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Related post: tired easily. A week, however, after taking up bis old cares and
responsibilities and worries, pruritus began about the ankles,
and groups of papules appeared around tlie knees and on the
legs. He was ordered to take Cost Of Diflucan Without Insurance a long rest and went away from
business and work of all kind. He regained bis general health
completely, the eruption disappeared, and since May, 1890. be
has remained well.
Case II (private practice).— J. H., male, aged forty-two. an
electrical machinist, consulted me October 5, ISflO. He stated
that he bad always been of a ners'ous temiierament, excitable,
prone to worry and to restlessness. The nature of his work
had also necessitated constant watclifulness and anxiety, owing
to its dangerous character. In 1876 a falling window shutter
struck him on the right shoulder, fracturing the clavicle and
four ribs, and for more than a year after he was unable to use
the right arm or leg. In 1883 he had a severe attack of dysen-
tery and, when barely recovered, he failed in business. In 18S4
he lost bis four children inside of a few weeks. His wife's ill-
ness began in the following year and has persisted ever since,
but it was severer for liim during the first year, as, owing to his
poor circumstances, be was obliged to work during thedaytime
and take care of her during the night. He thus bad little rest
and sleep, and this, conjoined to his mental sufleriug, the severe
moral shocks he liad experienced, and the harassing anxiety of
poverty and debt, operated an entire change in his character,
causing bini to become gloomy, despondent, and raebmcholic.
In I.SST he broke bis left leg, and his ciroiuustances became still
594
ELLIOT: DERMATITIS HERPETIFORMIS.
[N. Y. Med. Jocb.,
iiioio preoarioii«, but, finally recovering, ho began work again.
During May and .June, 1889, lie worked in a damp cellar con-
taining pools of stagnant water. Early in May attacks of quo-
tidian malarial fever began, and at tlie end of two or three
weeks he felt a most intense pruritus over the buttocks. When
he examined himself, he found that they were covered with an
eruption of "small water blisters and bumps" (vesicles and
papules?). A week later the face became swollen, very itchy,
and a similar outbreak ensued upon it, and e.xtension of the
process to the trunk and extremities gradually took place. Diflucan Price Without Insurance
Since that time Diflucan 250 Mg the patient has never been free from the dis-
ease, but crop after crop of lesions have appeared, vesicles,
papules, buUiB, and large "hives" occurring simultaneously, or
the one form or the other predominating in successive out-
breaks. The pruritus Best Price Diflucan has always been most intense, interfering
with his rest, causing loss of appetite and flesh, and even at
times forcing him to abandon work for days in sucoegsiou. Dur-
ing the course of the disease the patient constantly observed
that severe itching invariably preceded an outbreak of lesions
on any part of the surface, lasting for an hour or more, but abat-
ing somewhat with the appearance of the objective manifesta-
tions. Symmetrical distribution of the lesions was also noted,
and when an outbreak occurred on one side of the body it was
invariably followed within twenty-four hours by a similar crop
on the opposite side. An increase in the degree of the itching
and in the amount and intensity of the eruption followed regu-
larly after the reception of any shock, or with any accession of
worry, or when his work demanded more watchfulness than
usual — in other words, whenever, from any cause whatever, an
additional mental strain or effort was required of him. Con-
tinuous pressure upon any portion of the body was also followed
upon that part by an outbreak of lesions. Clonic spasms and
jerkings of the legs, but especially of the arms, were also com-
plained of as occurring when in bed, and lately, after a severe
wetting, a numbness of the extremities had developed and lasted
for several weeks. Shooting neuralgic pains had also begun at
that time and still occurred, being invariably followed by a crop
of lesions.
When seen by me the patient still suffered from occasional
attacks of quotidian malarial fever, but they did not appear to
be followed by any outbreaks of the cutaneous manifestations.
He was thin, much run down, anseraic, and very constipated.
Anorexia, but no gastric derangement. Urine abundant and
normal.
The entire surface was occupied by the eruption, except
over the abdomen and flanks. Very marked symmetrical ar-
rangement was observed. The morbid phenomena consisted of
vesicles, papules, and pustules grouped in patches and also oc-
curring discretely, covering more or less large areas, lying con-
tiguous to each other or separated by intervening masses of
crusts or by pigmented spots and surfaces of variable extent.
Every stage and grade of the process was apparent on the skin
from the fresh vesicle or papule or other lesion to the crusted
one, or the pigmented spot, or in many places to the supertieial
cicatrix, the result of the wounding and tearing of the skin by
the nails in the patient's endeavor to obtain relief from the itch-
ing. The body presented in consequence a most peculiar ap-
pearance, which, however, bore testimony to the severity of the

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