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Rh affected. The face usually presents a characteristic appearance, the cheeks being roughened or chapped, the eyelids stiffened and drawn into a condition bordering on ectropion, the lips dry, and the oral commissures more or less wrinkled. The hair is usually dry and sparse upon the scalp, and may be entirely absent upon those portions of the trunk and extremities where a slight growth is usually present. The nails are apt to be dry and brittle.

In cases of ichthyosis of a severe type in which no treatment is instituted and the ordinary use of soap and water is neglected, the epidermis becomes broken into small plates, which increase in thickness until the affected skin upon the extensor aspect of

18—Ichthyosis with broken epidermis.

the extremities is covered with more or less conical, blackish masses and resembles the bark of a tree. To this condition the term ichthyosis hystrix, or "porcupine skin," may be applied. It should be borne in mind, however, that this term is often used to designate a linear warty condition occurring in parallel streaks, usually upon one side of the body (nævus verrucosus), and which has no clinical relation to ordinary ichthyosis.

The severest form of the disease is one which develops in utero and is frequently fatal shortly after birth. This has been described as "diffuse congenital keratoma," "harlequin fœtus," etc. Dr. George G. Wheelock in a report of a case