PROCEEDINGS OF THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY OF LONDON. March 14, 1871. THOMAS BLIZARD CURLING, F.R.S., President, in the Chair. Present-43 Fellows and 3 visitors. The President addressed a few words to the meeting on first taking the chair, and thanked the Society for the honour they had done him in electing him as their President. Books were presented from Dr. Fenwick, Dr. Murchison, Dr. Benjamin Ridge, Mr. George Rigden, the Royal Society, the Obstetrical Society, and the India Office. The following gentlemen were proposed for election as Fellows of the Society: Thomas Lauder Brunton, M.D. VOL. VI. Henry John Strong, M.D. 27 The following communications were read : I. On Xanthelasma Palpebrarum, and its significance as a symptom. By JONATHAN HUTCHINSON, F.R.C.S., Surgeon to, and Lecturer on Surgery at, the London Hospital; Surgeon to the Royal London Ophthalmic Hospital, Moorfields, and to the Hospital for Diseases of the Skin. (Received February 11, 1871.) (Abstract.) THE author stated that his paper concerned the buff or yellow patches, not very unfrequently seen near the inner angles of the eyelids, which had been described by Dr. Addison under the name Vitiligoidea plana, and which had been accurately figured by Mr. Wilson, Hebra, and several other authorities. He preferred Mr. Wilson's name because it had reference simply to the very conspicuous colour of the patches and to their location; and because it involved no suggestion of similarity or relationship to any other malady. For some years the author had been engaged in collecting facts as to the clinical meaning of these curious patches, in the hope of finding that their presence might furnish a clue to their possessor's diathesis or state of health. More especially he had wished to investigate the correctness of Dr. Addison's belief (founded on but very few cases) that they were usually associated with disease of the liver. The paper was based upon the narrative of about thirty cases, and was illustrated by a series of coloured drawings. The chief conclusions arrived at are summed up in the following propositions : 1. That xanthelasma never occurs in children; whilst it is fairly common in middle and senile periods of life. 2. That, in a large majority of cases, its subject is not seriously ill, nor in any danger of becoming so. 3. That, in a small proportion of very severe cases, jaundice, with great enlargement of the liver, are met with. 4. That when jaundice occurs, it almost always precedes the xanthelasmic patches. 5. That the form of jaundice is peculiar, the skin becoming of an olive-brown, or almost black tint rather than yellow, and the colour being remarkable for its long persistence. 6. That the enlargement of the liver may be very great and that it may subside, and the patient regain good health. 7. That in many cases in which there has been no jaundice, there is yet the history of frequent and severe attacks of functional disturbance of the liver. 8. That xanthelasma occurs more frequently in females than in males, the proportion being two to one. 9. That in all cases the xanthelasmic patches appear in the eyelids first; and that not in more than about 8 per cent. do they ever extend to other parts. 10. That the patches invariably begin near the inner canthus, and almost invariably on the left side. 11. That xanthelasmic patches are of little value for purposes of prognosis, being usually the evidences of past rather than of coming disease. 12. That it seems not improbable that they may result from any cause which has induced repeated changes in the nutrition and especially in the pigmentation of the skin of the eyelids. Thus they occur to those who have been liable to have dark areola round the eyes, whether from "sick headaches," ovarian disturbance, nervous fatigue, pregnancy, or from any other cause. Hence their frequency in "bilious subjects" and in the female sex. 13. That it is probable that of the causes mentioned under which the pigmentation of the eyelids may be disturbed disorder of the liver is the most powerful; hence the fact that the more extensive cases are usually associated with hepatic disease. The author stated amongst other points that, when these patches are seen on the eyelids, it is usually safe to suggest that their possessor has been the subject, at some period of life, of very severe and frequent sick headaches, and that in two thirds of the cases this suggestion would be confirmed. He added that he had met with some cases in which some of the less usual evidences of disturbance of the nervous system in connection with sick head aches had also been observed. In one instance a man had been liable during his headaches to become temporarily quite blind of one eye, and now and then of both; and another, a woman was liable to sudden loss of muscular power in her arms. Two cases were related of great enlargement of the liver, with "black jaundice," both of which disappeared after a while. In one of these the patient became insane during the jaundice, but recovered afterwards, and is now well, but with large patches of xanthelasma. As regards the pathological anatomy of the patches, the author preferred to reserve his facts, which were as yet incomplete. He showed drawings, however, to illustrate the important fact, not previously noticeed, that the patches sometimes show evidence of other changes in the skin besides the accumulation of yellow material. Thus it is not uncommon for sebaceous glands to become much enlarged, and plugged by pellets of indurated secretion, blackened at the free extremity; and in one instance a number of large thin-walled serous cysts were developed. In these rarer forms of the malady its real nature is usually disclosed by the presence of some small spots of the characteristic buff tint. It is also recognisable from the fact that, whether the disease be cystic or sebaceous, the morbid conditions are arranged above and below the inner canthus, in what may, for convenience, be styled the xanthelasmic positions. Like xanthelasma in its more typical forms, they are also after a time accurately symmetrical. II. On Central America as a residence for Consumptive Patients. By JAMES WYNNE, M.D., Guatemala. Communicated by SPENCER WELLS, F.R.C.S. (Received February 14, 1871.) (Abstract.) THE object of this paper is to draw attention to the elevated table-lands of the Pacific slope of tropical America, and especially of Guatemala, a city situated 5000 feet above the sea in lat. 14° 37' 32" N., having a mean temperature of 66° F. The climate |