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either to their homes or, if the facts of the case callfor it, with a condition of residence in a suitablehospital. It seems that this power is not generallyknown or used ; and the Parliamentary MedicalCommittee has therefore urged the Home Office tocircularise magistrates, calling their attention totheir powers in such cases.

I am, Sir, yours faithfully, .

FRANCIS FREMANTLE,Chairman, Parliamentary Medical

12th Committee.House of Commons, July 13th. Committee.

PSEUDO-DERMATITIS AUTOPHYTICA

To the Editor of THE LANCETSiR,—In a comprehensive discussion on dermatitis

autophytica last year Dr. Henry MacCormac (Brit.med. J. 1937, 2, 1153) referred to this condition as" self-innicted skin disease." In other words, thereis a real physical lesion of the skin artificially producedby the patient. This is the usual meaning attachedto the term, and appears in most text-books. Incontrast with this type of case the following will beof interest :

A girl of 13 attended the skin department of theCardiff Royal Infirmary complaining of a persistentrash on the face. Three months previously there hadbeen an irritable red spot on the left cheek, with fever.She was seen by her doctor at that time and a diagnosisof erysipelas was made. She was treated with a blandointment and Prontosil by the mouth. The rashslowly spread until it was 2 in. across and thendisappeared, its total duration being three or fourweeks. The skin then remained normal for fourweeks. At the end of this time, one month before thedate of examination, a rash appeared on the same siteas before and had remained in spite of treatment withprontosil and ointment.The patient is a bright and apparently intelligent

girl, the youngest of a family of four sisters and onebrother. While she had the rash she has not attendedschool, but ordinarily she seems to like school andto get on well there. Her mother does not find herin any way a difficult child.The rash consists of a dusky deep red erythema,

sharply outlined, with no vesicles or scaling. It isdistributed on the whole of the nose and on theadjacent part of the left cheek, extending over themalar region. The appearance at once suggestserysipelas. On close inspection, however, the hairfollicles on the nose are visible as dark red points,as if containing dirt. Cleaning the skin with anether-soaked pledget of wool removes the " rash "entirely, leaving a completely normal skin. Thecolouring matter in the pledget is the colour ofrather dark cosmetic rouge. Rouge of this sortis used by the elder sisters of the patient, and shehas access to it. She denies all knowledge of thisand offers no explanation of the rash.

In this case, not only is the condition self-produced but the lesion is in fact non-existent. Thisis so different from dermatitis autophytica, wheredefinite, sometimes extensive and destructive physicallesions are found, that the same name cannot beapplied to both. For this reason I have used theterm pseudo-dermatitis autophytica. The whole ofthe second attack was no doubt artificial. I aminclined to believe that the first attack was originallyerysipelas, though possibly the artificial rash was

produced as the erysipelas subsided, thus explainingthe apparent failure of prontosil and the long durationof the condition.

A similar case was seen a short time previously.This was a girl of 11 who was referred to the skindepartment as a suspected dystrophy of the finger-nails which had not responded to oral medication.The nails were normal in shape and texture and

presented a peculiar polished appearance in places.They were, in fact, varnished, and to the surprise

. of the mother the " dystrophy " was removed witha nail-varnish remover.

In both of these cases the method of productionwas simple but had been very effective. This typeof case merits attention since both of the patientshad succeeded in deceiving parents, doctors, andschool authorities.-I am. Sir. vours faithfullv.

Cardiff, July 15th. F. RAY BETTLEY.

CHEMOTHERAPY BY RUBIAZOLTo the Editor of THE LANCET

SiR,—May I correct a statement in my paperentitled the Chemotherapy of Bacterial Infections(Eancet, May 14th and 21st, pp. 1125 and 1178)which was made under a misapprehension Theoffending statement refers to Rubiazol as "... theFrench equivalent of Prontosil, which owes itsmanufacture in France to the exemption of medica-ments from patent law in that country." It has beenrepresented to me by Messrs. Roussel Laboratoriesthat this statement and its implication are incorrect.They point out that although patent law in Francediffers from ours, it would not protect them incountries other than France against an action for

infringement in such a case as this, unless they couldclaim independent rights. I was misinformed inthis matter and regret that this statement shouldhave been misleading.

I am, Sir, vours faithfully.Harpenden, July 16th. LAWRENCE P. GARROD.

DIASTOLISATION

To the Editor of THE LANCETSm,-When on June 4th Mr. Miller wrote in your

correspondence columns about diastolisation I was

experimenting with a modification of this technique.I now connect the diastolisation tube by rubber andglass tubing with an air-pump.

Into the rubber tubing is inserted a piece of brasstubing, 42 in. long, in which three holes of differentdiameter have been drilled. These are such that

6 ’-L-t’.t-- L..L-

when all are left open, and the air-pump is running,no effect is produced on the tube. When one, two, orthree are closed by the fingers, varying degrees ofvibration are imparted to the tube. Instead ofpushing the tube in and out the fingers are movedrhythmically on and off the holes.

I have found that when this treatment is appliedto each nostril for about a minute, two or three timesa week, results appear better than with the othertechnique. The degree of intensity and the rapidityof rhythmical variations are determined by the con.dition to be treated and the sensitivity of eachindividual.

This little instrument, when attached to a Seiglespeculum, with an aural vibrator, can be used foroto-massage.

I am, Sir, yours faithfully, -----

Upper Brook-street, W., July 6th.HENRY W. HALES.