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All those who treat infants and young children encounter with more or less frequency instances in which the diapers after having been wet with urine for several hours give off the odor of ammonia.Frequently the odor is faint and the condition occurs in infants otherwise well and thriving. In some cases the ammoniacal odor is very pronounced and accompanied by irritation of the skin of the diaper region usually more marked over the buttocks and inner surfaces of the thighs. The lesion may consist only of diffuse redness but not infrequently vesicles and papules with more or less excoriation occur. There seems no doubt that the dermatitis is caused directly by the ammonia. Attention was called to the condition by Southworth 1 and it has been discussed in some detail by Zahorsky 2 and more recently by Brennemann.3 The latter observer has described especally the ulceration at the external urinary meatus that may occur in circumcised male children in association with the ammoniacal diaper, a lesion noted previously by Zahorsky.The characteristic lesions of the diaper region have long been recognized and have been described under a variety of names, but have not generally been attributed to ammonia in the napkin. It was formerly frequently confused with the lesions of hereditary syphilis and Parrot, who was one of the first to describe the condition, mistook it for a lenticular syphilide. Jacquet,4 however, clearly differentiated these eruptions of the diaper region from syphilitic lesions. He divided them into simple erythematous, erythemato-vesicular or erosive, papular or post-erosive and ulcerative forms all of which are stages of one process and may overlap or coexist in the same patient. Finkelstein 5

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Human infection by the organism now known as Coccidioides immitis was first reported in 1892 by Posadas and Wernicke in Buenos Aires. These observers regarded the parasites as protozoa, but later (1896) Rixford and Gilchrist gave the organism the binominal designation of Coccidioides immitis, and Oph\l=u"\ls succeeded in obtaining pure cultures in 1900. Other cases have been recognized from time to time, and recently MacNeal and Taylor1 have collected twenty-four cases from the literature. In one of these reported by Brown, however (Case 18), the diagnosis was not confirmed culturally or by microscopic examination. All the reported cases except the first have occurred in the United States, and in a large proportion of them the infection can be traced to the San Joaquin Valley in California. The disease affects chiefly adult males, only one woman and one child being included in the *

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