ECZEMA 243 



ally, and are usually grouped around one particular papilla, 

 which seems to be the primary seat of the initial neural 

 disturbance, each papilla so affected becoming, as the 

 neighbouring vascular structures become, secondarily en- 

 gaged or implicated, gradually surrounded by a halo of 

 hyperaemic or congested cutis, and surmounted by a 

 miniature scaly cap of rapidly shedding horny epidermic 

 scales from what appears to be a hypertrophic development 

 or keratine, or, in this case, neuro-keratine from the nature 

 of the structures involved. The local discomfort has not, 

 on the whole, been severe, and has been mainly due to 

 disturbances of the nerve elements, and manifested in 

 degrees of itching in intensity from the slightest to the 

 very severe there has been virtually no pain a peculi- 

 arity of this feeling of itching is, that it is only felt 

 proceeding from the seat of the eruptive patches, which 

 vary in size from a pin's head to a sixpenny piece, to 

 the distal ends of the thumbs and fingers affected, i.e. the 

 sensation of itching passes from the proximal, as repre- 

 sented by the nerve structures of the implicated skin, to 

 the distal distribution of the implicated nerve fibre ter- 

 minals on the bodies and points of the fingers and thumbs 

 before it can be consciously appreciated, or, in other words, 

 the molecular disturbances, initiated in the affected nerves, 

 pass onwards or forwards to their peripheral terminal 

 extensions preparatory to their conscious appreciation by 

 a reversal of the currents of the molecular disturbance. 

 The sense of itching, however, can be correctly localised 

 or located when the eyes are closed, but when the local 

 areas of disturbed sensation are rubbed or scratched, the 

 molecular disturbance ensuing, continues to extend ex- 

 clusively in a peripheral direction along the tracks of 

 distribution of the affected nerve fibres to their terminal 

 arborisations, their proximal parts being entirely un- 

 affected. All these phenomena have been, and are still, 

 confined within the layers of the skin, the affected parts 

 being easily and conspicuously movable over the under- 

 lying cellular and deeper seated structures, the hyperaemic 

 reddening, discolouration, and pigmentation being little 

 affected by pressure or position ; a noteworthy observation 

 made in this case, relating to the distribution of the areas 



