theless, seven were unhappy about the appearance of the scars and three found that they had some limitation of arm movement.A recent paper by Jemec4 reported his technique of subcutaneous curettage of the axillae. The marked area of skin is undermined with a pair of scissors through one or, if necessary, two short incisions. A sharp gynaecological curette is used to remove all subcutaneous fat in the area demarcated by the starch-iodine test. Curetting is continued until small petechiae appear on the surface of the skin and the scraping takes about 10 minutes. The wound is drained, the small incision sutured, and the stitches removed after about 10 days. Reporting on 20 patients submitted to this procedure, evaluated six to nine months later, Jemec found that 12 were entirely satisfied, four partly satisfied, three dissatisfied, and one was lost to follow-up. None of the patients complained of troublesome scars. A similar number of patients submitted to the excision operation achieved roughly similar results, but four of these were troubled by the axillary scarring.Because of the encouraging nature of this report, we decided to carry out a trial of the procedure in patients, to whom the problem was first carefully explained. Twelve patients (two males and 10 females) were operated on by this technique between January and April 1976. Review in February 1977 shows that two patients were completely satisfied with the result. One has a good result on one side but no effect on the other, and one says she is 50 % improved. One patient completely failed to respond to the operation and the remaining seven relapsed completely from one to five months after curettage. Five of these have already been re-operated upon by the axillary skin excision technique and one is on the waiting list for operation.We have therefore abandoned this subcutaneous curettage and we have returned to the well-tried axillary excision operation.Ellis, H, Practitioner, 1976, 217, 416 We report here a patient with deforming psoriatic arthritis and steatorrhoea. Biopsy of a skin nodule, jejunum, and rectum confirmed the diagnosis of amyloidosis. Case reportA 50-year-old man was referred with a five-month history of diarrhoea.He was passing 1-4 loose motions a day which flushed away from the lavatory pan with difficulty. His appetite was normal and he denied weight loss or abdominal pain. For 14 years he had been known to have psoriatic arthritis affecting the hands, elbows, ankles, knees, sacroiliac joints, and cervical spine. Skin lesions had never been observed but he had the typical nail changes of psoriasis. He had taken prednisolone for 12 years, but the arthritis had become progressively worse and led to his retirement four years previously. He appeared Cushingoid, with a blood pressure of 130/80 Hg. His nails were thickened, yellow, brittle, and pitted. Two small nodules were present on the skin of the palm of the left hand. Asymmetrical, generalised deforming arthritis was present. His liver and spleen were not palpable. The results of physic...

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Inasmuch as acute toxic processes in general are associated with a diminution of the double refractive lipoids of the adrenals, the inference lies close that in delirium tremens the body is flooded by some acutely toxic substance, the nature and origin of which is purely hypothetic at present. That something more than the alcohol itself is concerned in producing these changes is derived from the repeated examination of adrenals removed from the bodies of chronic alco¬ holics without delirium tremens, in which the altera¬ tions described were not present. AUTOGENOUS SERUM IN THE TREAT-MENT OF PSORIASIS HOWARD FOX, M.D. NEW YORKThe treatment of certain obstinate diseases of the skin by human serum is a therapeutic measure of comparatively recent date. In view of some of the favorable reports on this method it seems strange that it has not been given a more extended trial, especially in America. Al-

There are few diseases primarily affecting the skin which can appear in so many different forms as mycosis fungoides, and which, in the early stages may prove so difficult to recognize. It is also true that there are few diseases of the skin which have been studied so thoroughly from a clinical and pathologic standpoint. In spite of this we are still ignorant as to the cause and real nature of this affection. On account of some interesting features the following case seems worthy of being placed on record. Hi st ory. \ p=m-\ Sept ember 1912: The patient, G. L. S., was a man aged 47, born in the United States, an insurance agent. He was married and was the father of two apparently healthy children. An aunt was said to have suffered from psoriasis during her entire life. The patient had suffered from the usual diseases of childhood. At the age of 20, according to his statement, the patient first noticed an eruption on the elbows consisting of ''thick silvery white scales." A few years later the scalp, eyebrows and legs became affected. The eruption persisted, with partial intermissions, every summer and showed no particular change until April, 1002, when it became generalized. A posi tive diagnosis of psoriasis of the numniiilar type was made at.that time by Dr. George T. Jackson, who was seen in consultation. The same diagnosis was made by his family physician, Dr. J. Gardner Smith, who had previously treated him. Following the local application of ichtliyol ami ehrysarobin the eruption disappeared completely, M again b.une rather severe two years later.

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