically depended on the replacement of bromine ions by chlorine ions; in this connection may I direct credit for originality where, I believe, credit is due.The principle that the excretion of chlorides could be hastened by the administration of bromides and iodides, and that, conversely, the administration of chlorides hastens the elimination of the other two, was developed as far back as 1902 and 1911 (Sollmann: Manual of Pharmacology). Credit for the application of this biologic fact to therapeutics belongs, however, to the dermatologists Wile, Wright and Smith (Arch. Dermat. & Syph.6:529 [Nov.] 1922). A second report by Wile (Arch. Dermat. & Syph.8:407 [Sept.] 1923) in 1923 included the treatment of bromide intoxication as well as bromide dermatoses. Later, Stevenson (Arch. Dermat. & Syph.12:

TO THE EDITOR: —In connection with Doctor Rosser's article, "Chemical Rectal Stricture" in The Journal, May 23, may I call attention to one by myself, "Camphorated Oil Tumors" which appeared in The Journal, Jan. 7, 1922, as well as two others, "Experimental Production of Paraffin Oil Tumors in Monkeys," in the February issue of the Archives of Dermatology and Syphilology, and "The Danger of Liquid Petrolatum in Parenteral Injections," in The Journal, June 16, 1923?In the last paper, it was pointed out that the dangers were present whether the material was injected into the skin, scrotum or serous cavities and that injections of oil are made even into the larynx and lungs. Dr. Rosser has added another location.I am prompted to write you mainly to supply reference to the work already done in the skin which has thrown light on the nature of the reaction and the pathology