Robert P. Warin

Reticulohistiocytosis (Lipoid Dermato-arthritis)

medical attendants during the intensely distressing period of maximal disability is invaluable. Once deterioration appears to be checked a reasonably confident prognosis can be given-though a warning should be issued of the possibility of personality changes during the convalescence and the rather more remote danger of permanent impairment of intellectual capacity. Summary A description is given of eight examples of a clinical syndrome of gradual onset in which develops almost total paralysis of all motor function, originating first in the mid-brain and later in the whole brain-stem, accompanied by only mild pyramidal or long-tract sensory disturbance, and no cardiac or respiratory abnormality. From a stationary stage of extreme gravity, dramatic total recovery has occurred in seven cases, with no neurological sequelae. The pathology of the fatal case is described, and a state of transient cerebral oedema, possibly related to a systemic virus infection, is suggested as the basic cause.

Role of candida albicans infection in napkin rashes

Skin scrapings, mouth swabs, and faecal specimens from children with eruptions in the napkin area and from a series of normal infants were examined for the presence of Candida albicans. This was found in 41% of all napkin eruptions but in only one of the 68 normal infants. While C. albicans is a common secondary invader of all types of napkin eruption, primary Candida infection of the skin in the napkin area is probably uncommon. No evidence was found that generalized psoriasiform or eczematous eruptions occurring in association with napkin rashes are due to an allergic response to the fungus. C. albicans is more likely to be present in a napkin rash if the organism has been found in the alimentary tract.

Studies in the Epidemiology of Tinea Pedis—VI

fungus is widely scattered in the soil it is all the more surprising that it has not been incriminated more often as a source of epidemic spread. A factor which possibly contributes to this state of affairs is that most studies on the epidemiology of fungus infections have been made in cities, and such infections may not be investigated when they occur in country districts. Difficulties in transport and either the necessity of sending patients a distance to hospital or unwillingness to collect appropriate samples, together with the rapid response made to treatment of infections with this fungus, all contribute. Another which is possibly applicable only in rural communities was noticed in this epidemic. Treatment of one patient was tantamount to treating several in that, once a diagnosis had been reached on one patient, a number made their own diagnosis and proceeded to share the same ointment pot. Once a patient was satisfied with his own clinical improvement the appropriate medicament was rapidly loaned out to some other group of sufferers. In the present instance this admirable community spirit certainly militated against collection of appropriate skin samples. Although 13 patients developed lesions on their arms, only two had them on their hands, possibly because the patients washed only their hands after work. There was no history of trauma, but it is not impossible that the coarse texture of the cucumber plants could have caused mild trauma of exposed parts of the body. Under greenhouse conditions the skins were moist with sweat. Although the first lesions seen in the surgery were dry and scaly, half of the total patients had lesions which showed vesicle formation and two patients developed florid ringworms with marked inflammatory reaction. The lesions in the secondary outbreak were all minor and without inflammatory response; that is to say, the ringworms contracted by spread from patient to patient appeared to be less virulent. The two florid lesions with marked inflammatory reactions were contracted from soil. Multiple ringworms were found only in those patients infected in the greenhouse. Untreated, the ringworms ran a self-limiting course of five to six weeks. Whitfields ointment was effective in all cases treated. Two months later two of the patients were seen again, and still showed some discoloration of the skin at the site of their ringworms.

Prognosis of Eczema-asthma Syndrome

two showed clinical signs and one more animal had centralnervous-system lesions. Of 30 monkeys injected by the same route with Sabins strain, 15 showed lesions of the central nervous system and in six the lesions spread to the brain stein. Since none of the 30 monkeys showed clinical signs, choice of Sabins type 1 strain as a reference strain was accompanied by the requirement that no paralysis should be observed after intramuscular injection, but no mention was made of lesions of the central nervous system. It can be easily argued that lesions observed in the brain stem after intramuscular inoculation are as indicative of residual neurovirulence as actual paralysis. Ignoring these facts might be taken to indicate that the monkey safety standards were picked to fit a particular strain and not the strain to fit the standards. The Surgeon General qualified his choice of Sabins type 3 by referring to its relatively poor immunizing properties and to the fact that it changes in neurovirulence for monkeys after one passage through man. The Koprowski type 3 vaccine has better immunizing properties and is identical with the Sabin type 3 vaccine after passage through man. It is therefore difficult to understand why the Sabin type 3 vaccine was the only type 3 strain approved. In addition, since all the vaccines tested in monkeys had probably been contaminated with monkey virus (vacuolating virus), it would be dangerous to make any generalization until it can be proved in what wav such an agent has affected the results of the neurovirulence tests.

Hydrocortisone ointment in the eczemas.

Cortisone has been tused with dramatic effect in diseases of the skin. Unfortunately, the side-effects of cortisone therapy are hazardous and limit its use in dermatological practice to potentially fatal illnesses such as pemphigus, disseminated lupus erythematosus, and exfoliative dermatitis. The local application of cortisone has little or no anti-inflammatory effect on the skin, though it has been of value as an ophthalmic application, being readily absorbed through the conjunctiva. Hyd-ocortisone has been found to exert antiinflammatory effects when applied to the skin as well as when administered systemically. No systemic effects have been reported in the hundreds of patients who have used hydrocortisone ointment, and Smith (1953) found no significant change in the circulating eosinophil count when ointment containing 150 mg. of hydrocortisone was applied to normal or diseasedskin.

Fungal infections of the skin.

Infections of the skin by various species of the yeast Candida, commonly C. albicans, have become more frequent in recent years, and their recognition and treatment are important. These fungi are frequent commensals in animals and men, and are present in the alimentary tract and mucosa of many people. They may become pathogenic on the skin if local and general conditions become suitable. They prefer moist sites (Fig. 1), scaling cracked skin, and pockets between the nail fold and nail plate ; and skin contaminated with sugar from glycosuria or from which bacterial competition has been removed by the use of antibiotics. General conditions favouring growth include debility and serious illness, diabetes, antibiotic and steroid therapy, and rarely hypocalcaemia. Candida infection is recog nized by the well-defined edge of the inflamed area, which is often undermined, and the adjacent skin may show small super ficial pustules, which rupture and leave a tiny circle with a raised edge. Evaluation of mycological reports on scrapings can be difficult, and a positive culture is of little significance unless fungal elements are found on direct microscopy.

Treatment of Gout with H.P.C

medical practitioners who are not specialized and who are by common (expert) consent recognized as good and efficient. I should ask these to answer questions based on the matter they were taught at medical school. I should then eliminate from the medical curriculum factual teaching which is remembered by less than 10% of those asked for their answers. I think Dr. Wilson, if he had gone to medical ,school in the era thus reformed, would have opportunity for boasting at least cultural equality with those educated in other faculties, and most likely he would not be a worse but a better doctor as well.-I am, etc.,