Dr. Kendig Replies

It should first be pointed out that in Nansemond County, Virginia, the incidence of presumptive sarcoidosis is 500 per 100,000 population, more than three times greater than that noted anywhere else in the world. Other nearby counties appear to be similarly affected and sarcoidosis is a common diagnosis in the geographic area served by the Medical College of Virginia Hospitals. Dr. Pickering correctly states that "sarcoidosis is difficult to define and protean in its manifestations and simulates many disease entitles such as tuberculosis, fungal infection, leprosy, syphilis, berylliosis, silicosis, tumor, and foreign bodies."