this has now become a deep olive brown. During the last five years there has been a gradual change in the integument of the eyelids, giving her a strange expression. This affection of the skin began in the upper lid of the left eye, and extended round by the inner cauthus to the lower lid. A similar affection then commenced in the right eyelid, and the appearances now presented by the two are remarkably symmetrical. The surface of the affected parts is slightly raised, and the edge defined. The colour is a light opaque yellow-" coloration feuille morte," with a mottling of the faintest rose tint, with a small meandering vessel or two, especially on the patches, which are recent and extending. On passing the finger over the surface there is a slight, yet but very slight, feeling of resistance. The older spots are the most raised. The cuticle is unaffected, and by slight tension of the skin, will be seen to pass unchanged from the normal to the diseased parts. The discoloured patches often smart, and, to use the patient's expression, "seem as if gathering ;" they have also an increased sensibility.

It will be observed, that as the disease extended, it has run along the lids so as to avoid the Meibomian region, and that in the left eyelid are two sebaceous follicles, enlarged and filled with dark pigment cells; during the last two years a spot of black pigment has appeared on the mucous membrane of the lower lip. The whole course of the disease has been very slow, and its increase, by degrees, almost insensible. There is no affection of the skin of any other part of the body beyond the change in its colour above indicated. The liver is enlarged, and there is much tenderness about the left hypochondria. The urine contains bile, and the conjunctivæ are of a decided jaundiced tinge.

We have preferred thus recording the cases which have formed the source from which our knowledge of this affection is drawn, to giving any more abstract dissertation upon it; hoping thus that the experience of others may be the more easily compared with our own, for, doubtless, cases of the like kind have occurred to most; although, until attention is especially drawn to a subject, the individual importance of isolated cases is apt to be overlooked. The connection of this affection of the skin with hepatic derangement is

obvious, and the exception which occurred in diabetes is of the more interest, inasmuch as modern pathology points to the liver as the faulty organ in this disease. In what way the defective action of the liver operates, can, perhaps, be no further explained at present, than by the general theory of disordered circulating fluids. It is a matter of experience, that various affections of the cutaneous surface, such as numbness, itching, lichen, urticaria, &c., are closely connected with jaundice, depending, probably, upon the direct action of the morbid fluids upon the cutaneous tissues.

The treatment of these cases has been hitherto unsuccessful. They have manifested an inveteracy equal to that of the morbid conditions of the liver, with which they seem to be associated. In the case of S-, many of the tubercles had slowly subsided before he left the hospital, but in the others there was no tendency to disappearance, especially in the patches about the eyelids. Some slight benefit seemed to follow the careful and repeated application of nitrate of silver, but when the disease is extensive this would hardly be practicable. Mrs. P— informs us that although none of the tubercles have disappeared, yet they are now rather less prominent than they were a year ago.

1

In the subsequent volume of the Guy's Hospital Reports the following note is added, giving details of the progress of Mrs. P―'s case, and a drawing of the hands illustrating the transition of the variety "plana " into the "tuberosa.". [ED.]

Vitiligoidea, as we have shown, may occur under either form separately, and for some time it was difficult to associate the two conditions. In Mrs. P-'s case they occur together, and in the hands the plane passes insensibly into the tuberose form. When the eruption first appeared in the hands, it was limited to the flexures of the joints of the fingers, and of the palms, producing to the superficial Guy's Hospital Reports,' vol. viii, 1853, p. 149.

14

observer an appearance not unlike psoriasis palmaris, but with this easily recognisable difference, that in vitiligoides the cuticle is unaffected over the diseased parts. The morbid change gradually extended over the fingers, at first producing scarcely any elevation, as in the patches round the eye, and coincidently with this extension, raised tubercular masses formed on the knuckles. During the past year the disease has continued to progress, with the exception of the spots round the eyes. The skin of the palm is now becoming raised and tuberose, as on the back of the joints, and the hands are so tender that she is scarcely able to use them. Similar formations have taken place on the nates. The disease on the elbows and ears has advanced, as in the other parts. Jaundice remains; the nutrition is good.

The nature of this remarkable affection is still obscure. It is important to note that during the last few months the tendons over the metacarpo-phalangeal articulations have become tuberose, having apparently undergone a change similar to that of the skin, although the integuments over them are unaffected.

ON THE

PARASITICAL VEGETABLE NATURE

OF

PITYRIASIS VERSICOLOR

(Microsporon furfur, ROBIN).1

IN 1846, Eichstedt found a fungus growing amongst the epithelial scales in pityriasis versicolor. The discovery was confirmed during the following year, by Slyter, in a tract 'De Vegetabilibus organismi animalis parasitis ac de novo epiphyto in Pityriasi versicolori obvio.'

In this country, and in France, the subject still seems to remain in doubt. Robin, in his elaborate treatise Des Végéteaux Parasites qui croissent sur les animaux vivants,' details the observations of the above-named authors, but adds in a note, "Je n'ai pu verifier moi-même ces faits." Wilson, in an edition of his work on 'Diseases of the Skin,' so recent as 1851, says," Dr. Gustav Simon places chloasma (Pityriasis versicolor) in his sixth group of diseases of the skin, which he entitles Parasites, considering this eruption as depending, like favus, sycosis, and alopecia circumscripta, upon the presence of a parasitical vegetable fungus. I do not agree with him in this opinion, and have failed to discover any vegetable organisms, although I have searched for them with care.",

In an edition of Cazenave's lectures, published in 1853, 1 Reprinted from 'Guy's Hospital Reports,' vol. ii, 1856, p. 191.

there are the following remarks:-" Envisagé dans son ensemble le pityriasis est une affection complexe (sic) dont le caractère intime est exprimé par la double existence d'une secrétion anormale de la matière epidermique et d'une lésion de secrétion de la matière colorante."

With the subject in this uncertain state, it will not be superfluous to record any observations which may bear upon it. In the several cases where I have looked for the fungus in pityriasis versicolor, I have always found its sporules amongst the scales of the epidermis; but until recently, I have failed to detect the ramifying branches of the mycelium itself. This failure I now know to have arisen from want of care in manipulation. The description of the fungus given by Robin' agrees with what I have observed, except the rarity and difficulty of making out the terminations of the filaments, which I have not found. It will be seen from the subjoined sketch, that the filaments sometimes end

a a. Mycelium. The filaments 000 to 10000 inch.

3 Simple termination.

B B'. Terminations containing sporules.

y y. Terminations as receptacles.

8. Sporules free, 4000 to 5000 inch.

1 Trichomata (fila) in squamis epithelialibus sita, nunquam etiam earum marginem excedentia, multipliciter torta et inter se nexa ut raro fili finis cujusdam certo cognosci queat; simplicibus parallelis lineis terminata nunquam aut articulata aut in margine vincta nec contenti quid in eo apparet; passim in ramulos divisa. Sporidia rotunda binis adumbrantur lineis concentricis quarum interior spatium lucidum circumdat in acervulis agminata. (Robin, op. citat., p. 436.)