142 Dr. J, Carson on a Case of 



flexors of the fingers. The spots spread circularly in every 

 direction, at first preserving a perfectly round form, but as 

 they increased becoming more irregular. The small spots 

 now present the appearance of a pale red scale, hardly dif- 

 fering except in increased degree of thickness from the na- 

 tural epidermis. The colour of the scale, of course, depends 

 on the cutis below it. This appearance surrounds the larger 

 spots for about a line in breadth, and the extension of the 

 disease depends on the eccentric progress of such a line of 

 squammification, if I may so express it. The parts which 

 have been affected present a remarkable contrast, in ap- 

 pearance, to those which are healthy, something like that 

 between the healthy skin and that covering an old cicatrix. 

 The hairs do not seem to grow on it with the same degree 

 of strength, or in the same number ; it has none of the oily 

 appearance depending on the various secretions of the 

 skin, and I have never been able to discover any perspira- 

 tion on it when the neighbouring parts were so affected. 



All those parts which have been affected, and which in 

 different places cover a considerable portion of the skin, 

 are so completely insensible, that pinching or burning 

 with heated iron was not perceived by him. This fact, I 

 have repeatedly established in the presence of several 

 medical gentlemen to their entire satisfaction.* The region 

 of insensibility is distinctly limited by the small line of 

 scales. From some discrepancies in his story, I was in- 

 duced to believe at first, some disposition on his part, to 

 deceive. I several times applied the hot iron to the spots 

 on the back, when his attention was occupied by another 

 in conversation, and when he had not the least reason to 

 expect that such was my intention, without his evidencing, 

 by the the slightest gesture, his consciousness of sensation. 

 I am inclined to think, that the discrepancies above alluded 

 to, arose from his not comprehending my cpiestion. His 

 general health is evidently bad, though I was not able to 



* I have, by including the cellular substances, and some of the muscles of the 

 back in the ringers, and pinching them hard, attempted to ascertain how deep the 

 insensibility existed. He never complained of any pain, yet, I think, seemed to 

 be conscious we were handling the parts. In an operation, unless some nerves be 

 cut, the patient is, in general, scarcely conscious of pain in the section of these 

 parts. 



