Marion B. Sulzberger

Influence of Ascorbic Acid of Diet on Sensitization of Guinea Pigs to Neoarsphenamine

Frei reported 1 that he was able to sensitize the skin of guinea pigs to neoarsphenamine. One of us (S) observed 2 a high degree of variation in the response of different series of guinea pigs to this type of sensitization. Mayer and Sulzberger 3 concluded that the composition of the diet was of fundamental significance, for, the animals receiving summer fodder were resistant to sensitization (only 0 to 12% becoming sensitized), whereas animals receiving winter fodder were sensitizable 75 to 100%. The “seasonal” difference in the diets depended upon the inclusion or omission of greens. Sensitization of guinea pigs to paraphenylene diamine as well as their reaction to infection with a virulent strain of tubercle bacilli have been reported to be similarly influenced by diet. 3 , 4 Our attention was directed to the vitamin C content of the rations. When pure crystalline vitamin C became available, it was decided to use the synthetic product∗ as the source of vitamin C instead of citrus or tomato juice. Young guinea pigs weighing approximately 250 gm. were placed upon the scorbutogenic diet described by Demole, 5 consisting of 2 kilos oat flakes and one kilo dried whole milk (previously heated for 2 hours at 120°C.) made into cakes with the aid of 6 egg whites and baked on a greased pan for 20–25 minutes. 200 mg. per week of cod liver oil were fed each guinea pig and a small amount of dried hay supplied. After 10 to 15 days on this diet, the negative control animals commenced to lose weight and showed early signs of scurvy. Three to 4 weeks later they died and at autopsy further manifestatations of scurvy were found.

Incidence of Epidermal Methylcholanthrene Tumors in Mice After Administration of Cortisone.

Summary 1. Under the conditions of our experiments; the administration of cortisone to mice given external applications of methyl-cholanthrene in benzene or in carbowax 1500 was followed by some reduction of the early inflammatory response and by an increase in the incidence of epidermal tumor formation per number of animals, as compared with the results in the control experiments without cortisone injections. 2. Biopsy excisions performed in the methylcholanthrene-exposed skin areas appeared to increase still further the incidence of tumor formation in the mice treated with cortisone.

IMMUNOLOGIC CHANGES BROUGHT ABOUT BY FUNGI AND FUNGOUS PRODUCTS

From a very early date, research on the immunologic reactions produced by fungi has served as a sort of pioneer system of experimentation for the investigation of infections in general. Interest in experimentation with fungi lies not solely in the importance of fungous diseases themselves but also, as Bloch pointed out as early as 1908, in the fact that studies of fungous infections are such excellent simple means for investigating the immunologic happenings which occur in infections in general and that, in particular, there is such a close analogy, and in many respects identity, between the results of immunologic studies with fungi and those with the tubercle bacilli. Paradoxically enough, the recognition of pathogenic fungi can be said to have been the very beginning of the bacteriologic era. Indeed, Schoenlein’s recognition of the genus Ackorion as the cause of favus represents the first sure identification of a microorganism as the causal factor of a human disease. Further, one may fix the beginning of the immunology of fungous diseases as far back as 1902, when Plato and Neisser produced and employed trichophytin extracts analogous to the crude tuberculin of Koch. Very early, Gruby, and much later Sabouraud, two French dermatologists, studied the clinical manifestations of fungous infections of the skin, hair, and nails. They engaged in the clinical description and the cultural and botanical classification of the various types of fungi found in man and concluded that different diseases were caused by different fungi, not by the same fungus, Sabouraud showed that each species of fungus had a tendency to produce a particular form of disease. After this great advance, however, the subject was dead for many years. It appeared that most of the known fungi pathogenic to mammals had been classified and that nothing very startling or new remained to be described. This stagnation lasted until 1907 or 1908, when Bloch introduced the animal experiments into the studies of fungi. This inaugurated a long series of studies by many men. Then came a great list of workers, topped by J. Jadassohn, one of the originators, including Jessner, Truffi, Martenstein, Biberstein, W. Jadassohn, Saeves, Kogoj, and many others. Animal experiments with dermatophytic fungi were soon found to have substantial advantages over experiments with many other forms of pathogenic microorganisms. For example, the animals were not killed by the disease, nor was absolutely exact dosage required. The disease was practically confined to the skin and its appendages, so that everything that happened could be observed directly and at desirable intervals, histopathologically, microscopically, immunologically, and in many other ways. Then there were no special precautions to be taken in the laboratory to pre-

PANEL DISCUSSION ON THE CLINICAL MANAGEMENT OF SKIN DISEASE IN GERIATRIC PATIENTS

Moderator: CARL T. NELSON, M.D., Professor of Dermatology, and Chairman, Department of Dermatology, Columbia University, College of Physicians and Surgeons, New York, N. Y. Panelists: CHARLES R. REIN, M.D.,t Associate Professor of Clinical Dermatology and Syphilology, New York University Post-Graduate Medical School, New York, N. Y.; HARRY M. ROBINSON, JR., M.D., Professor of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland; STEPHEN ROTHMAN, M.D., Professor of Dermatology, University of Chicago School of Medicine, Chicago, Illinois; MARION B. SULZBERGER, M.D., Professor and Chairman, Department of Dermatology and Syphilology, New York University-Bellevue Medical Center, New York, N. Y.; EUGENE F. TRAUB, M.D., Clinical Professor of Dermatology, Temple University School of Medicine, Philadelphia, Pennsylvania.

Über die Anwendung von ACTH und Cortison in der Dermatologie

Wenn ich mich berechtigt fuhle, in diesem Rahmen etwas uber unsere Erfahrungen mit ACTH und Cortison in der Anwendung bei Dermatosen auszusagen, so nur deshalb, weil wir in den Vereinigten Staaten von Amerika eher und in groseren Mengen mit diesen nutzlichen und wertvollen Hormonen arbeiten konnten. Je langer wir uns mit diesen Hormonen des Hypophysenvorderlappens und der Nebennieren-rinde beschaftigt haben, um so interessanter und vielseitiger sind sie uns geworden und um so grosere therapeutische Anwendungsmoglichkeiten haben sich ergeben.

SOME CHAEACTEEISTICS OF THE CONTACT‐TYPE ALLEEGIC ECZEMATOUS PEOCESS IN MAN: A DISCUSSION OF ITS COMPAEATIVE IMMUNOLOGY AND MOEPHOLOGY.*

IN accepting the very kind invitation of Professor Charpy to prepare a rcport on some immunologic aspects of eczematous contact dermatitis, we are conscious not only of the honour but also of the great difficulty of our task. For purposes of clarity we shall attempt t o divide our subject as follows : (i) Some features which characterize the contact-type allergic eczematous reaction in man as an immunologic process, and help to differentiate it from non-immunologic forms of skin damage. (ii) Some dserences bet,ween allergic eczematous contact-type reactions in man and those in laboratory animals.

SKIN TRANSPLANTS‐HOMOGRAFTS

When I first received the invitation to participate in the conference on which this monograph is based, I felt that it would be presumptuous of me to accept and to think that I could possibly add anything to the expositions of Doctor Cooke. Twenty-five years of listening have taught me that it is always instructive to hear Doctor Cooke, always difficult to add anything to his thorough analyses. But then I thought that the inclusion of some dermatollogic experiences and ideas would, to say the least, not be entirely inappropriate in a conference so intimately concerned with the skin and its behavior. Undoubtedly failure of homografts to persist is a complex matter, not easily explained nor attributable to any single known mechanism. The dermatologist well acquainted with the unfathomable complexity and almost incredible individuality of the epidermis cannot be very much astonished by this fact. For the epidermis, with its appendages and other structures, is indeed one of the most highly differentiated and distinctive of all the tissues which go to make up the individual. I t is therefore quite understandable that the individual’s epidermis should be as characteristic of that individual and as different from the epidermis of every other individual as the individual himself is different from each and every one of his fellows. A very simple well-known example of this remarkable dermatologic individuality is evident in the design of the fingerprints, which so absolutely differentiate and identify each individual. I should like to mention briefly just three of the other types of characteristics which may confer individuality upon each epidermis.

MULTIPLE FACTORS IN THE ELICITATION OF SKIN DISEASES—AND HOW THIS CONCEPT MUST INFLUENCE OUR APPROACHES TO ETIOLOGY AND MANAGEMENT

Early in this century it was believed that diseases could be treated best by finding one specific agent that could kill the causal microorganism or specifically attack the pathogenic mechanism. This concept was based on the error of considering diseases as due to single causes, acting alone. We now know that this is not the case and that many important diseases are either initiated or maintained by multiple factors acting together. Sometimes it suffices to do away with just one of these pathogenic factors for cure or improvement to occur. This is why there exist so many different schools of thought, not only as to the proper medicament to use, but also as to the causal mechanism of a disease. Skin diseases often are among the best examples to illustrate clearly and simply some fundamental law such as this concept of multiple causation. Let us take for example acne vulgaris. Acne is undeniably an endocrine disease and caused by the male sex hormone-for that hormone is indeed the primary stimulant of the pilosebaceous apparatus leading to the production of the comedo and to the succeeding acne papules, pustules and, in some cases, cysts and scars. But it is equally true that there are powerful local factors in acne and that only certain predisposed pilosebaceous structures

Neue und wirksamere Methoden der dermatologischen Therapie

Wenn unser Fach weiter gedeihen und bluhen soll, was es sicher auch tun wird, dann mussen wir uns hauptsachlich zwei Aufgaben vor Augen halten. Die erste ist, das man die wissenschaftlichen Fortschritte, die fundamentalen neuen Erkenntnisse, die man hinsichtlich der menschlichen Haut und aus dem Studium der menschlichen Haut erzielen kann, immer weiter ausbauen mus, wie wir es auch in der Vergangenheit getan haben. Hierfur sind die Dermatologen wirklich pradisponiert. Die zweite Aufgabe ist, das wir das klinische Konnen und Wissen und die klinische Kunst beibehalten und weiter vertiefen mussen, so das wir die kranken Menschen heilen und ihnen helfen konnen.

Die Dermatologie im Wandel der Zeiten (Der letzten 30 Jahre)

Ich will damit beginnen, meine Gedanken uber dreisig Jahre in die Vergangenheit zuruckgehen zu lassen, bis zu der Zeit, als ich im Jahre 1929 in New York City mit Dr. Fred Wise zu arbeiten begann.