242 PHYSIC 



processes, cutaneous and others, or a well-defined attack 

 of gout of the more prevalent or typical variety. Here 

 the operation of exciting causes sufficient to initiate a 

 gouty manifestation of morbid processes would not suffice 

 to disturb the equilibrium of health in the now pre- 

 disposed, and would, consequently, pass entirely unnoticed. 



An illustration of the gouty variety of eczema, or 

 neuro-dermatitis, is afforded in the following case which 

 has lately come under our notice, and which we have very 

 closely watched and more fully reported and commented 

 upon than its intrinsic merits perhaps required. 



A. A., aged 61 years, previously active and healthy 

 and free from disease, constitutional or acquired, began, 

 a few weeks previous to applying for advice, to manifest 

 an unusual irritability of the skin, resulting in slight 

 erythematous reddenings of it at points where friction 

 was experienced, such as the dorsal aspects of the thumbs 

 and forefingers of both hands at their carpal ends mainly, 

 or just where the shirt cuffs extended to, and the lateral 

 and upper parts of the nose where pressed by spectacles ; 

 these were the only spots on the whole surface of the skin 

 to manifest the erythematous appearance referred to, else- 

 where the skin was perfectly healthy, and the condition of 

 the general health of the body unimpaired. On the 

 removal of the exciting causes of these local manifesta- 

 tions improvement began to take place, and continues, 

 but has not as yet (after one month of treatment) 

 resulted in complete recovery of the former condition of 

 the skin, nor in the disappearance of disagreeable local 

 sensations, hyper-aesthetic, and par-aesthetic, as well as 

 an-aesthetic. 



The condition originally set up by the irritants men- 

 tioned, and which still to some extent persists, is one, 

 primarily, of peri-neuritis and neuro-dermatitis, involving, 

 in clearly defined small surface areas, the peripheral cutane- 

 ous nerve terminals, with their neurilemmar coverings, 

 and, secondarily, of hyperaemic and inflammatory vascular 

 local changes dependent on the primary nervine disturb- 

 ances. The clearly defined small surface areas are situated 

 over the papillary elevations of the dermis, are smaller 

 or larger according to the development of these individu- 



