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cither surface invasion, local infection, or disease. PROCEEDINGS OF SOCIETIES. 909 The diagnosis of any of the exanthemata may not safely be made without a skin eruption. As soon as any one undertaivcs to do tliat, he will be drowned or worse. Another definite statement safe to make is that whatever the length of time one of llicse eruptions takes to arrive at its culmination — wlicthcr one day as in the case of German Quanto Costa Cialis 20 Mg Farmacia measles, or eight to twelve, as in small()Ox — it will be a greater number of days before the rash disappears. As to the order in which these symptoms appear, tlirit also is strictly limited in each of these diseases. Dr. John I^andoli'ii Graii.\m said in his ex- perience a great many errors of diagnosis in erup- tive diseases were the result of taking too much for granted. One shoulrl always bear in mind the fact liiat for every crujjtive contagious disease there was a noncontagious rash that will simulate it. As an example of the casual way in which some men ap- proacli this subject, Doctor Graham said that in the last year he had seen two cases reported as typhus fever which were found on investigation to be pure anQuanto Costa Cialis 20 Mg Farmacia time. She had a very bad case of intestinal stasis. Was the. desquamation not due to intestinal stasis? Ex- ercise and control of the bowels had been the effec- tual remedies. , Dr. Max Shi-.i-.r considered that the eruption and desquamation in erythema scarlatini forme may bear a close resemblance to that of scarlet fever. The former was an affection [jroduced by some toxinc and fref|uently ushered in with fever and a red throat, followed immediately, or in a day or two, by an eruption which might exactly resemble scarlet fever. Descjuamation, which might be fine, or abun- dant and in large flakes, began in a few days. Dr. S. D. IIuDBAKD, replying to the comment made regarding erythema scarlatini fonne, said that both Fox and Jackson of the Columbia University Quanto Costa Cialis 20 Mg Farmacia (Vanderbilt Clinic) hesitated regarding this diagno- sis when it presented itself, especially in children and in the initial attack. He had called on a little girl about ten years old, presenting a typical history of scarlet, with sequen- tial symptoms followed by desf|uamation which had occurred in September. She had a recurrence at Christmas of the same year. This case had been seen by several of the diagnosticians of the Depart- ment of Ilealtli who, jn the first attack, concluded it scarlet fever, but, on the recurrence, revised tlieir diagnosis. It is also interesting that, following each attack, albumen presented itself in the urine. Recovery was complete and without any sequellae. There had been no recurrence for eleven years. The "sore throat" of exfoliating dermatitis was occasionally jirescnt, but was not the character of throat seen in scarlet, in that there was but little if any congestion, but there was pain on taking food. He had followed verj' carefully five of these recur- ring exfoliating erythemas, and, in each instance, the initial attack was mistaken for scarlet. The desquamation did not have the tiny bull's eye dcs- c|uamation of scarlet; the latter as the only condi- tion Quanto Costa Cialis 20 Mg Farmacia observed by liim which had that jwculiarity : commenced to dest|uamate in the site of the little puncta, started as a fine pin hole elevation of the cellular structure, apparently the cone of the puncta. anrl spread peripherally, coalescing with others forming a sheet or scale. In regard to Quanto Costa Cialis 20 Mg Farmacia the fourth disease. Doctor Hubbar