a "nightcap," in the form of one tumbler of whiskey toddy. Twenty years ago he had a slight attack of illness, which taught him that Venus not unfrequently transfers her devotees from the sphere of her own charms to the gentle guardianship of Mercury. There was, however, nothing very severe in this attack, and recovery was believed to be complete. In the latter end of 1859, the forefinger of the left hand gave to the patient a disagreeable sensation ; the sensation was that of numbness and tingling. The skin then, for about an inch from the tip of the finger, assumed a dry, scaly appearance, with what seemed also to be absolute shrinking of the extremity. The nail became of dirty brown, and slightly pitted; it also wore away at the edges, but not irregularly. The finger was unpresentable, and gave its owner so much annoyance, that he assured me he would rather have it removed by amputation than that it should remain in its existing condition.

The analysis of the cases above cited leave the nature of the disease in obscurity. In the first and last cases, there was a pre-existent syphilitic taint; in the second case, while there were symptoms which are compatible with syphilis, such as lepra and falling off of the hair, all other evidence was against the pre-existence of that disorder. In the first case there was no eruption of the skin; in the last two the skin was affected more or less with scaly disease. The patients were all about the middle age; but in constitutional character the first and last were strongly

opposed to the second. One patient had worked in lead as a painter; the woman had all her life been at domestic duties; and the third was engaged in a mercantile pursuit, in which the pen was more employed than aught else manually.

CAUSE AND CAUSATION OF THE DISEASE.

The disease allies itself to squamous disorders of the skin, but whether it is identical either with lepra or psoriasis I am not prepared to say; for, while it may exist with these disorders, it may also, as we have seen, exist independently. I think there is no doubt that it commences in the matrix, and that all the conditions of nail are due to a partial or complete death of the structures attacked; in other words, there are interposed between the secreting membrane and the under surface of the nail, epithelial layers, which separate the two structures, and prevent that osmotic change by which the nail is repaired in proportion to its mechanical or natural destruction.

Is the disease purely of syphilitic or of mercurial origin? An affirmative answer has been assumed to this question. Mr. Gay, who spoke at the meeting of the Medical Society, at which some of the cases narrated here were discussed, assumed this affirmative in its entirety, and brought forward, it must be

* In addition to these, I once incidentally saw another case at that period of the disease when pitting with dirty glazed surface are the external symptoms. The history of this case is not known to me accurately; but I may say that the patient was engaged in a profession in which manual labour is excluded.

admitted, considerable evidence in favour of such affirmative. However, I am not prepared to admit the point as proven. I shall show, indeed, evidence further on, which will prove that in some cases treatment negatives the argument of a syphilitic origin. Indeed, in the two examples which I have given, where there had really been an attack of syphilis, I doubt whether that disease was still at work. It seemed to me in both these cases that a free mode of living, and dyspepsia, had more to do with the affection than the specific and long removed enemy.

There is clearly nothing in occupation which leads to the disorder; the first named patient had worked in lead; but I have made inquiries amongst leadpainters, and find that no special affection of this kind is known amongst them; further, we had before us other occupations, all different, and one not manual, so that the evidence points to a constitutional, as opposed to a local, origin for the disease.

DIAGNOSIS.

The disease of the nails under review has three stages. The first stage is marked by a sensation of numbness and tingling beneath the surface of the nail. In the second stage there is an appearance of dirty glazed discoloration of the nail, with pitting of the surface. In the third stage there is a crumbling down of the nail-structure from the edges and the free margin, with more or less of irregularity, thickening from the under part, cupped surface depression, and looseness.

TREATMENT.

In the first case to which my attention was drawn, various forms of treatment had been already pursued. Local treatment had been tried; the nails had been washed with lotions of zinc and lead; they had been encased from the air; and they had been painted with iodine. Internally, mercury had been administered; after that quinine; and again mercury. Believing at first that the disease was of syphilitic character, I suggested iodide of potassium internally in five grain doses three times a day; and my friend who brought the patient to me carried out this treatment fairly for many weeks. It had no effect for good. The patient got tired, and consulted a new practitioner altogether: I have been unable to learn with what effect.

In the case of the woman, the treatment adopted previously to my attendance had again been both local and general. Locally, zinc lotions, zinc ointment, glycerine, and iodine had been applied. Internally, mercury had been administered, and iodide of potassium, but with no avail. The presence of the skin-eruption turned me to another indication. Instead of pursuing local treatment, I commenced with Fowler's arsenical solution as a general medicine, in doses, first of three minims, and afterwards of four minims, three times daily. The good effect of this treatment was quickly shown. The first dose of medicine was taken on the 6th of April. On the 26th of May the eruption of the skin was greatly

better, and the disease in the nails was entirely arrested. On the 26th of July all the nails had nearly regained their normal character, except the nail of the right forefinger. At this visit the patient complained of catarrh; the arsenical mixture was therefore replaced by a saline, which she continued to take until August the 9th without consulting me. At her return on that day, I found the squamous symptoms the same. I once more ordered the arsenical solution; and, as she bore it without any unpleasant sign, it was continued steadily until August 23rd. The nails might now be considered as well. All were restored to perfect smoothness, except the first and second of the left hand. These retained the faintest signs of indentation, and the first one was rather thicker than the others; but an observer, who saw them without previous knowledge, would certainly not conceive that they had been extensively disorganized. The eruption on the skin was yet not altogether removed. There was an irritable patch around the nipple of the right mamma, and a second one in the groin. The medicine was continued until the 1st of September, when the skin eruption had also disappeared. After ceasing the arsenic for a month, there was a reappearance of cutaneous scales about the nipple; but the nails continued unaffected. The arsenical solution was reordered, again with removal of the squamous patch. This patient still remains under treatment.

The third case had been treated merely locally; iodine had been particularly tried, but without any