Page:Archives of dermatology, vol 6.djvu/143

Rh appeared in the last sixteen months, nor have those already there undergone any change whatever. Another remarkable fact is, that a large hickory-nut-sized tumor, situated near the elbow, which was thoroughly and completely excised (enucleated) for microscopical examination sixteen months ago, is now replaced by a tumor assuming its original dimensions and other external physical properties. Moreover, the cicatricial-looking spots are few, and not much larger than a pea, and, therefore, out of proportion, both as regards size and number, to the lesions, which now, at any rate, are mostly large and numerous.

The tumors, plates, etc., are not painful, except from the fissuring produced by scratching. The pruritus, which is the prominent feature of the case, and the only thing for which the patient seeks relief, when I first saw her was almost unbearable, and had been so for many years. It is the same in intensity at all times, both as to season and hour. She thinks it has diminished in the past few months, although when I saw her, a few weeks ago, the scratch-marks were painfully apparent. The mere touching of the lesions causes the most intense desire to scratch.

The patient has had the most varied treatments, and has been under the care of a number of excellent general practitioners and surgeons. She has taken arsenic, mercury, and iodide of potassium in large quantities, and most persistently. The local treatment has been quite as varied; but the only point I wish to note in this connection is, that "the places," as the patient terms them, have been thoroughly cauterized on several occasions without effect in preventing a return.

I shall now briefly review the case, giving first the history as gleaned from the patient, and afterwards the result of my own observations. According, then, to the patient's statement, the trouble commenced twenty-two years ago in the form of blisters, which itched; she could not remember their number, size, nor how long they lasted. She insisted, however, that they involved the same situations now affected. When the tumors, etc., first appeared she does not recall, except that it was many years ago, at least twenty, and that they seemed to be a sequence of the "blisters." She further believes that the fluid from the blisters was locally contagious. In former years she says that the tumors would ulcerate, and afterwards heal up. She also thinks that a tumor or plate will spring up at the site of an itching-point in the skin, and as a result of the scratching. She likewise claims that the integument in the neighborhood of the lesions sometimes becomes quite red and swollen.

From my own observations, I cannot confirm all of the patient's statements; and in fact my experience is quite contrary to some of them. For instance, during the sixteen months while she was under my care the lesions remained in statu quo; no new ones were developed, or at the most a very few, and not enough to be particularly noted. The urticarial element in the case was not observed;