Altogether there was little to be gathered from the histology quâ cause, except that the appearances of the blood-vessels perhaps pointed to a general blood condition.

Dr. Thiele, Pathologist to University College Hospital, kindly examined the blood and reported: Total red corpuscles per c.mm., 6,560,000; total whites per c.mm., 21,878. Hæmoglobin, 84%. C.T., 65. Differential count of whites: Small lymphocytes, 18·2%; large lymphocytes, 9·4%; neutrophiles, 60·7%; oxyphiles, 1·6%: hyaline cells, 2·1%.

IDIOPATHIC MULTIPLE PIGMENT SARCOMA (IDIOPATHIC MULTIPLE HÆMORRHAGIC SARCOMA) OF KAPOSI.
By F. PARKES WEBER, M.D., F.R.C.P., AND PAUL DASER, M.D.

The patient, Jakob Z——, is a Polish Jew, aged 46 years, from Galicia, who has lived nine years in England, and says he has enjoyed good health. There is no evidence of previous alcoholism or syphilis. The patient was brought by Dr. Weber before the Dermatological Society of London on February 8th, 1905.

The present illness commenced about three years before, when he chanced to wound the sole of his right foot with a nail. A pedunculated growth, about the size of a cherry, arose from the wound. This description reminds one of the strawberry-like granulation tumours sometimes growing from small wounds or ulcers on the fingers, which have been termed “botryomycosis,” or rather “botryomycomata,” because at one time they were supposed to be caused by the “botryomyces.”[[2]] The growth was removed by a doctor. Afterwards small bluish nodules developed from time to time on the feet and legs. Some of these nodules apparently undergo the following series of changes: They slowly increase in size, and after about three months constitute little pendulous tumours, which ultimately fall off spontaneously or else are knocked off or pulled off by chance; in this way local healing occurs, but fresh nodules form elsewhere. Though, as stated, some of the nodules become pedunculated growths, others appear to atrophy and merely leave brownish pigment in the skin, whilst others seem to undergo very little change, and, at all events, persist for a long time in their primitive form, namely, as hard bluish lumps under the epidermis. Treatment has been as yet without result.

Present condition (January, 1905).—On the hands about the knuckles and backs of the fingers are a few minute slightly elevated bluish nodules. On the sole of the right foot, especially on the inner part, there are nodules in various stages of development. The minute ones, those in an early stage of development, are slightly elevated and of a bluish colour, similar to those on the hands. Others, further advanced in development, are small, sessile, or pedunculated hard outgrowths, without bluish colour and sometimes covered by thickened epidermis. There is a large patch of pigmented (brown) skin on the dorsal surface of the right foot, and in the neighbourhood of this pigmented area are some minute nodules of similar character to those already described. It is possible that the pigmented skin has been the site of minute growths which have undergone spontaneous involution, and have, as frequently happens in Lichen planus, left pigmentation of the skin behind them. The right thigh and leg are not affected.

The left lower extremity is the part most affected by the disease, and there is chronic, rather firm, œdema of the left foot and ankle. The nodules on the left foot are similar to those on the right, but are more widely distributed, and the left foot differs from the right in the absence of the pigmented area and in the presence of the œdema to which we have just alluded. Of the little sessile or pedunculated tumours on the back of the left foot and in the neighbourhood of the ankle-joint (see Fig. 1) the biggest are of the size of a large pea. There are likewise little tumours of various sizes—that is, in various stages of development—on the inner aspect of the left popliteal region (see Fig. 2) and in the neighbourhood of the patella, the smaller ones being bluish and slightly elevated, the larger ones being reddish, lentil-sized, sessile outgrowths.

There are no nodules or growths on other parts of the limbs, trunk, or head, with the exception of four or five minute purplish or bluish papules on the glans penis and neighbouring skin.

Figure 1