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354.	SCORBUTUS. Model of the inner side of the left thigh, knee, and leg of a man affected with scurvy. Numerous small purpuric spots may be observed upon the thigh and knee, and on the ham and calf there are large vibices.

The patient was an inmate of the Dreadnought Hospital Ship.

355.	SCORBUTUS. Model of the right arm and forearm of a man, showing numerous scattered purpuric spots, most of which are of very small size. In the flexure of the elbow there is a diffuse staining, which perhaps represents one of the subcutaneous vibices so frequently seen in scorbutus.

The patient was on board the Dreadnought.

The name is applicable to any case occurring in a member of the white races of mankind, and attended with a dark brown or blackish discoloration of the skin.

One form of it was shown by Dr. Addison to be dependent upon a destructive (and probably tuberculous) change in the supra-renal capsules; this may be distinguished as melasma supra-renale. In it the distribution of the colour presents the peculiarity that it is either an exaggeration of a natural pigmentation, or else corresponds with some abnormal pigmentation, which, however, may occur even in a healthy individual provided that the skin be exposed to a sufficiently intense and prolonged stimulation. In other words, the brown or black coloration of the skin in melasma supra-renale is often exactly like that which is seen in the dark races of mankind, or which may arise even in a white man who has for years been in a hot climate under the influence of the rays of a tropical sun. It generally affects chiefly parts exposed to the air, such as the face, the neck, and the backs of the hands; and the nipples and genital organs, which are normally pigmented in a slight degree, become of a very much darker colour. Or, again, the distribution of the pigment may resemble that which may be caused in any one by the heat of a fire (ephelis ab igne); of this I have seen a well-marked example. Parts which have been blistered also assume a much darker colour than in healthy persons. Minute black scattered

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