black and completely filling the mouth. During the last week there was a continued flow of offensive saliva from the mouth. When I first saw the patient she had on the backs of the hands and on the extensor surfaces of the forearms small dry scaly patches resembling a mild psoriasis. I gave this no thought at the time. Within two weeks after operation, however, these patches increased in extent and on parts of the arms, back and chest there was a condition resembling in places a dry eczema, and

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... in others an erythema. The patient gradually lost strength and flesh. Her insanity became violent and she died six weeks after operation in a state of acute mania.