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Under this title, the author describes a peculiar form of skin disease which apparently appeared in an epidemic form in the Lambeth Infirmary. The cases which occurred were 163 in number—89 males, 74 females—and they were observed between July 1st and October 31st, 1891 and represented 19.2 percent of all the patients who came under treatment during that length of time. His definition of the disease is: A contagious malady, in which the main lesion is a dermatitis, sometimes attended by the formation of vesicles, and always resulting in a desquamation of the cuticle; usually accompanied by a certain amount of constitutional disturbance and running a more or less definite course of seven or eight weeks. The eruption presented three stages: A papulo-erythematous stage, which lasted from three to eight days. The eruption began as an erythematous papular rash, the skin being considerably thickened and indurated and in parts oedematous. The margin of the patch faded out and terminated sometimes with and sometimes without an abrupt raised edge, a few papules being scattered beyond. Instead of the papular rash, the first symptom was in some cases a raised blotch of congestion, having an abrupt margin and a circular outline, or in others, there were one or more flat papules which enlarged and resembled tinea circinata. Stage of exudation and desquamation—three to eight weeks. Confluence of the rash taking place, the appearances for days and weeks would be a crimson thickened and indurated surface, continually desquamating in scales and flakes of all sizes mixed with dried up exudation. According to the presence or absence of the latter, there were two varieties of the disease—a moist type, which ran a more rapid course and in which the papules became vesicles and a copious exudation, such as is seen in eczema, took place; the second variety, a dry one, was more prolonged, the skin remaining dry throughout, no exudation occurring and the appearances being those of a pityriasis rubra. Stage of subsidence. By degrees the inflammation subsided, the skin remaining thick, indurated, polished in appearance, brown in color, sometimes raw or smooth, shiny and parchmentlike, with cracks and fissures here and there. In some cases, eversion of the eyelids was noted and in some of the older people, a purpuric condition. . . George T. Elliot. J Cutan Genito-Urin Dis. May 1892;10:207-209.

In the study of the instances of the disease which I have just described, it was most clearly evident from their pathological course that their existence was intimately connected with a disturbance of some kind in the nervous system, and essentially dependent upon it. In both predisposition existed, in so far that the one (Case I.) the woman was worn out with anxiety, want of rest, etc., from nursing the member of her family who died just before the first attack of the disease, she was hysterical and nervous; in the other (Case II.) he had been subjected for years to severe responsibilities, cares, and worries, which had impaired his general health. In Case I, complete recovery took place after a certain length of time, and she remained well, until experiencing another mental emotion and shock—from business reverses—a relapse occurred. From this time on, every relapse slight or great, every recrudescence of the cutaneous symptoms, subjective or objective, could be traced to some such slight or severe mental emotion or impression, or increased worry, or care, or anxiety and furthermore the grade of the relapse, whether transient or grave, varied according to the grade of the emotion, shock, or other disturbance received. It was also constantly seen how objective manifestations constantly followed immediately upon neuralgic pains, or a hemicrania or some other evidence of sensory innervation. Still more conclusive, perhaps, of the neurotic character of the disease was the observation that diminution in the severity of the subjective and objective manifestations occurred in proportion as the patient's morale improved, and the final cessation of the pathological symptoms and entire quiescence of the disease were only obtained when the changed circumstances of the patient's life protected her against the occurrence of mental emotions or shocks and precluded the experience of annoyances, worries, or cares. J Cutan Genito-Urin Dis. September 1891;9:331-332.

The discovery of the tubercle bacillus by Koch and the incontestable proof furnished by experimental inoculation that it was the cause of pulmonary tuberculosis, has acted as a powerful incentive to the study of disease from a bacteriological standpoint of view, and, leading to the study anew of many affections hitherto considered as of unknown origin or doubtful nature, has allowed many of them to be established upon a firm basis. One of the most important results of this method of study has been the discovery that affections, previously considered separate and distinct one from the other, were in reality only clinical manifestations of the same disease; that is, they were due to the same cause—a fact which was most brilliantly seen in tuberculosis as it occurs in the skin. In this organ of the body, the most varying clinical phenomena have been found to be dependent upon the presence