913

Hutchinson’s case. He had found no change in the mucouslayer of the epidermis, but some hypertrophy of the Mal-pjghian layer. The sheaths of the hair-follicles were irre-gularly developed and dilated. In the corium were largesuperficial lacunar spaces, mostly elongated, and disposedvertically. Some of these spaces were empty, others filledwholly or partially with amorphous granular material, andoccasionally mingled with blood-corpuscles. The cavitieshad mostly ragged walls in the midst of loose fibro-cellulartissue. In some specimens he had found acari folliculorum inthe mouths of the follicles.-The PRESIDENT added thatlie showed one of these cases to Dr. Tilbury Fox, whoagreed with him that the condition was not the same as thatin his (Dr. Fox’s) case.-Dr. THOMAS Fox, referring to thiscase, mentioned that the vesicles did not appear till sixmonths after birth, and that they then increase pari passuwith the growth of the naevus. He considered that thevesicular changes then present were identical with those ofMr. Hutchinson’s cases, the microscopical characters beingalso similar, and that both were examples of lymphatic dis-ease.-Dr. HOGGAN, on the other hand, thought that whereasDr. Fox’s case was connected with lymphatics, the presentwere not; and he suggested that in the latter the conditionwas due to obstruction of the sebaceous gland-ducts.-Dr. THIN thought Mr. Hutchinson’s cases unique. Thedisease was too localised to have a constitutional origin, andwas also free from any ulceration. He thought the presenceof. the acari might throw light on them, seeing what exten-sive destructive changes had been found in the skin of thedog affected with these parasites by Dr. Sparks, in a paperead at the Medico-Chirurgical Society some years ago. HEcould not agree to the " lymphatic " view, seeing how diffi.cult it was to demonstrate the lymphatics of the skin. 11 Amore likely explanation was that the cavities in the coriunwere produced by exudation from bloodvessels, causing a disruption of tissue.-The PRESIDENT hoped they would be abl(to examine the other case microscopically.-Dr. SANGSTEIcould not admit that the condition was nreciselv similar t<that in Dr. Fox’s case, which was further complicated withDevoid growth. There was no evidence of any connexionwith sebaceous glands. He agreed with Dr. Thin, that thechanges were those of fluid accumulation causing ruptureof tissue; and, in the light of Dr. Sparks’ observations,thought it possible that the acari might be proved to be notso harmless as generally held.Dr. BRAILEY showed a specimen of a Tumour implicating

the anterior lobe of the Brain and the Optic Nerve-from aninfant, three months of age, under the care of Mr. Joyce, ofCranbrook. When born the right eye was slightly pro-truded, and the upper lid a little congested. A tumourabove the orbit gradually increased; the child became muchemaciated, but death took place without there having beenany special cerebral symptoms. The right anterior cerebrallobe was found involved in a mass of new growth, whichhad invaded the orbit, causing absorption of its roof, andhad protruded over the face. The eye was not invaded by i

the growth, which presented a reticulated stroma enclosingepithelioid cells. Dr. Brailey considered it an alveolarsarcoma, closely simulating carcinomatous structure. It wasinteresting in that it clearly arose during intra-uterine life.- The PRESIDENT also thought it an alveolar sarcoma, fromits close resemblance to a growth of like kind he had met within the subcutaneous tissue.-Mr. GODLEE said that in oneform of these alveolar sarcomata a criterion for discriminationbetween them and carcinoma lay in the existence of minutestroma between individual cells. A specimen he haddescribed some years ago showed this. That also was fromthe skin.-Dr. THIN suggested the use of eosin as enablingobservers to differentiate between cells of connective tissueand those of epithelial origin.Mr. MEREDITH exhibited an Ovarian Cyst, which had

repeatedly ruptured for nine years before removal. It wasremoved by Mr. K. Thornton from a single woman forty-seven years of age. She first noticed enlargement of theabdomen ten years ago, and, in 1871, tapping was practised.The cyst filled up in four months, and then suddenly, aftersome pain, the swelling disappeared ; and at the same time,for some four or five days, she had copious diuresis. Thisrefilling and rupture, with diuresis, took place about three orfour times annually, until April, 1879, when it was againtapped by Mr. Edwards, of Ipswich. Since April it hadtwice refilled, and twice ruptured. At the end of Septembershe came to the Samaritan Hospital, but, the cyst beingthen collapsed, two months were allowed to elapse. The

cyst filled up again, and ovariotomy was performed on-

Dec. 4th by Mr. Thornton. The cyst contained twenty-onepints of fluid. It was a unilocnlar true ovarian cyst, withwalls very ill-supplied with vessels, and the interior showedmuch atheromatous change, and numerous points of ulcera-tion extending through to the outermost layers. It was tothis that the repeated spontaneous rupture was due, thecyst-wall yielding at one oi these points whenever thetension in the cyst became greatly heightened. Theapertures must have closed up rapidly on each occasion.It was also interesting as regards the frequency of therupture and the amount of fluid absorbed by the peri-

, toneum. -

, Mr. H. MORRIS showed a recent specimen of Intra-: capsular Fracture of the Neck of the Femur in an old man.’, The case was of interest clinically owing to the difficulty im

determining whether the hip was dislocated, a difficulty; enhanced by the fact (discovered after death) that there was; a bony mass growing out of the posterior border of the great-’- trochanter, which during life gave rise to the appearance oi:3 the head of the bone on the dorsum ilii.b The PRESIDENT then read over the list of specimens showni by card ; and Mr. MORRANT BAKER drew attention to- thetwo specimens thus shown of Dislocation of the Head of.

Femur on to the dorsum ilii in hip disease, by Dr. Lediard.1 Mr. Baker said that he had upon a previous occasion de-3 murred to the statement that such dislocation was at all- frequent-i. e., in the early stages of the disease. The spe-3 cimens shown by Dr. Lediard were in advanced cases, andr the condition they exhibited was not as complete a dorsale dislocation as is said to occur.

Specimens, t-c., 2vathoact oral communication.1. Drawings from cases of Cancer of the Breast. By

Mr. Hulke.2. Specimens and drawings of two cases of Osteitis in

connexion with Inherited Syphilis. By Mr. Hutchinson.’

3. Complete Occlusion of the Right Division of the Pul- monary Artery, the result of disease ; Atheroma of Pulmon-

ary Artery. By Dr. Ewart..

4. Broad Fibro-Cretaceous Ring surrounding the Heart’in’ the situation of the Auriculo-Ventricular Sulcus. By Dr.’

Ewart.. 5. Dislocation of Hip-joint from Disease (two specimens).’

By Dr. Lediard.6. Kidneys united by a Fibrous Band. By Dr.

’Lediard. . ____

THE HEALTH OF SAN FRANCISCO.

THE medical officer of health for the city and county ofSan Francisco, Dr. J. L. Meares, gives the annual rate ofmortality for his district (estimated population 305,000)during the year ending June 30th, 1879, at 14’75 per 1000(the lowest rate of mortality yet recorded in the district), asagainst 16’59 in the preceding year. The annual rate of

mortality in the Registrar-General’s standard group of ruraldistricts in this country is 16’50 per 1000. So low a mor-

tality in a city and district such as that of San Francisco

may well excite surprise. The city still retains abundantevidence of that utter neglect of sanitary considerationswhich accompanied its foundation and development, andamong its population there are some sections, notably theChinese, who live under conditions in which the most rudi-mentary requirements of health appear to be ignored.Recently the health authorities have made most strenuousefforts to enforce some sort of sanitary regulation inthe city, and, in certain respects, it would appear &raquo;ot

unsuccessfully. But Dr. Meares’ report does not lack illus-trations of the great amount of work which has yet to bedone before San Francisco can be reckoned among localitieswhich may claim a respectable position as clean and

wholesomely conditioned places of the earth. Have we

here, in this low mortality of San Francisco, a sort ofcriterion of the important part which time has played, aswell as sanitary negligence, in the development of the un-healthiness of the cities of the old world, : and of districtswhich have been longer occupied ?