134 An Introduction to Medical Mycology 



acidity of the tissues. It should be reiterated that roentgen rays are danger- 

 ous unless employed with care and judgment and after study of the proper 

 technic (see MacKee and Cipollaro, X-Rays and Radium in the Treatment 

 of Diseases of the Skin). 



(3) Biologic methods.— The use of biologic products ( trichophytin ) in 

 the treatment of fungous eruptions (particularly dermatophytids ) has been 

 the subject of much investigation and subsequent discussion. Early reports 

 (such as those of Van Dyck and others) were extremely optimistic. Sulz- 

 berger and Wise expressed their enthusiastic belief that a new and useful 

 method of curing recalcitrant lesions had been brought forward. They 

 reported cases in which cutaneous allergy to species of Trichophyton had 

 been relieved by desensitization. Subsequent investigation has produced 

 sharply divided opinions, ranging from that of Traub and Tolmach, who 

 expressed doubt that trichophytin is of any therapeutic value, to that of 

 Robinson and Grauer, who have obtained spectacular results with autog- 

 enous vaccines. Sulzberger later expressed his belief in the soundness of 

 the conception of the principle of desensitization but admitted that the 

 clinical response to treatment was poor. Combes and some others have held 

 that the principle of desensitization is wrong, as a reduction in the immune 

 forces may follow reduction in sensitivity. From our research, it seems that 

 in most of the cases of actual fungous infection, an increase in sensitivity 

 is desirable (provided this is linked up with acceleration of the immune 

 forces). Thus, in the infections due to T. purpureum, the lack of reaction 

 at the site of the trichophytin test after 48 hours is too frequent to be ig- 

 nored as an explanation for the chronicity of this type of fungous disease. 

 In dermatophytid, the condition should respond when the residual focus 

 is eliminated. We believe that the diagnosis of dermatophytid is made 

 much too often and that this reaction is relatively infrequent. The vesic- 

 ular eruptions on the hands can be proved to be of mycotic origin in not 

 more than one case in 10. In the cases in which theoretically trichophytin 

 should be of service, it is unnecessary. In general, we do not at the present 

 time advocate its use in treating either a definite fungous disease or an 

 allergic manifestation (dermatophytid). This statement holds true for 

 fungous infections due to any dermatophyte and in any site, including the 

 scalp. Considering our results, we are unable to agree that the extravagant 

 claims for one extensively advertised (South American) brand of trichophy- 

 tin are justified. 



A rational therapeutic attack in another direction has been attempted. 

 Weidman and Chambers noted that some interdigital webs were free 

 from fungous disease, and were often able to isolate Bacillus subtilis from 

 this site. Subsequent implantation of the cultural growth of B. subtilis on 



