122 EREAUX: DERMATOLOGY Canad. M. A. J.Feb194, ol.'70

`6. MNARGOLIN, S. G.: Psychotherapeutic Principles inPsychiosomiiatic Medicine, in WXittkower, E. D. andCleghorn, R. A.: Recent Developmnents in Psycho-somatic MIedicine, J. B. Lippincott Co., Philadelphia,in piress.

'9. RUESCH, J.: Dialectica, 5: 99, 1951.30. SZASZ, T. S.: Psychoamalyt. Rev., 39: 115, 1952.:31. Wisomm, J. O.: Brit. J. M1. Psychol., 26: 15, 1953.32. LINN, L. AND GOLDMAN, 1. B.: Psychosom. Med., 11:

307, 1949.33. .MACGREGOR, F. C.: Psychosom. Med., 12: 277, 1950.34. MAIACGRECOR, F. C.: Am. Sociol. Rev., 16: 629, 1951.35. BARKER, R. S., WRIGHT, B. A. AND GoxIcK, M. R.:

Social Science Research Council Bulletin 55, NewYork, 1946.

.3-6. AW'IrTKOWER, E. D. AND DAVENPORT, R. C.: Psychosom.Med., 8: 121, 1946.

37. Idem: Occup. Med., 3: 20, 1947.:S. HA'MBURG, D. A., ARTZ, C. P., REIss, E., AmSPACHER,

W. H. AND CHAMBER, R. E.: Newv England J. lied.,248: 355, 1953.

39. HAMBURG, D. A., HAMBURG, B. AND DEGOZA, S.:Psychiatry, 16: 1, 1953.

4 0. SAND, R.: The Advance to Social Medicine, TheStaples Press, London and New York, 1952.

41. RYLE, J.: Changing Disciplines, Oxford Univer-sityPiress, London, 1948.

4 2. HALLIDAY, J. L.: Psychosocial Medicine, WK. WX. Nortonand Co., Inc., New York, 1948.

43. RUESCH, J., HARRIS, R. E., CHRISTIANSEN, C., LOEB,N. B., DEWEES, S. AND JACOBSON, A.: DuodenalUlcer-A Socio-psychological Study, Univ. of Cali-for-nia Press, Berkley, 1948.

4 4. RvESCH, J., HAfIRIS, R. E., LOEB, N. B., CHRISTIANSEN,C.. DEWEES, S., HELLES, S. H. AND JACOBSON, A.:Chronic Disease and Psychological Invalidisnm, APsychosomatic Study, tTniv. of California Piress,Be-kley, 1951.

4.5. BERLE. B., PINSKY, R., WOLF, S. AND WOLFF, H. G.:J. A. 31. A.. 149: 1 6 2 4, 1 9 52.

46. STANTON. A. H. AND SCHAVWARTZ, M. S.: P'sicliiatry, 12:243. 1949.

47. SCHWARTZ, M. S. AND STANTON, A. H.: Psychiatry, 13:399, 1950.

48. GORDON, J. E.: Am. J. PUb. Health, 39: 504, 1949.49. GORDON, J. E., O'ROUTRKE, E., RICHARDSON, F. L. W.

AND LINDEMANN, E.: Amn. J. M. Sc., 223: 316, 1952.50. REDLICH, F. C., HOLLINGSHEAD, A. B., ROBERTS, B. H.,

ROBINSON, H. A., FREEMAN, L. Z. AND MYERS, J. K.:Ant. J. Psychiat., 109: 729, 1953.

51. HALL, O.: Caat. J. Ecot. & Pol. Sc., 12: 30, 1946.52. Idemt: Amn. J. Sociol., 53: 327, 1948.53. Idenm: Anm. J. Sociol., 55: 243, 1949.54. SMIITH, H.: Sociological Study of Hospitals, un-

published Ph.D. dissertation, Department of Soci-ology, UJniversity of Chicago, 1949.

55. PARSONS, R.: Am. J. Orthop8ychiat., 21: 452, 1951.56. MEAD, M.: Some Relationships Between Social Anthro-

pology and Medicine, in Alexander, R. and Ross, H..Dynamic Psychiatry, J. B. Lippincott Co., Phila-delphia, 1952.

57. BERRY, G. P.: J. Med. Education, 28: 17, 1953.58. BROWNE, J. S. L.: J. Clin. Investigation, 27: 520, 1948.59. HUBBARD, J. P., MITCHELL, J. M., POOLE, M. L. AND

ROGERS, A. WV.: J. Med. Education, 2: 19, 1952.60. APPEL, K. E., MITCHELL, J. M. AND LHAMON, W. T.:

Diplonlate, 24: 89, 1952.61. EVANS, L. J.: Society of the New York Hospital

Record, p. 3, 1952.62. SPILLANE, J. D.: The Lancet, 1: 94, 1953.63. BOWLER, J. P. AND SYCAMORE, L. K.: The Responsibility

of tne Voluntary Hospital and its Medical Staff inthe Distribution of Medical Service. Presented atSymiiposiunm Arr-anged by the United Hospital Fund,New York, 1944.

64. BAEHR, M.:Modern Hospital, 80: 92, 1953.65. Idem: Ani. J. Pub. Health, 42: 131, 1953.66. BARNARD, C. I.: Rockefeller Foundation-A Review

for 1950-51, New York, 1952.67. DICHTER. E.: A Psychological Study of the Doctor-

Patient Relationship, California' Medical Associa-tion, 1950.

RECENT THERAPEUTICADVANCES IN DERMATOLOGY

L. P. EREAUX, M.D., C.M., Montreal

TIlE THERAPEUTIC HORIZONS in dermatology are

constantly being broadened due to the close co-operation between the research departments ofthe major drug companies and clinicians workingin manv clinics. This general resume will discussbut a few of the newer products which haveproved their worth in the treatment of ourpatients.

Anitibiotics.-There is a tendency on the partof the profession to use the antibiotics with areckless abandon, for all and sundry conditions.Specific indications must first be established bymeans of cultural evidence and sensitivity tests,before embarking on a course of antibiotictherapy. Recheck cultures and additional sensi-tivitv tests must be undertaken throughout thecourse of prolonged infections. By these precau-tionarv measures, resistant strains may be dis-covered and the allergic hazards attendant onthe tinnecessary administration of antibiotics cansomaetimes be avoided. If side effects occur theycazn best be controlled by: (1) Cessation of drugor chanainog to another type of antibiotic; (2)exlhiblition of cortisone in small doses for short

periods; (.3) administration of the antihistaminesin high dosage.Pyodermias respond readily to the newer anti-

biotic ointments which are now marketed inwater soluble bases. Aureomycin, bacitracin,chloromycetin, ilotycin, neomycin, polysporin,tyrotrycin-all have found their valued positionsin the cture of impetigo contagiosa, secondarilyinfected dermatitis and nummular dermatitis.Cultures and sensitivity tests to their spectra ofactivity will be the indication for their "expen-sive" use. Neomycin has a universal application,and its powder in 1%/ aqueous solution, whenused as ear drops, provokes miracles in clearingup some infections of the ear canal. Neomycinointment has served us well in the treatment ofotitis externa, while in an ophthalmic ointmentboth aureomycin and neomycin have supplantedthe use of yellow oxide mercury in the treatmentof seborrhceic blepharitis and styes.We do not now use penicillin or streptomycin

ointments due to their high sensitization index.Antibiotic ointments act efficiently when appliedas a thin film and do not require the thick ap-plications of older type ointments to obtain thedesired results.

It has become apparent in the treatment offurunculosis and folliculitis, that the antibioticsare useftul onlv as emiergency agents to quell the

Canad. M. A. J.Feb. 195. vi. 70 EREAUX: DERMATOLOGY 123

fires ot iinflamimation. For lasting pyodermic pro-

tection. one must lean heavily on vaccine therapy.Stock or atutogenous vaccines are generally em-

plov'ed. btit we prefer the administration of a

sluspenlsion1 of autogenous vaccine in staphylo-coccus toxoid.1 Follow-up booster injections offull fiinal doses at monthly intervals for threesubsequtienit injections are given, depending on

the response of the staphylococcus titre.Antibiotics injected in the centre of boils and

cysts is a useful procedure. There is still no sub-stitute for cleanliness in the treatment of super-

ficial inifections and quicker healing will be ob-tained by mechanical debridement with compress

therap- or baths, than by placing completerelianice on antibiotic injections or applications.

Antib)iotic troches used for the cure of oralconditionis carry along with their therapeuticbenefit the inherent dangers of contact sensitiza-zation of the mucous membrane. The newer

preparations of aureomycin contain inhibitors tothle overrrowth of monilia, but many a suffererwLith prtritus ani acquired during a course ofaureoinvcin therapy has rued the day this anti-biotic as discovered. All too often, the omissionof the administration of the B complex group

gives rise to unpleasant "side, and end", effects.The incidence of pruritus ani occurring during

aureotnycin therapy has decreased with the re-

cently advised dosage reduction of the drug,which now routinely should not exceed one gramper day.

Herpes simplex, following viral infections, can

occasioniallx be aborted by painting the lesionstwice daily with 1%Xs aureomycin2 or neomycinfilm miade up in methyl cellulose. One must firstremove the superficial infected elements by com-

presses in order to allow a better penetrationof the antibiotic.Aureomvcin and chloromycetin have their

place in the treatment of herpes zoster, providedthat these agents are administered in the earlystage of the process. Indifferent response is ob-tained once the shingles are full-blown. Prota-mide,3 a denatured proteolytic enzyme, has cutshort the course of the occasional case of herpeszoster anid has contributed to patient comfort.This product may be helpful occasionally, too, inthe'lightniing pains of tabes. Chloromycetin4 inthe dosage of one to two grams daily for twoweeks removes the blush of rosacea with itsaccompanying pustular elements. The hazards tothe blooi iniherent in chloromycetin have been

pointed out by rival drug corporations, butfortunately in our series of rosacea no ill effectshave been encountered.

Inconstant results are obtained in the treat-ment of molluscum contagiosum by the employ-ment of aureomycin internally or by the use ofaureomycin and neomycin films. One finds thepercentage of cures following their use runsparallel to those obtained from the use of sulfa-pyridine. There is still no substitute for thecurette for the rapid clearing of these trouble-some infectious warts. Podophyllin 20% inalcohol has its advocates for the removal ofmolluscum contagiosum. The resurrection of thisold drug from the therapeutic files of fifty yearsago has proved a boon in the treatment, too, ofcondylomata acuminata. By its action, venerealwarts melt like snow before the sun. The bestvehicle to use for podophyllin is friars' balsam oralcohol rather than liquid paraffin, because exact-ness of application can be better maintained.This is professional treatment and should not beentrusted to the hands of patients. Do not usepodophyllin on the face because of the dangerof damage to the eyes.

Stasis ulcers.-The introduction of Varidase5has done much to accelerate tissue cleansing andrepair in a multitude of infective processes. It hasa particularly useful place in the rapid cleansingof varicose ulcers. The use of ichthopaste, domeboot, or of other supportive bandages of thistype have made many fast friends for the surgeonand dermatologist in healing of long standingstasis ulcers. One must first remove the infectiveand exudative elements by the use of saline or1% sulfanilamide compresses.When the skin surface is clean and dry,

powders or ointments of aureomycin, neomycinor terramycin are dusted or applied over theaffected parts and the limb is then envelopedfrom the toes to level of the knee and thebandage is left thus from five to -seven days.As healing progresses the bandage periods maybe extended up to two to three weeks, and heal-ing may further be accelerated by the applica-tion of water soluble tar ointments, applied tothe broken surfaces and then covered by theUnna's boot dressing.6

Finally, surgical appraisal, with a view to cor-rective ligation, may be found necessary in apercentage of cases. Elastic stockings or tensorbandages should then be advised to prevent arecurrence of the condition.

124 EREAUX: DERMATOLOGY

Antihistamnines.-The antihistamines are withthe vitamins in the multiplicity of their productsoffered to the profession. All antihistamines areof therapeutic value but also possess unpleasantside effects capable of producing nausea, dizzi-ness, or dangerous "hangover" effects. Personsreceiving these drugs should be warned againstpossible drowsiness, and high dosage should notbe considered for the ambulatory patient.

Insufficient dosage of the antihistamines hascontributed in a large part to our past failures inclearing urticaria and many toxic eruptions.Histamine-flooded tissues in the acute allergicdisorders need massive doses of the anti-histamines to stem the allergic tides. We do notnow hesitate to give 100 mgm. q.3 h., up to 800mgm. daily, until symptoms are brought undercontrol. Antistine, 2 c.c. (100 mgm.) by the intra-muscular route, has proved a useful drug in ourhands.

Fractional doses of the antihistamines are use-ful in controlling pruritus during the wakinghours, while doses of a larger magnitudegenerally induce a comfortable night's rest.When heavier sedation is required chloralhydrate in capsule form gives more favourableresults than do the barbiturates. These latter, wesuspect, tend to increase the patient's itch whentheir sleep provoking attributes have worn off.

Antihistaminic ointments play a questionablerole in dermatological therapeutics. Spectacularresults have been reported in the treatment ofthe neurodermatitides but their danger of skinsensitization keeps lurking in the background.Ointment of this type reinforced with any oneof the variety of the "caine" derivatives shouldbe shunned by the knowledgeable physician.

Stulphonainide.s.-M\edical journals daily recordthe discovery of new sulphonamide compounds.These and the triple sulfas aid the acne suffererin the pustular phase. In dermatology, sulfa-pyridine has proved the most reliable controllingmeasure that we have yet been able to offer tothe patients with dermatitis herpetiformis. Forthose intolerant to this drug, it has been stug-gested that doses of folic acid, five microuniiits,be given with each dose of the drug, or that thesulfapyridine be made up into an emulsion' andgiven in homeopathic doses to those who finddifficulty in absorbing this otherwise toxicradical. Sulfoxone diasone8 has been suggestedas an improvement for the control of dermatitis

Canad. MI. A. J.Feb. 19g4. vol. 70

herpetiformis. It is a toxic drug and needs morecareful supervision than does sulfapyridine.The late Dr. Harold Orr drew our attention to

the benefits to be derived from a 1% aqueoussulphanilamide solution as a means for control-ling the secondary invaders in infectious eezema-toid dermatitis, nummular eczema, and stasisdermatitis. Over several years we have not en-countered one single case of sulpha sensitizationdue to the employment of these compresses.

ACTI!, cortisone and hydrocortone.-Much hasbeen written concerning the life-saving attributesof these drutgs in the treatment of lupus ery-thematosus acute disseminata and pemphigus.Pemphigus, that rare but hitherto invariably

fatal disease has responded in dramatic fashionto the treatment with the cortico-steroids.Seventeen cases of all types of pemphigus havebeen treated by the Royal Victoria Hospitalgroup during the past three and one-half years.Cases have been maintained on these drugs forperiods varying from six months to three and ahalf years. Fourteen of our cases have survived;all but one of these are again leading usefullives. Seven "cures"? have maintained their gainsand have averaged better than six months with-out treatment of any type. The three cases whosuccumbed were of the acute fulminating typeand death occurred within three to four weeksafter onset of therapy.ACTH, cortisone, and hydrocortone should be

reserved for the treatment of life-threateningdermatoses, but they also have their place intreating acute allergic disorders too. Urticaria,drug eruptions, the erythema multiforme groupand contact dermatoses of plant and chemicalorigin can be rapidly cleared under shortcourses of these drugs. The bald-headed mavbless the day of their discovery, for they haveaccelerated the rate of regrowth in early casesof alopecia areata by internal and topical use.9The indiscriminate use of ACTH and cortisone

for the chronic grouip of skin disorders, such asatopic dermatitis, psoriasis, and exfoliativedermatitis is fraught with danger. Routinely, allevidence of these diseases clear within two tofive days while patients are on the drugs, butafter withdrawal, at a later period, severe re-lapses tend to occur. ACTH, cortisone, andhvdrocortone stop the disease processes in theirtracks but when this braking effect is removecl.the pathologv tends to recur and progr.ss furtherafield.

Canad. M. A. J.Feb. 1954, vol. 70 EREAUX: DERMATOLOGY 125

With increasing publicity, ACTH and corti-sone are being administered in a wholesalefashion, and we in dermatology are daily beingcalled upon to untangle the complications aris-ing from their injudicious use by the profession.Many will be at variance with this statement,but I maintain that ACTH and cortisone assystemic remedies control much, cure but few,and may actually aggravate a multitude of self-limited skin conditions.Cortone and hydrocortone instillations are

beneficial in treating many ophthalmological andotological conditions, and special mention mustbe made of acute interstitial syphilitic iritis andotitis externa.10 The drug of the year is hydro-cortone acetate when employed in ointmentform. To quote Sulzberger:'-

"Hydrocortone ointment gives considerable promise asa local external therapeutic agent in selective commondermatoses, as well as being effective by subcutaneousinjections for some skin lesions and skin reactions."

Ointments employed in a 1 or 21/2% con-centration made up in a paraffin or carbo-waxbase, yield results similar to those obtained bythe parenterally administered cortone or hydro-cortone, without the danger of the troublesomeside-effects. Hydrocortone ointment unfortu-nately possesses the limitations of the paren-terally administered cortone or hydrocortone, inthat, in many cases, on withdrawal of the oint-ment, a relapse of the condition under treatmentoccurs.

It is the preparation par excellence for thetreatment of acute contact dermatitis of allergiccausation. Its itch-relieving properties in thetreatment of infants suffering with atopic derma-titis are excellent. Cosmetic, chemical and plantdermatoses, and contact dermatoses, clear underits influence. Many cases of atopic dermatitis,neurodermatitis, pruritus ani et vulvxe, havebeen benefited. This improvement, however, isnot always sustained when the drug is with-drawn. It is a product to conjure with and, whena better understanding of its action is learnedand techniques perfected, it may be the comingpreparation for the dermatologist. In our hands,cortone 1% ointment was beneficial in the treat-ment of early keloid and of lupus erythematosusof a chronic discoid type.The liquid hydrocortone has been advised

intradermnally for the treatment of such variedconditions- as: discoid lupus erythematosus,

localized neurodermatitis, and isolated plaquesof psoriasis. In the synovial type of cyst, or inthe mucous cyst, injection therapy has causedresolution of the process.

Vitamins.-The Charpy, Dowling, Thomasmethod with its use of D-2 in the treatment oflupus vulgaris has been an outstanding advance.D-2 has served well in the treatment of cutaneoussarcoidosis, and some reports praise its use in thetreatment of atopic dermatitis and even in acnevulgaris cystica. Vitamin A internally has im-proved cases of acne vulgaris and as an ointmenthas been helpful in ichthyosis and in removingseborrhoeic warts. Isonicotinic acid hydrazide isrunning the gamut of trial in lupus vulgaris andallied tubercular conditions. In erythema indura-tum and even in leprosy it has proved its worth.Hormones.-The field of usefulness for hor-

mone therapy in skin is ever-widening. CEstro-gens internally and topically have benefited theacne vulgaris sufferers12 and Barber has foundthem beneficial in the treatment of seborrhceaof the scalp. A premarin-containing ointment hasimproved cases of rosacea and has been useful inthe treatment of x-ray dermatitis.

Miscellaneous preparations. - Notwithstandingthe apparent failure of the reeking goat onyonder hill to become sweet and pure withchlorophyll, we have found the aqueous solublechlorophyll 1% concentration in a wetting basea deodorant par excellence in the care of ourpemphigus patients. Perhaps, the odour from thesecondary invaders has been cut down by theaction of the antibiotics and the skin has beenkept firmer by the use of the adrenocorticalextracts. However, the stench of pemphiguscases can now be controlled by ointment applica-tion and by chlorophyll fans. Infective surfacesand stasis ulcers have also responded to 1%chlorophyll ointment. One must watch for pos-sible sensitizations.With present day knowledge, the best way to

stop dandruff is to employ selenium disulphide.13This is a commercial product marketed underthe name of Sel Sun, but woe betide the personwho does not completely cleanse cosmetic prepa-rations from his or her scalp prior to its applica-tion. With improper prior cleansing of the scalp,yellow, green and even purple hair has resultedfollowing its application. It is the best prepara-tion to date for the treatment of cradle cap or theseborrhcea capitis at any age. Warnings havebeen issued about the toxicity of this prepara-

126 EREAUX: DERMATOLOGY

tion. During a two-year trial we have found it tobe well tolerated by most individuals.

Antipruritcs.-The search still goes on for theideal antipruritic application for the skin.Several preparations have recently been ad-vanced for this important purpose. Quotane'4 isuseful and has minimal sensitizing effect. Thepreparation Eurax, 15 in a vanishing cream base,is an excellent scabecide and also an antipruriticof the first order.

Dermatitis venenata from poisoIn ivy is withUs in all seasons, caused in summer by contactwith the plant, and at other times by dried plantelements, or even from contaminated articles.With the advent of the zirconium salts,16 an ad-vance has been made in aborting or neutraliz-ing the irritating plant juices. Zirconium oint-ments work effectively against the fresh applica-tion of oleoresin on the skin but after prolongedcontact their therapeutic efficiency is inclinedto be impaired.

Ethyl chloride17 sprayed once daily for four or

five days on the lesions of poison ivy reduces theitch and the period of disability. High promiseawaits the use of hydrocortone ointment in sup-

pressing the action of these irritating plant resinson the skin. Cortone internally, in selected cases,

cuts short the period of disability of the plantdermatitides. Oral hyposensitization methodswith the oleoresins for the desensitizations ofragweed dermatitis offers relief for this rebelliouscondition. Following the oral desensitizationtreatments the exit portion of the G.I. tract mayregister a vigorous protest against this regimenby developing pruritus ani.

Banthine and probanthine have aided thosesuffering from dysidrosis and bromidrosis.

Unsaturated fattyJ acids. - The unsaturatedfatty acid compounds were introduced as anti-mycotic remedies. They are fungistatic, nottruly fungicidal, and have proved to be non-

irritating to the skin when used over a longperiod. Some compounds have the disadvantageof possessing an unpleasant odour and, althoughhelpful, we have not found them to give constantresults in treating fungus infections.The search continues for a specific agent

against the infections caused by the various-ring-worms. Many of the newer products have claimsbased on the results obtained in vitro. Afterclinical trial they fail to effect cures. Undecylinicacid, when used as an antimycotic agent, can

Canad. Al. A. J.Feb. 1954, vol. 70

best be employed in conjunction with zinc orcopper undecylinate.The use of undecylinic acid in the treatment of

psoriasis is now no longer extolled. Some threeyears ago we at first thought that this new treat-ment held promise for the cure of psoriasis, butin the overall picture found but 5% who seemedto have clearing of their lesions following itsingestion. On later examination few of the caseswhich showed primary benefits, failed to main-tain their gain. One compound, F99, which hashad great vogue with the laity has increased thepractice of G.I. specialists from resulting gastro-intestinal upsets.

Great promise has attended the use of stil-bamidine in the treatment of actinomNvcosis andblastomycosis, and the suppurative ringworms.

Atabrinc. - Atabrine was first reported inRussia in 1941 and later in England in 195118 asa successful treatment of lupus erythematosus.The lesions of the chronic discoid type of thisdisease have dissolved away following its ad-ministration. The drug may be toxic to certainindividuals, but if the dose is carefully con-trolled, few side-effects wil lbe encountered. Atthe onset we felt that it was necessary to giveAtabrine till the patient's tissues became yellowfrom the dye. Now under the dosage scheduleof 100 mgm. three times daily for a week, 200mgm. per day for the following week, and 100mgm. daily for the remaining period up to sixweeks, we lhave had comparable results underthis regimen as were obtained by heavierdosage in the first trials. Patients are appreciativeof the savings effected, and the freedom fromrepeated unpleasant intravenous and intra-muscular injections of gold and bismuth affordedby this treatment. Chloroquine succeeds at timeswhen atabrine is not well tolerated.

It should always be kept in mind that sunlightis injurious to sufferers with lupus erythematosus,and some screening ointments or lotions, as wellas a protective hat, should be used to shield pa-tients from the injurious actinic rays. Atabrine,chloroquine, and quinine, appear to increase thetolerance of the skin to the sun's rays. In this waythese are doubly beneficial in treating lupuserythematosus.

Barrier creamts.-In the industrial field, theintroduction of barrier creams has been a stepof major importance. The conservation of manpower and the keeping of skilled labour at theirposts durina wvar time in England. instigated

Canad.1. A. J. GALDSTON: PSYCHOSOMATIC MEDICINE 127Feb. 1954, vol. 70

much research in combating the industrialdermatitis arising in war plants. Now throughthe medium of the Kerodex products a completerange of protective barrier creams is availablefor all types of industrial needs. By their useskilled workmen experiencing allergic reactionto their industrial contacts may, in many cases,be returned to their posts with complete protec-tion against further trouble. Barrier creams havealso been designed, to protect the harassedhousewife in the pursuit of her routine chores.The silicone compounds made up as protective

creams have recently been introduced intodermatology. Covicone, one of these, will affordprotection against many types of industrial,household, and plant irritants. The water-proof-ing effect of the silicones protects the skin againstbody fluids and their use will prove to be a boonto pediatricians and surgeons in the preventionof skin irritations met with in their specialties.Barrier and protective creams are not primarilytherapeutic agents and should never be em-

ployed as healing agents on broken skinsurfaces.

Thus, dermatology by the use of new and im-proved preparations and its older standardformule continues to offer protection, care, andcure for many of the ills of the flesh.

REFERENCES

1. KALZ, G.: Personal Communication.2. KALZ, F. et al.: Canad. M. A. J., 61: 171, 1949.3. COMBES, F. C. AND CANIZARES, O.: New York State

J. Med., p. 15, March, 1952.4. Presse, Med., 60: 424, 1952.5. TILLETT, W. S., SHERRY, S., CHRISTENSEN, L. R.,

JOHNSON, A. J. AND HAZELHURST, G.: Ann. Surg.,131: 12, 1950.

6. COOPER, W. M.: Am. J. Surg., 75: 483, 1948.7. CRAIG, G. E.: Schoch letter, Dallas, Texas, March.

1953.8. CORNBLEET, F.: Arch. Dermat. & Syph., 64: 684, 1951.9. DILLAHA, C. J. AND ROTHMAN, S.: J. A. M. A., 150:

546, 1952.10. NELSON, C. T.: Personal Communication.11. SULZBERGER, M. B., WITTEN, V. H. AND SMITH, C. C.:

J. A. M. A., 151: 468, 1953.12. KALZ, F., PRICHARD, H., FOURNIER, C. AND JANAUSKAS,

A.: Canad. M. A. J., 67: 5, 1952.13. SREPYAN, A. H.: Arch. Dermat. & Syph., 65: 2, 1952.14. LYNCH, F. W. AND ACKERLY, 0. E.: Arch. Dermnat. &

Syph., 65: 35, 1952.15. PECK, S. M. AND MICHELFELDER, T. J.: New York

State J. Med., 50: 1934, 1950.16. CRONK, G. A.: Arch. Dermat. & Syph., 66: 282, 1952.17. ROBINSON, M. M.: J. Invest. Dermat., 8: 239, 1947.18. PAGE, F.: Lancet, 2: 755, 1951.

THE ROOTS OFPSYCHOSOMATIC MEDICINE*

IAGO GALDSTON, M.D., New York, N.Y.

THE INVITATION to trace the roots of psychoso-matic medicine could with full warrant be takenas a commission to scan the full panorama ofmedical history. For medical history reveals thatsince the most ancient of times, even before thedays of Hippocrates, physicians knew that thepsyche and the soma were intertwined in a reci-procal relation. Plato pronounced an alreadyancient injunction when he warned:

"For this is the great error of our day that in the treat-miient of the human body, physicians separate the soulfroin the body."-Plato, Charmides 156-157.

I shall not, however, inflict upon you so greata resume, and indeed on this score there is noneed to scan the more remote history of medi-cine. That has already been done by the incom-parable Burton in his Anatomy of Melancholy.In this superb volume there is to be found allthe references bearing upon the protean dis-temper MNlelancholia which the most catholic ofcompiler-s could gather.

*An address delivered at the Allan Memorial Institute ofPsychiatry, -Montreal, on October 21, 195a3.

Yet precisely because I wvill not inflict uponvoui a resume of medical history from the pointof view of psychosomatic medicine I deem itno imposition to dilate on this most extraordi-nary man and his work. The occasion is ap-propriate since it was Osler who first recognizedthe psychiatric import of The Anatomy of Melan-choly. Ile considered it "the greatest medicaltreatise ever written by a layman." Osler wasenchanted with the man and intrigued by hiswork. In an address delivered at Oxford, Eng-land, on April 24, 1916, Osler linked Burton withShakespeare and Bacon, and crowned him thetransmuter supreme in the triad of Creators,Transmuters, and Transmitters.

"The silent, sedentary, solitary student (as he termshimself) in the most flourishing college of Europe,augustissimo Collegio, with Saturn lord of his geniture,to relieve a gravidum cor, swept all known literature intoa cento. No book was ever so belied by its title as ThleAnatomy of Afelancholy."i

Osler recognized the psychiatric import of theAnatomy, but he never elaborated upon it. Thiswas attempted in 1944 by Bergen Evans in awork entitled The Psychiatry of Robert Burtorn.2The achievement is creditable. Evans, however,missed the unique value of the Anatomy as arepository of psychiatric history. But better than