uth, anus, etc.; there is a total
absence of fever or other general symptoms. About 50 per cent die of
marasmus and loss of heat, with or without diarrhea. In those who
recover the surface gradually becomes pale and the desquamation ceases.
Opinions differ regarding it, some considering it of septic origin,
while others believe it to be nothing but pemphigus foliaceus. Kaposi
regards it as an aggravation of the physiologic exfoliation of the
new-born. Elliott of New York reports two cases with a review of the
subject, but none have been reported in England. Cases on the Continent
have been described by Billard, von Baer, Caspary, those already
mentioned, and others.

The name epidemic exfoliative dermatitis has been given to an epidemic
skin-disease which made its appearance in 1891 in England; 425 cases
were collected in six institutions, besides sporadic cases in private
houses.

In 1895, in London, some photographs and sketches were exhibited that
were taken from several of the 163 cases which occurred in the
Paddington Infirmary and Workhouse, under the care of Dr. Savill, from
whose negatives they were prepared. They were arranged in order to
illustrate the successive stages of the disorder. The eruption starts
usually with discrete papules, often in stellate groups, and generally
arranged symmetrically when on the limbs. These become fused into
crimson, slightly raised maculae, which in severe cases become further
fused into red thickened patches, in which the papules can still be
felt and sometimes seen. Vesicles form, and exudation occurs in only
about one-third of the cases. Desquamation of the epidermis is the
invariable feature of all cases, and it usually commences between the
fourth and eighth days. In severe cases successive layers of the
epidermis are shed, in larger or smaller scales, throughout the whole
course of the malady. One-half of the epidermis shed from the hand of a
patient is exhibited in this collection.

Of sphaceloderma, or gangrene of the skin, probably the most
interesting is Raynaud's disease of symmetric gangrene, a vascular
disorder, which is seen in three grades of intensity: there is local
syncope, producing the condition known as dead-fingers or dead-toes,
and analogous to that produced by intense cold; and local asphyxia,
which usually follows local syncope, or may develop independently.
Chilblains are the mildest manifestation of this condition. The
fingers, toes, and ears, ar