H. S. Stannus 
357 
any size reduced to the pink colour such as is seen in ordinary cases of leucoderma 
i n natives. 
It is however difficult to see where to draw limits around any particular type, 
though I must agree with Ziemann in setting apart the hand and foot type as a 
fairly definite variety. I agree with him in thinking that the disease does often 
start during youth, but I am not convinced that it always does so. Again it is 
nearly always symmetrical after it has been existent for some time, but not always 
so at the beginning. I believe that in most cases the hands are affected before 
the feet, and though in the majority of cases the progress is very slow, yet in some 
it may run a more rapid course for a time, and then become stationary. 
I have certainly never seen more than four-fifths of the hands or feet affected. 
The flexor surfaces are more extensively involved than the extensor, but the 
change is by no means so commonly limited to the hands and feet as Ziemann 
makes out. I would say that it is more usual for some two or three inches of the 
fore-arm to be involved as well. I should be inclined to lay more stress on the 
character of the colour changes. Practically in all my cases there was hyper- 
pigmentation to be seen in areas of skin adjoining those in which loss of colour 
had taken place. This was generally most marked as a black band around the 
wrist, but was seen elsewhere. 
The loss of pigment as above mentioned would appear to take place at a 
number of points more or less at the same or at different times, so that round 
areas are produced showing varying degrees of loss of colour which may coalesce 
with the formation of larger areas with scalloped margins. Often in the middle 
of .such a depigmented area, one that may have been reduced to whitish-pink 
or yellowish orange colour, small spots of more deeply pigmented skin may be 
seen to remain. 
Ziemann has compared the appearance to the result of extensive superficial 
burns which have healed without the formation of granulation tissue. Such a 
description I do not consider good, as under those circumstances the skiu is 
essentially pink and never of the orange yellow or yellow white colour character- 
istic of the affection uuder consideration. Again, the laying down of pigment 
after burns occurs at points partly separated from one another, which appear very 
dark indeed, and do not resemble the darkly pigmented patches seen in this 
disease. 
Attention might again be drawn to the fact that the history of yaws was 
obtained in several cases and a few show evidence of lesions almost certainly the 
result of framboesia, I refer to the pitted appearance of the hand and hyper- 
keratosis. The loss of the hair from the digits in one case should also be noted as 
possible evidence of a trophic element in the etiology of the affection. 
Below are short notes of cases of melanodermia of congenital origin as far as 
their histories could be elicited. 
Biometrika ix 46 
