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THE subject of iirticaria is onle of considerable importance, for the complaint is not inifrequenitly metwith both in private and in hospital practice, alnd also because of the distress it occasions its unfortunlate victims. To the dermatologist it isof heculiar interest, for it exemplifies, lerhaps better tlhan aiiotlher skin complaint, the close relationshiip between the science of cutaneous medicine and the other branches of medicine.' It serves to impress uponi us the fact that a' change in the skin is often the expression of some pathological process which is taking place in, another part of the body, and that its elucidationi and treatmenit requirea knowledge of the latest advanices in biology and physiology. The signs and symptoms of the condition are fortunately easily recognized, although the wlleals vary enormously in shape and size. Occasionally, it is true, there may be a confusion with the bullous rashes should the horny layer of the urticarial wheals be raised in the centre by an excess of serum, but this is an infrequent occurrelnce. On other occasions the oedema of a limb or other part of the bodv may be so pronounced as to earn the distinctive name "anciorieurotic oedema," a term which m-lay preferably be replaced by that of " giant urticaria." It is conivenienit, perhaps, to follow the line of the majoritv of textbooks and divide the subject inito four main groups: -(1) factitious urticaria, (2) acuite urticaria, (3) chronic urticaria, (4) papular urticaria of clhildlhood; but to obtain an accurate co'nception it is necessary to realize that it is not a disease, but a symptom attribuitable to one of many cauises. Urticaria Factitia or Derinographisni.-This peculiar respoonse of thle skin to local triuma may or may not be conicomitant with urticaria vulgaris. Lewis, in his classical -work on the meclhanism of wheal plodluction, states that both this form and tlle w-leal secondarv to internal causes is due to the release of a histamine-like substance fi-om tlle cells of the skin. Whythe pbrsoin w-ith urticaria factitia acquires this exaggerated susceptibility of the cells of the skin is not clear. The condition is miiet with in apparent good health. Oin the other hand, the incidence is higher in epileptics and alcoholics. I recently saww-ell-marked dermographism begill durinig the course of secondary syphilis. Acuite Urticaria.-It is common knowledge that this state usually; follo'ws the ingestion of some particular article of diet, aiid is often accompaniied by more or less severe constitutional symptoms such as vomiting, diarrhoea, and a genelral feeling of malaise. The rash is usually profuse and sometimes even bullo s. It miiav involve tlhe mUCOUS miiembranie of the lips, tongue, or glottis. TIme latter complication, however, is rare, but cases are recorded in which traclheotomy has been niecessary. Fortuinatelv this drastic remecd may now be obviated by the hyipodermic injection of adrenalin e. Chronic T! ticaria.-It is this chlroic, recuirrinig stage which exercises the skill and patience of tmle physician, for tlle dulrationi imiay beimeasured in terms of w-eeks and montlhs or even years, anid it mav be duie to an embarrassing variety of causes.

Remarks on URTICARIA: ITS PATHOGENESIS AND ETIOLOGY