a perfect fit, the intact skin broke down within six hours). Careful observation, in addition to the various patch tests, eliminated the possibiity of artefact, except perhaps in Case V.In every case except No. II careful inquiry was made as t6 the taking of any drugs such as sulphur or mercury, and it appeared that none of the patients was taking even a purgative or was under treatment for syphilis.There remains the possibility of an allergic or pseudo-allergic cause. To incriminate the spectacle frames as a cause of an allergic skin response one must inquire: (1) Can the metal become ionized under conditions of wear ? (Woods, 1933;Landsteiner, 1924.) (2) Do the history and mode of' onset suggest allergy ? (3) Does the lesion clear promptly on removal of the frames ? (4) What is the response to specific patch tests? (5) -Can this specific hypersensitivity be transmitted? (Prausnitz and Kulstner, 1921.) Lain quotes a company of manufacturing opticians who, after research, stated that they believed there was an electrolytic battery action between the dissimilar metals of the alloy in the presence of perspiration and aided by body heat.Specimens of the frames were submitted to Lieut. Atkins, who reports as follows:" The specimens were washed in absolute alcohol to remove traces of grease and then placed in distilled water, slightly acid as it always is, for several days. There was no trace of nickel by the most sensitive tests, and the surface remained bright. With sodium chloride in the water, between 1% and 2%, there was, however, slight reaction, so that after two or three days there was a marked pink with dimethyl glyoxine and ammonia with specimen 'C,' a definite but lesser pink with specimen ' A,' and no perceptible pink with specimen ' B.' It is possible that there would be still greater reaction if a complete frame was tested, due to one side being electronegative to the other. In this case the dermatitis might be earlier and more marked on one side. It is also obvious that this reaction requires the intermediary of sweat." It will be noted that all the cases except 11 and V suffered from pityriasis sicca capitis, and all reported that they sweated very easily. The wearing of a respirator of course induces free perspiration under the rubber. In only one case was an inequality in the dermatitis noted-the worst case, No. III, in which the left side was earlier and more severely affected.With regard to the second requirement, all these cases conform to the allergic types, with the exception of the doubtful case, No. V. Case II is the only one with a history of a previous intolerance, which explains the short latent period here.Case III also, with a brief latent period, had a breaking of the skin before the burning and itching, and may be explained as the mechanical effect of a bad fit which later became a true allergy, since, in the absence of mechanical irritation, the intact skin broke down in six hours. It does not seem necessary in any of these cases to appeal to the " silent sensitization " mentioned b...
