When the answer to the question "Age of talk¬ ing?" was indefinite, i. e., "about a year," "around eighteen months," "at the usual age," that record was excluded from this studv.

The so-called congenital skin defects have not been recorded frequently in the literature. The majority of the accessible reports deal with skin defects of the scalp, which vary in size from a pinpoint to a small coin. They are usually circular in shape, sometimes oval or irregular, and generally have clean-cut edges. The first authentic case seems to have been recorded by an English physician, Campbell, who in 1826 reported a skin defect of the scalp the size of a crown, which assumed the characteristics of a progressive ulcer. Priestley, in 1859, reported a congenital skin defect over the anterior fontanel about the size of a shilling. The defect healed in a short time, the process of repair beginning at the edge of the ulceration. Billard, in 1828, reported a case of skin defect over the parietal bone supposed to have been caused by a uterine polyp of the mother. Emanuel, in 1905, reported an infant with congenital absence of skin involving hands, legs and feet. The child was born dead. There was no evidence of syphilis. Numerous reports have been published from time to time which will be referred to in tabulated form and in the references at the end of the article. Most writers on the subject of congenital defects attribute them either to errors in development, or to inflammatory adhesions between the external layers of the skin and the amnion. At the point where this adhesion has taken place, the growth of flat epithelium is retarded. As the liquor amnii accumulates, the so-called Simonart's bands are formed. These are adhesions which form threads or bands between the amnion and the fetus. If these bands are torn loose from the integument of the fetus, a skin defect remains. Not infrequently, these skin defects are associated with other congenital malformations, for instance, with deformities of the extremities such as deficient fingers, hands, or feet. As has already been noted, the lesions are found most frequently on the scalp. They may occur, however, on the trunk, though in one case reported by Bürger, in addition to the scalp defect, ulcerating lesions occurred on both knees and on both elbows. Macé reported an infant who at the time of birth showed these characteristic defects Read at the meeting of the American Pediatric Society, White Sulphur

Pfannenstiel1 gave the first detailed description of familial icterus of newborn children. He described two fatal cases and collected the scattered reports in the literature. The cause of familial icterus of newborn children is unknown. The disease has nothing in common with Buhl's or Winckel's disease. There is no evidence to prove that familial icterus is due to septic processes. It is not present at birth, but appears during the first days of life. In none of the cases is there a history of birth injury, nor does it seem to be due to toxemia of pregnancy. Most of these children are strong, robust and mature at birth. One might say that the children are in a sense physically defective and very soon become incapacitated to carry on extra-uterine existence. It is possible that the liver failed in the performance of its extra-uterine function.

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