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September 1995

Scratch and Sniff: The Dynamic Duo

Author Affiliations

University of Rochester (NY) School of Medicine and Dentistry

Arch Dermatol. 1995;131(9):997-999. doi:10.1001/archderm.1995.01690210027004

Are odors diagnostic? In this age of polymerase chain reactions, in situ hybridization, and immunohistochemical staining, is there any room left for the nose in diagnosing disease? Long ago, and perhaps far away, smell was crucial to describing an illness. Infectious diseases were known by their characteristic odors—scrofula as smelling like stale beer; typhoid, like freshly baked brown bread; rubella, like plucked feathers; and diphtheria, as ''sweetish.''1,2 Anosmics might be banned from medical school. Perhaps we have left the descriptions behind along with these illnesses we rarely encounter today. After all, how many young physicians, residents, or medical students have ever seen a case of diphtheria or even rubella, and how many fewer have ever plucked a chicken? We have learned that pellagra (that ''must appear'' diagnosis in our differential by rote, but not by example, for photosensitive dermatoses) should smell like sour bread and that the exotic favus

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