244 PHYSIC 



of morbid cuticular disturbance, was that the dorsal, as 

 distinguished from the palmar aspect of the affected carpi 

 and digits, was alone affected, that the lines of demarcation 

 between the two aspects were sharply defined, and that 

 above the wrist joints the inner, as distinguished from 

 the outer, surfaces or aspects of the forearms were affected, 

 so far as any infinitesimal sympathy, structural or func- 

 tional, was concerned. 



As an explanation of these seeming local preferences of 

 the disease, besides its unmistakable distribution on 

 strictly nerve ' ' trunk and fibre lines," we would suggest 

 that the anatomical and histological characters of the 

 affected and unaffected areas, respectively, constitute it one 

 of natural selection, founded on the progress of the 

 materies morbi along the lines of least resistance, these 

 being afforded in and determined by the more soft and 

 yielding cutaneous textures covering the affected, as com- 

 pared with the more resistant and denser unaffected parts, 

 where, naturally, the facility or otherwise of the nervine 

 circulation is modified by the nature of its environment. 



Pigmentation, to some extent, marks the sites of the 

 disappearing eruptive patches, and seems to be due to the 

 slow absorption of neurolised haemoglobin, and, it may be, 

 the limited presence of arsenic, due to its therapeutic intro- 

 duction during the course of the treatment latterly pur- 

 sued. The nasal development of the eruption, which was 

 followed by disturbed innervation of the frontal parts of 

 the scalp with a few small patches, or rather points, of 

 keratosis, disappeared in less than two months, leaving 

 the affected parts of the skin quite normal both in colour 

 and texture. About this period the wrists and hands, 

 which had also greatly improved, began to show, especially 

 on the dorsal aspect of the left wrist extending to the back 

 of the same hand, a blush of cutaneous hyperaemia, with a 

 slight sense of itching, in patches more or less correspond- 

 ing in position with those of the primary attack, and which 

 looked like a slight recrudescence of the disease, and seemed 

 to point to the presence of lurking remains of the eczema- 

 tous materies morbi, and to an effort of the vis medicatrix 

 nature to "clear the system." 



Immediately after this slight recrudescence, an acute 



