tinued to enlarge in all directions, the borders being very firm to the touch, while the center was occupied by a constantly growing, dry, gangrenous mass, which was in time loosened by suppuration, evidently of secondary origin, occurring beneath it, exposing a round, deeply excavated, sharply circumscribed ulcer, with elevated, firm borders, spreading in depth and circumference, the bottom covered by a grayish or black slough. After healing, a white, slightly depressed scar took the place of the ulcer. Rapid healing followed a thorough and complete excision of the lesion. Microscopically, the disease involved the entire thickness of the skin, forming in the center a homogeneous mass, and cavities upon the sides, with degenerating epithelium and cellular debris. In the lowest layers of the mucous layer and in the papillary and subpapillary portions of the corium great numbers of bacilli were found, scattered irregularly, resembling the Bacillus tuberculosis. The ordinary Staphylococcus pyogenes aurens was also present in large numbers.

Hydroa Vacciniforme.-J. C. White' reports several cases of this rare affection. After discussing the features at length, the pustulation and subsequent scarring, he asks whether these cases should be included in that other peculiar disease, dermatitis multiformis; or whether they were of a protean and exaggerated nature, atypical in relation to seat and to season, and did not belong to the true hydroa vacciniforme.

Universal Lichen Planus Followed by Sudden Death.-J. A. Fordyce reports a case occurring in a woman, aged 60. (See Plate 6.) There existed severe mental strain, with mental aberration; also alcoholism. After improvement under arsenic until the eruption almost had gone, one day, while leaving her bed, she fell down unconscious and died soon after. At autopsy the heart showed dilatation and some atrophy of the muscle.

HYPERTROPHIES AND ATROPHIES.

The Contagiousness of Alopecia Areata.-Blaschko 3 presented a boy before the Berlin Medical Society, who was 1 of 8, belonging to the same school, attacked by alopecia areata. These boys were playmates and lived near together. Other diseases resembling alopecia areata were apparently positively excluded.

Kober reports a similar epidemic occurring in a gymnasium. Eight boys, between the ages of 12 and 13, 6 in one class and 2 in another, were attacked by typical alopecia areata within a short time. It is noteworthy that the 6 in one class occupied the same bench.

Plonski likewise reports 2 cases supporting the theory of contagion. A 9-years-old boy presented round, hairless areas upon the scalp, the skin being normal in color, smooth, and without scales. Three weeks later a 6-years-old sister was found to have similar bald patches. In the second observation 2 sisters, the one 10, the other 6 years old, presented patches of alopecia areata, lasting respectively 1 year and 6 months.

Treatment of Alopecia Areata.-McGowan finds trikresol a useful agent in the treatment of alopecia areata. It is applied pure to

1 Jour. Cutan. and Gen.-Urin. Dis., Nov., 1898.

3 Berlin. klin. Woch., No. 5, 1898.

5 Derm. Zeit., Band 5, Heft 3.

2 Ibid., Feb., 1899. Ibid., No. 15, 1898. Jour. Cutan. and Gen.-Urin. Dis., May, 1899.

the scalp, and in 50% alcoholic solution to the face. It must be well rubbed into the bald areas and into the roots of the hairs for in. around them. The applications cause moderate burning, which, however, usually ceases in a few minutes. The skin at first turns white; but after a few hours this whiteness is followed by hyperemia. Upon the scalp a slight exudation of serum occurs; upon the face vesication sometimes takes place. At the end of 24 hours a dry, brownish scale forms, which falls in from 4 to 10 days; another application of the remedy may then be made. It is considered superior to carbolic acid (which causes irritation and pain), and the author's good results in a number of cases warrant him in recommending the drug. From the histories of the cases reported we learn that the average time of cure was 2 months, irrespective of the age of the patients. The drug was rubbed into the scalp about once every fifth day.

Sprangenthal has found the following application useful: R. Mercuric chlorid, 20 gr.; glycerini, 4 drams; eau de Cologne, 18 oz.-M. Under treatment with this lotion the hair was fully restored in about 1 year after the beginning of the disease.

Treatment of Baldness.-Barie has found that rubbing the scalp nightly with the following lotion will stop falling of the hair: R. Hydrochloric acid, 75 drops; alcohol, 2250 drops.-M.

The Relationship of Darier's Disease to Ichthyosis.-E. Doctor,3 after a clinical and microscopic study of 2 recent cases of Darier's disease, concludes that the differences between this affection and ichthyosis are not sufficient to justify the setting up of a new type of disease. Darier's disease is a hyperkeratosis connected with the hairfollicles and the ducts of the sweat-glands. Usually there is also parakeratosis. It is a variety of ichthyosis, differing from the common form clinically chiefly through its localization and the presence of the so-called Darier nodules; microscopically, by the proliferation of the papillæ and the rete mucosum.

Atrophying Hyperkeratosis.-Ducrey and Respighi prefer to call the affection, first described by Mibelli under the name porokeratosis, atrophying hyperkeratosis. From a new and extensive clinical and histologic study of this singular disease they conclude that it may occur upon the mucous membranes as well as upon the skin; and that, by reason of its special and constant clinical and anatomic characters, it must be considered a particular morbid entity, not to be confounded with the lichen of Wilson, with which dermatosis it seems to be most nearly related, nor ranged in the group of ichthyoses.

Recent Notes on Scleroderma.-H. F. Lawrence reports a case of scleroderma diffusum following severe shock to the central nervous system in a woman, aged 48. In 2 months the first patches developed, spreading until the head, hands, and feet alone were free. The general health was much impaired; locally, appeared the characteristic boardlike hardness; sensation seemed but slightly affected. Treatment: rest

1 Buffalo Med. Jour., Nov., 1898.

2 Cron. med., Oct. 3, 1898; N. Y. Med. Jour., Jan. 14, 1899.

Arch. f. Derm. u. Syph., Band 46, Heft 3.

Ann. de Derm. et de Syph., Nos. 7, 8, 9, 1898.

5 Intercol. Med. Jour. Austral., July 20, 1898.

in bed, warmth, and nourishing food; locally, galvanism and massage with lanolin; internally, thyroid extract, malt extract, iron, and strychnin. Improvement was marked. The skin so affected is very irritable and liable to injury from friction of the clothes, the damage to the tissue occurring as painless, unhealing ulcers. The morbid process apparently involves an hypertrophy of the preexisting collagenous bundles, causing pressure-atrophy of the blood vessels and sweat-glands, the condition of the function of the latter being a valuable point in prognosis.

Leredde and Thomas' report the necropsy on the case of a male, aged 40, syphilitic, who resisted all treatment, became much emaciated, and died. The only macroscopic lesions, apart from those of the skin, were found in the vascular system: the aorta was exceedingly atheromatous and the arteries of the limbs absolutely calcified; the nerves histologically presented nothing abnormal. The pathogenesis is discussed. Méry lays stress on the arteries, which, he thinks, infectious; some look to lesions in the thyroid; others, as Brissaud, regard the nervous system important. The coexistence of hemiatrophia is cited in evidence. Finally, the possibility of toxic origin is admitted.

Infectious diseases preceding scleroderma are often noted, as rheumatism, typhoid fever, erysipelas, diphtheria, and syphilis. May not the dermatosclerosis be due to some toxic substance affecting the connective tissue, as the toxins of tuberculosis are supposed to cause the "cutaneous tuberculides"?

3

Uhlenhuth discusses scleroderma in connection with a case in a violinist, aged 41. Scleroderma occurs once in 19,000 of all diseases, or once in 1800 of skin-affections; 65% are women. The affection is divided into (1) morphea, (2) scleroderma diffusum, and (3) sclerodactyl; and again into acute and chronic. The first stage is the edematous; with this may appear pigmentation and paresthesia; the urine contains sugar. Pathologically, the pigmentation is interesting, as being like the "bronzed skin" of Addison's disease. The theories of causation are various: Hereditary tendency, trophoneurosis, the infection theory (Spadaro and Hoppe-Seyler), and that of Singer, who classes scleroderma with myxedema and exophthalmic goiter. In treatment, next to nutritious diet, iron and codliver oil in large doses, potassium iodid and hot baths, with the use of ointments (Mosler), are much recommended. Calcium sulfoichthyol is mentioned, and salol for those who cannot afford the baths.

L. Stevens reports an autopsy on a case concerning which thorough observations during life are on record. He notes that in the spinal cord the gray matter on the affected side was diminished, the ganglion-cells smaller and less numerous, and the neuroglia more dense than on the other side. Throughout the cord, medulla, and pons the arteries were surrounded by spaces, empty or filled with a homogeneous substance, the spaces having well-defined margins. The nerve-fibers from the cervical and lumbar plexuses showed marked parenchymatous degeneration; the neuritis is regarded as secondary, but of this a reasonable doubt could be entertained.

1 Arch. de Méd. expér. et d'Anat. path., Sept., 1898. 3 Berlin. klin. Woch., Mar. 6, 1899.

2 Sem. méd., Sept., 1898.

* Lancet, Jan. 7, 1899.