quired often more consideration than was requisite for preWe scribing any supposed appropriate drug treatment. are therefore, at present, advocates of the exactest treatment of the patient under acute rheumatism, though we may doubt the value of so-called specific drugs. ON A CERTAIN AFFECTION OF THE SKIN, VITILIGOIDEA a. PLANA, 6. TUBEROSA.' THE object of this communication is to call attention to a somewhat rare disease of the skin, which, so far as our observations extend, presents itself under two forms: namely, either as tubercles, varying from the size of a pin's head to that of a large pea, isolated or confluent; or, secondly, as yellowish patches of irregular outline, slightly elevated, and Iwith but little hardness. Either of these forms may occur separately, or the two may be combined in the same individual. Under the latter circumstances we are able to trace the connection of the two through an intermediate series of gradations, which clearly demonstrate their essential relations. It is doubtful whether this disease has been hitherto 1 By Thomas Addison, M.D., and William Gull, M.D. Reprinted from the 'Guy's Hospital Reports,' vol. vii, 1851, p. 625. The above appears in the 'Guy's Hospital Reports' under the joint names of Dr. Addison and Dr. Gull; it appears also in Dr. Addison's collected works, edited by Dr. Wilks. The following note with regard to this paper was found in Sir William's handwriting after his death :-"This paper I wrote entirely, and coined the generic and specific designation, and pointed out its clinical relation to liver affection. When the paper was finished I asked the favour of Dr. Addison to let his name appear with mine at the head of the communication, which he did. My request was on the ground of gaining authority for what I had written, and I was then working with Addison, who saw the cases with me."—[ED.] described. The only account which at all corresponds to it is that given by Willan, of vitiligo. He defines vitiligo to consist of "white, shining, smooth tubercles arising in the skin, about the ears, neck, and face, terminating without suppuration." Bateman adds, "This disease is somewhat rare, and perhaps but little known." The plate he gives of it is very unlike the appearances presented by the cases we have seen, yet the further description given by him would, to a certain extent, apply to them. "It is characterised," he says, "by the appearance of smooth, white, shining tubercles, which rise on the skin, sometimes in particular parts, as about the ears, neck, and face, and sometimes over nearly the whole body, intermixed with shining papulæ. They vary much in their course and progress; in some cases they reach their full size in the space of a week (attaining the magnitude of a large wart), and then begin to subside, becoming flattened to the level of the cuticle in about ten days. In other instances they advance less rapidly, and the elevation which they acquire is less considerable; in fact, they are less distinctly tubercular. But in these cases they are more permanent; and as they gradually subside to the level of the surface, they creep along in one direction,―as, for example, across the face, chequering the whole superficies with a veal-skin appearance. All the hairs drop out where the disease passes, and never sprout again; a smooth, shining surface, as if polished, being left, and the morbid whiteness remaining through life. The eruption never goes on to ulceration." We have extracted the whole description given by this author of vitiligo, that our readers may judge how near it applies to the cases we have to record. As many particulars are named in it which were not present in our cases, and also many are wanting which we have observed, there may be a doubt whether it is here applicable. The two forms of the affection are indicated, and perhaps the want of exact correspondence may be attributable to the want of a sufficiently large number of cases from which to frame a more accurate general description. Believing it to be probable that Willan would have included the cases here recorded under Vitiligo, or an allied affection, we have named them accordingly, distinguishing the two varieties by |