KERATOSIS AND HYPERKERATOSIS 171 



release from its histological attachments, and the part of 

 the body from which the detachment is being effected in 

 relation to facility or difficulty of shedding, necessarily 

 afford the starting points and procure the conditions for 

 the maintenance of hyperkeratosal evolution. It behoves 

 us, therefore, to give warning that the process of keratosis 

 must be prevented in all cases whenever a tendency is 

 evinced towards hyperkeratosis, on the principle that 

 " prevention is better than cure." 



As illustration of the truth of this observation and the 

 success of its practical application, we would give a short 

 resume of a case which lately came under our observation. 

 The subject of the following clinical remarks was in 

 advanced middle life, and had for years, during winter 

 .and spring, suffered from chapped hands and hyperkera- 

 tosis of the dorsal aspect of the carpal and metacarpal 

 portions of thumb and forefinger of both hands. The 

 condition of things, when first observed, consisted of a 

 series of slight chaps over the dorsal aspect of the hands 

 and fingers generally, with a dried and roughened feeling 

 of the skin, and locally, over the region particularised as 

 affected by hyperkeratosis, was a well-marked area on 

 both hands, the right in particular, of irregularly but 

 definitely raised epidermal exuviae, which to the finger 

 gave the well-known sensation of " sand paper," and which 

 looked to be determined in pattern by the peripheral 

 terminal nervature. This exuvial epidermal upheaval 

 was evidently determined by non-detachment of the 

 external epidermal layers, and their continued adherence 

 to the epidermal matrix, due mainly to the absence of the 

 moisture of perspiration, determined by the repressive 

 influence of the winter cold on the sudoriferous economy 

 of the involved areas of the frequently exposed extremities. 

 This state of things having occurred from year to year, 

 and having as often disappeared, naturally gave rise to 

 the idea that it was a seasonal phenomenon, and only 

 required the use of preventive means to be entirely obvi- 

 ated, and if, unfortunately, by oversight allowed to 

 develop, that the use of curative means indicated by the 

 clinical condition were equally likely to be successful in 

 removing it. 



