occurring in rapid succession in the children of three families in India (exact locality not specified), which bears some resemblance to the pemphigus contagiosus above described. It differs, however, inasmuch as in the Indian disease the bullae were very large— often larger than hen's eggs— and persisted for from one to three weeks. In one of the thirteen cases described there followed a certain amount of sloughing at the seat of the bullæ; in the others there was neither ulceration nor constitutional disturbance.
Etiology and pathology.— Like ordinary impetigo contagiosa, this is undoubtedly a germ disease. I have found a diplococcns in the epidermis and fluid of the blister; whether this is the special bacterium responsible for the disease, cultivation and inoculation experiment have not yet decided. The Leishman body has been found in the contents of the blebs. Its presence there has probably no etiological significance so far as this special lesion is concerned.
Diagnosis.— Absence of constitutional symptoms, or a history of such, distinguishes pemphigus contagiosus from chicken-pox. Absence of trichophyton elements and of a well-defined, slightly raised, festooned, and itching margin, together with the presence of large blebs and scaling of the epidermis, distinguish it from ordinary forms of body ringworm— a disease with which, when occurring in the armpits and crutch in adults, it is frequently confounded.
Treatment.— Cleanliness, the frequent use of a bichloride of mercury lotion (1 to 1,000), and a dusting powder of equal parts of boric acid, starch, and zinc oxide, are speedily effective. In the school and nursery those responsible for the care of children must be informed of the contagiousness of this unpleasant affection, and measures be instituted accordingly.
3. FUNGOUS SKIN DISEASES
MYCETOMA
Definition.— A fungous disease of warm climates, affecting principally the foot, occasionally the hand, rarely the internal organs or other parts
