ECZEMA 241 



the dermis, with the nerve terminals therein distributed, 

 and, it may be, the outer capillary vessels, blood and 

 lymph ; and provided, also, that no solution of continuity 

 of these has taken place, nor other morbid results been 

 induced. Should, however, any rupture or solution of 

 continuity of nerve or vascular textures have occurred, 

 and healing by first intention not have taken place, then 

 a neuro-vascular irritative pathological process is the result, 

 which will persist and extend in proportion to the strength 

 and continuance of the original irritation and the intensity 

 of the existent predisposition. 



The diseased process thus initiated may, at this stage, 

 be described as neuritis if we are entitled to the use of 

 the term involving the nerve terminals and fibrils, dis- 

 tributed to the parts affected, with their peri-neural sheaths 

 and the vascular and other textures immediately surround- 

 ing them, the neuritis being accompanied by more or less 

 thickening of the dermis, due to exudation (neuro- 

 dermatic) from, it may be, the capillaries, as well as from 

 the nerve terminals implicated, i.e. from the peri-neural 

 or neurilemmar sheaths, with the medullary and axis 

 cylinder or nerve terminal sheaths proper, the first of 

 which enclose inter-spaces containing cerebro-spinal fluid, 

 and the latter the more solid, medullary, and axis cylinder 

 substances respectively, the rupture of one, or both, of 

 which sheaths, and the exudation of their contents, afford 

 the thickening material. Should the fluid portion of the 

 extravasated or exuded material predominate, vesiculation, 

 followed by surface leakage, may ensue. 



The first stage in the development of these untoward 

 pathological changes or results requires the pre-existence 

 of what may be called a hyper-aesthetic condition of the 

 peripheral or cutaneous nerve expansions, along with and 

 due to, it may be, an unusually acrid condition of the 

 peri-neural lymph or fluid, as well as the existence of the 

 necessary mechanical or other irritation. 



As an example of a constitutional and local predisposi- 

 tion to the occurrence of eczema or neuro-dermatitis, we 

 might mention the gouty disposition or habit of body 

 wherein the operation of slight exciting causes usher in 

 or precipitate a local manifestation of gouty symptoms or 



II Q 



