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After a time, they suddenly became dark on the upper surface, and shining, appearing as though they had been coated with varnish. These changes were unattended by pain. The next indication was, that the surface of the nails began to be pitted—covered, that is, with fine indentations; then the nails were lifted from the fingers by a hard deposit ; finally, the raised nails gave way in an irregular manner at the free margins, as though they had been bitten with small teeth.
When this gentleman came before me, every nail in both hands was affected. Some nails were destroyed nearly to the angular junction with the skin, a large and ugly gap being left in place of the nail ; other nails were half destroyed, the horny structure being raised a full eighth of an inch from the matrix, and being jagged at the free extremity like the occipital suture. The hands were unpresentable altogether. With all this, the health of the patient was good. There was no eruption of the skin, nor any sign of syphilis, albeit there was an admission of a syphilitic attack some twenty years ago. The hair was firm on the head, but inclined to grey: the age, about forty-two years. The patient himself was engaged as a master in the painting and decorating business. He had sometimes painted with his own hands, but not much. He was a full made, fresh looking man; irritable, I should say, but temperate in living ; taking a good animal diet, and a little ale, but not indulging in alcoholics to absolute intemperance. He was dyspeptic, and given to hypochondriasis.
A second case was as follows. A woman, 47 years of age, came before me with chronic bronchial catarrh. In the course of examination, she removed her gloves and shewed me her nails. They were diseased in the same way as in the case immediately preceding. Her history was clearly given. She had been the mother of six living children, and had suffered from one miscarriage. She was still menstruating regularly. Three years previously to the date on which she came to me (April 6th, 1860), she became affected with a scaly eruption, lepra vulgaris, which commenced about the head: there was also some falling off of the hair. I made the most rigid inquiries as to the nature of this eruption and its cause, and no information was withheld me, as I believe; but I could not see reason even for a suspicion of preexisting syphilitic. malady. The lepra continued alone until August 1859, when she first perceived a peculiar sensation beneath the nails. The surface beneath the nails felt benumbed ; and at times, especially in the evening, it was the seat of a tingling sensation, described in common parlance as pins and needles. The immersion of the hands in water moderately warm would bring out this sensation at any hour of the day; but it always occurred, spontaneously, about bed time. After a few weeks, the nails commenced to look glazed. “They seemed," said the patient, “ as if they had been smeared over with varnish of a yellow tinge.” They then began to show little indentations all over the surface, as if they had been pricked with the point of a pin, and