CASE I.-MYCOSIS FUNGOIDES OF ALIBERT.

Diagnosis.—Julius Romualdo, of Roccapiemonte, aged sixty-nine years, a priest. He does not present anything remarkable in his antecedents, and assures us that for the last fourteen years he has always enjoyed perfect health. His actual cutaneous disease began about two years ago, after a feeling of pain in different parts of his body, beginning in his feet; and also by an intense itching, together with an almost contemporaneous appearance of erythematous stains on the trunk and on the extremities. These stains, gradually coming up to the level of the healthy skin, assumed, after the lapse of two months, in some places particularly, the appearance of real tuberous excrescences. Some of them disappeared spontaneously, while others remained there, afterward becoming ulcerated.

Examination of the Cutaneous Surface.-(See Figs. 1, 2.) The affection is spread over the trunk and the extremities, in the shape of deep-seated, reddish stains, of varying thickness, of noduli and tubera; some reddish and some of a bright red color; partly ulcerated (superficial ulceration on a white-grayish ground).

In some points can be observed an abundant sero-lymphatic exudation. On the posterior part of the trunk the middle portion is sound, the affection being on the sides and on the base of the thorax, and spreading over the scapular region and over the deltoid externus. It extends over the anterior parts of the trunk and over the surface of the abdomen. It is less developed over the lateral regions of the trunk on the right side. On all these points are to be seen erythematous stains, diffused and a little elevated (on the posterior cervical region and on the shoulders), excrescences in the shape of tubera, some of which are oblong (3 to 4 by 2 cent.), some circular. Some of these tubera are sound, some excoriated and others deeply ulcerated, with a whitegrayish base. The excoriations result partly from the infiltration proper, and partly from the scratching caused by the great itching which torments the patient; so much so, that excoriations on sound tissue may also be seen on him, covered with small blood crusts. On the anterior part of the abdomen, at the sides and on the sacral region, the affection is diffused and of a macular and infiltrated form, with tuberous ovoidal elevations scattered over it.

The Superior Extremities.-On the internal surface of the right forearm, down to its inferior third, there are some simple macular patches, in discrete form, while on the inferior portion of the left arm, from the armpit down, besides some erythematous spots and flat elevations, there are also to be seen real tuberous excrescences, three to four centimetres long, by two to three centimetres broad, as well as larger ones, some of which are ulcerated, as on the scapular and axillary regions.

ones.

The Inferior Extremities.-These are less affected by the disease than the superior The right thigh is affected over a very large extent of its internal surface, while the left one only shows the disease on its superior fourth. In the legs the disease is less advanced, the macular form, lightly infiltrated, being there prevalent. Ichthyotic, whitish scales are to be noticed on the elbows and knees, as well as xeroderma on the legs.

The face is altogether free from the affection.

The enlargement of the inguinal lymphatic glands is remarkable. The latero-cervical ones, too, are greatly swollen, especially on the supra-clavicular regions.

Form of a Malady of the Skin, the Pernicious Lymphodermy," by M. Kaposi, Medic. Jahrb. der k. Gesellschaft der Aerzte, Wien, 1885. "A Case of Granuloma Fungoides," by Auspitz, Vierteljahrsch. f. Dermat. und Syph., 1885. "A Study on the Mycosis Fungoides," by Vidal and Brocq, France Médicale, Nos. 79 and 85, 1884. "Mycosis Fungoides," by Rindfleisch, Deutsche med. Wochensch., 1885. "Mycosis Fungoides," by Tilden, Amer. Dermatol. Assoc., August 26th, 1885.