A. Dermalgia and desquamation, Field, 143, Nov. 30, '78, 427. Erythematous disks (Grellety), 89, 24, 206. Erythematous eruption with tingling and itching, Slocum, 143, '77, 334.

* Hahnemann - Reine Arzneimittellehre, 2te Aufl. Dresden, 1825, 8: 143.

Scarlatinoid redness, papules, Kobner, 114, '77, 305.

Scarlet eruption, 209.

Bright scarlatinoid eruption all over the body and intolerable itching, Skinner, 116, 1/70, 103.

Rash as vivid as scarlatina, with intolerable and incessant itching-, followed by universal exfoliation of the cuticle; Hemming, 116, 2/69, 533.

Scarlet efflorescence, edema, wheals, pruritus, King, 161, Mch. 1, '79, 251.

Flat, slightly raised patches of a rose-pink color, and accompanied by much tingling and itching, Farquharson, 137, Nov. 16, '78.

Burning and eruption like erythema exsudativum multiforme, Heu-singer, 114, '77, 361.

Edematous erythema, followed by desquamation, Garraway, 116, 2/69, 388.

Urticarial eruption, Thin, 146, 1/79, 421; 206; 209.

Erysipelatous redness and wheals, Newman, 116, Apr. 8, '71.

Bullous eruption (Panas), 89, 66.

Rubeoloid eruption, Farquharson, 172, 12:

The following have been observed in workers in quinine factories:

Confluent vesicles, sometimes ulcerating, sometimes diying into crusts. The forearms, internal aspect of the thighs and genitals, are the parts affected by preference. Sometimes the vesicles are isolated, at other times they are confluent and unite to form bulls. Extensive surfaces may be deprived of epidermis by furfuraceous or foliaceous desquamation, 185, May and July, '76.

Pruritus, erythematous, roseolous, pustular, and purpuric eruptions and desquamation (many authors cited).*

Dr. P. A. Morrow has made a careful study (155, March, '80) of the recorded cases of quinine eruption, as well as those which he has individually met with, and writes as follows:

"The prevailing type of the quinine exanthem is erythematous. In most cases it appears as an efflorescence of a bright, vivid hue, disappearing on pressure, and closely resembling the rash of scarlatina. It first shows itself upon the face and neck, but soon becomes diffused over the whole surface of the body; in exceptional cases it may not become generalized; or it may appear in the form of distinct red spots, which usually become confluent and patchy, and the coloration may exhibit a darker hue, resembling that of measles. Again, it may present itself with the typical wheals of urticaria. In this class of cases there is more or less oedema, and the subjective symptoms of burning, tingling, itching, etc., are more distressing. An examination of the sixty oases above referred to shows that many varieties of form are represented. In thirty-eight cases the general character of the eruption was erythematous. It was further described as 'scarlatinal,' 'scarlatinoid,' 'bright red,' 'measly,' 'rubeolous,' 'papular,' 'erysipelatous.' In two cases it was 'vesicular.' In twelve cases it was described as 'urticarial' with ' puf-finess of face,' etc. Of the severer forms, I have collected live cases of purpura. They are presented with so much detail and by such careful observers that no doubt can sin of the possibility of the occurrence of these haemorrhagic accidents. Vepan reports four cases in which an eruption of petechial spots occurred over the whole body from the use of comparatively small doses of quinine. In one case the purpura was accompanied with bleeding from the gums and sanguinolent stools.

* Jeudi de Guissac - Des eruptions quiniques. Paris, 1876.

"Gauchet reports a case in which the intolerance of quinine was so absolute that small doses, only ten centigr., continued for four days, produced purpura, with buccal haemorrhage, principally from the gums The petechial spots were abundant and generally distributed. In this case Gauchet gave quinine in opposition to the wishes of the patient, who stated that she had taken it before, and that it always caused her to spit blood.

"Of the bullous form of the eruption I have less specific details. M. Panas affirms that the administration of large doses of quinine (two to three grammes, as is the custom in Algiers and Greece) provoked an eruption presenting the characters of the bullae of pemphigus.

"In one case, reported by Professor Schuppert, six-grain doses produced an intense localized dermatitis, with commencing gangrene of the scrotum. In one of Professor Kobner's cases, quinine always produced an erysipelas of the scrotum. In several cases this special tendency to irritate the skin of the genital parts is noted.

"In many of the cases reported, several successive outbreaks of the eruption occurred, because the physician either repeated the dose without suspecting the causal association of the remedy and the disease, or did so because he wished to satisfy his own mind as to the patient's susceptibility. It is worthy of note that what may be called the idiosyncratic intolerance of the drug may be an acquired peculiarity. In a number of the cases, my own among them, the patient was previously accustomed to take large doses of quinine without any unusual effects upon the skin.

"The cutaneous disturbances have seemed to follow indifferently the exhibition of any of the preparations of cinchona. In two or three cases where preparations of the bark were given, the physician, thinking that the irritant effects might be due to some adulteration, substituted the alkaloid, with a repetition of the same effects. In a majority of the cases, what may be regarded as small doses - one to two grains - were given. The subjects of these observations, I had almost forgotten to state, were mostly females. The greater fineness of the skin and its more exquisite sensibility in women would explain its relatively greater susceptibility to irritant action.

"The quinine exanthem derives its chief clinical importance from its close resemblance to the rash of scarlatina. This resemblance is rendered more real from the congestion and swelling of the mucous membrane of the throat and fauces and the subsequent desquamation, which may be more or less complete, and may last from a few days to several weeks. In one case, reported by Dr. Pfluger, there was exfoliation of the epidermis in large lamella1, giving a complete cast of the fingers, like a glove. When the eruption is accompanied with fever and high temperature, as in the cases of Professor Kob-ner and two other reporters, its similitude to scarlatina is so perfect as to deceive the most skilful and experienced physicians, but all these cases are quite exceptional. The differential diagnosis is usually easy, from the absence of fever and high temperature, the sudden development of the rash, and its rapid subsidence upon the suspension of the medicine."

C. Urticaria, 44, 502; 72, 154; Lente, 143, Nov. 16, '78, 388. Pemphigus, 61, 214.

Erysipelas, Perroud, 106, 2: 241; Satterlee, 155, Dec. '74. Rhus poisoning, Cantrell, 151, Aug. '77. Scleroderma, 76, 410.