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the prevention of waste of men in his front lines. A dermatologist acts as Cialis Dosage 40 Mg a real economy by returning men suffering from skin diseases back to the front in the shortest space of time. The skin department of a base hospital not only relieves the surgical department but it safeguards it from contamination from such contagious Cialis Dosage 40 Mg skin diseases as happen to be going the rounds. The general practitioner is only too glad to disclaim any great knowledge of skin diseases, and this holds equally true with the volun- teer army surgeon. Where does the work of the dermatologist begin ? I would say as consultant to the recruiting officers. Here he may be able to give an expert opinion regarding cases claiming exemption on account of having, or having had, certain diseases, such as syphilis, dermatitis Cialis Dosage 40 Mg herpetiformis, chronic or recur- ring eczema, erythema perstans, psoriasis, lichen planus, especially when the medical officers conduct- ing the examination find little to bear out the truth of the conscripts' declarations. On the other hand, his opinion would be valuable in estimating whether a man who asserted that he was cured was really cured or temporarily in abeyance to treatment. Ex- perience has shown Cialis Dosage 40 Mg that it takes but a short time in the army if skin diseases are not treated for the adverse conditions, such as tinned food, poor wash- ing facilities, and cold in the front line trenches, to bring forth their particular maladies in all their frightfulness, and I use this word advisedly. Next, I believe, prophylaxis may be of some benefit especially in the prevention of the spread of scabies and pediculi, which at times amount to a scourge if the conditions are favorable. One needs only to pause a moment and ask oneself: "How often did Jack get a change of clothes and bath when facing the Turks on rocky Gallipoli's inhos- pitable slopes?" or "Did Bill really carry all the day's ration of water in that small bottle when crossing Asia Minor's deserts?" These two diseases contracted on active service are almost invariably accompanied with ecthyma or impetigo in virulent forms. Noncommissioned officers should be in- structed to insist on the cleanliness of the men, as far as possible, particularly of their hands and faces even when water is scarce. Every man could wear a small sulphur bag, back and front on a neck string, after the manner advised by Jamieson, to keep him free of pediculi. Incidentally I have already mentioned some fac- tors productive of skin diseases on active service. Flies, food, fingers, fluids, filth, and fools certainly are responsible for a great deal, causing or con- veying many of the actual troubles. Fly and flea bites as well as those of other insects form a percentage of the cases in the south. Phlebotomus fever and malaria, communicated by the bites of the phlebotomus fly and the mosquito, respectively, are not in themselves skin diseases. Typhus fever, however, is of direct interest to the dermatologist, being conveyed by the flea and being manifest by the peculiar marbling of the skin. These pests are insufl:erable in hot countries when you are on active service. Food is usually good, one finds, though the tendency is to eat too much nitrogenous tinned foods when on the move or in the front line. Urti- caria is common, psoriasis rapidly becomes worse, and eczema becomes really terrible. Water is used in proportion to its scarcity. When little exists and the quality is poor, less is used for wash- ing and drinking. The dyspeptic with his crop of acne becomes a sight. His natural cathar- tic is missing or the diluent to his unnaturally concentrated food is absent, and his compan- ions wonder whether he has smallpox. The pur- ity of water is, as a rule, of primary importance to the dermatologist in so far as skin diseases are concerned. Occasionally men are seen who have the most violent attacks of urticaria just after bath- ing, either from the action of cold on the person predisposed or from some contamination in the water. The latter is probably the case when several men present themselves after having bathed in the same pool. Typhoid fever and the more prevalent dysentery are both water borne diseases. The first is of interest to the dermatologist from a differen- tial diagnostic standpoint of the skin manifestation and in the treatment of the accompanying herpes, although that may be left properly to the medical department. Both these diseases may be accom- panied by considerable scalding around the anus, which may provoke the attending surgeon to calling in your professional Cialis Dosage 40 Mg skill. The initial skin lesion in a large number of cases is a scratch mark from a dirty fingernail ; this spot, having matured a fine growth of germs, becomes the focus for transmis- sion to other spots wherever the finger happens to scratch. When the soldier shakes hands with his companions, he transmits the disease to them so that at the end Cialis Dosage 40 Mg of their "nine days in," the regi- mental Cialis Dosage 40 Mg surgeon having run out of unguentum hydrargyri ammoniati, or mercurial ointment, and also of every available substitute, they nearly all present the vagabond's pediculosis corporis disease, even to having their hair matted with it. The worst cases are sent down to you at the base, Cialis Dosage 40 Mg while the milder ones only reach the cas- ualty clearing hospital and the others Cialis Dosage 40 Mg may continue under the care of the regimental surgeon who re- plenishes his stock of exhausted medicaments. The extremes of heat and cold suffered by men in the trenches tend to aggravate many conditions, but aside from Cialis Dosage 40 Mg this they are more or less the direct cause of work that comes under your department. 45(J MEDICINE AND SURGERY IN THE .-IRMi^'AND NAVY. [New Cialis Dosage 40 Mg Yoek MiDICU. JOUKNAL. You may have anything from frostbite to sun blisters Cialis Dosage 40 Mg to treat in the course of twelve months. Dampness associated with cold predisposes the men to rheumatism and its concomitant, at times, pur-