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w^ith purulent material and some had dried up forming impetigolike crusts, a few with an inflammatory areola. .Almost all Is Generic Viagra Legal In Canada of the vesicles on the legs, the arms, and the buttocks were filled with blood. A great many of the vesicles were umbilicated and "shctlike" to the touch. In- terspersed with the haemorrhagic lesions were a few, re- cent, clear vesicles of the usual varicella type. Lesions of Is Generic Viagra Legal In Canada the typical form were also present on the scalp and the neck. There was no eruption on the palms or the soles. The lesions were almost entirely discrete, with the excep- tion nf a tendency to confluence on the buttocks and in the gluteal region. On the following day, the fourth day of the eruption, the clear and the cloudy vesicles on the face had become haemorrhagic and fresh vesicles with clear contents were still appearing. Vesicles were noted on the tongue, the fauces, the soft palate, and the tonsils ; these appeared with clear contents but within a few hours became filled with blood. The legs were swollen to almost double their normal size, were slightly cyanosed and very painful on the slightest movement. The urine was scanty and highly colored. -^s the lesions became umbilicated the centres turned to a blackish blue color, this black area extended amtil when the vesicle had entirely dried up, the lesions ■exhibited necrosis, gangrene, varying from split pea to dime in size. These later areas were noted almost en- tirely on the buttocks. The temperature on March 22d, five days after the start ■of the outbreak was subnormal, the pulse 150, and tlie lieart sounds weak and rapid. Croup and bronchitis were marked. On the twenty-third, the temperature was mo' F., the pulse very rapid and weak. The croup and the bronchitis had become much worse, although no pneu- monic Is Generic Viagra Legal In Canada areas could be determined. There was extensive recession of the chest walls. The child's condition became steadily worse and death occurred at one o'clock in the morning of March 24th, exactly one week after the start -of the eruption. Since Hutchinson's description of varicella gan- grsenosa practically every case of varicella that had gangrenous areas associated with it has been classed under this caption. The author maintains that this classification is too broad and considers that a division of these cases should be made. The writer believes that there is a true haemorrhagic form of varicella, the same as there is a haeinor- rhagic form of the various other exanthemata ; that there is also a haemorrhagic form of varicella which terminates in gangrene ; these two types simply showing a virulent infection or a lowered resistance of the individual or a combination of the two. There is also, I consider, a form of varicella start- ing with the usual type of lesions, the clear vesicle becoming filled with ptirulent material, and by a continuous process may become finally gangrenous in type, but usually of an ecthymatous or impeti- genous character. This later form of eruption I believe should be classed under varicella. There is. however, a group of cases in which the gangrenous areas do not develop until the previous varicella has practically disappeared, and one should be exceed- ingly skeptical in attributing the former disease as the cause of the latter condition. In fact a great many Is Generic Viagra Legal In Canada writers on the subject consider that this fonn of gangrene is due Is Generic Viagra Legal In Canada to microorganismal infect ii^n. Baudouin and Wickham fotmd in a patient e^xam- ined by them Streptococcus pyogenes; the Bacillus pyocyanens has Is Generic Viagra Legal In Canada been supported by Ehlers ; and the Bacillus dipliiherice has been brought forward as causal by Labbe and Demarque and several others, including Oettinger. Ecthyma terebrant des en- fants, as described by Baudouin and Wickham, is closely allied to this latter group. The consensus of opinion at the present day is that varicella gan- graenosa, described first by Hutchinson, may not only be associated with varicella but may follow vaccination and numerous other conditions, and therefore the former can hardly be mentioned as causal. Crocker clearly Is Generic Viagra Legal In Canada Is Generic Viagra Legal In Canada discusses this phase in a complete paper on the subject. Probably the best and the least confusing name for this latter con- dition would be dermatitis gangrsenosa infantum, as employed by Lipes in his article on the subject. After a careful investigation of the subject, the author considers that the case reported in thi? paper is one of true varicella, starting as the usual tj'pe, and because of the virulence of the infectinn. becoming hremorrhagic and then gangrenous. The case is closely allied to the fatal cases of Crocker and Demme. which have been given in detail under the heading of varicella with li;emorrhagic and gan- grenous lesions. The writer has been able to find but SIX cases of varicella with h.Tsmorrhagic le- sions in the literature on the subject, which have been given in detail in the early part of this paper. CONCLUSIONS. There is a true form of hasmorrhagic varicella, starting with the usual type of vesicles with clear contents, which some hours after their formation ROSE: IMPORTANT FACTOR IN CIRCULATION. 8-0 become rilled with blood. It is a rare complication of varicella. The latter h;emorrhagic vesicles may lead to the formation of gangrenous areas. The case of the author comes under this heading. The virulence of the infection and the resistance of the individual govern the hjemorrhagic and gan- grenous tendency. There is also a true form of varicella, in which the contents of the vesicles become purulent and may lead to gangrenous areas, but usually to the ecthymatous or impetigenous types. The term varicella gangrenosa should be applied only to cases of gangrene directly caused by vari- cella. The term dermatitis gangrsenosa infantum should be applied to cases of gangrene in children, wheth-