(2) A woman, aged 38 years, suffering from a curious _eruption
associated with obscure nerve symptoms_. The history showed that four
years ago she had suffered from some chest affection, accompanied by the
expectoration of blood and offensive matter. She was ill three months,
and during her convalescence she scratched her right thumb, and a
lymphangitis of the arm, with axillary abscess, resulted. She next
developed a painful swelling of the right elbow, which was opened and
drained, and she thought a piece of bone came away; the arm was put up
in splints. The right elbow had been stiff since that time, and during
its healing she had developed pricking sensations in the fingers, which
became contracted. There was then an interval of nine months’ good
health, after which, two years ago, she developed an abscess in front of
the right thigh, which eventually broke, and laid her up for four
months. Subsequently, about eighteen months ago, the rash appeared, at
first round the site of the abscess, then spreading towards the buttock
and loin, and finally extending down the leg.
On exhibition, the patient showed an extensive anæsthetic area over the
right side extending up into the axilla, curving down both in front and
behind at the level of about the sixth rib, and embracing the whole of
the right arm and leg, with the exception of small islands on the palm,
sole, and gluteal region, where sensation still persisted. The rash
followed a similar distribution, but did not affect the arm, and tailed
off on the leg with the appearance of isolated spots. The rash
developed, according to the patient’s history, in the form of red spots,
on which a blister full of clear fluid formed. The fluid then became
mattery, and an ulcer resulted. The development of an ulcer was heralded
by a pricking sensation. On exhibition, the striking characteristics
were the presence of patches of excoriated skin and white scars,
surrounded by pigmentation. The patches were oval in shape, with the
long axis running down the limb or transversely on the trunk. The more
recent lesions consisted of red, raised papules with an excoriation on
the summit. In spite of bandaging with boric acid ointment in the
hospital a few lesions formed beneath the dressings, though more
appeared outside. Examination of the supposed affected joints showed
nothing abnormal; the reactions of the atrophied muscles to electricity
were also normal. The anæsthesia was shown to be of psychical nature,
and the exhibitor therefore considered most, if not all, of her
disabilities to be of an hysterical nature. He asked the opinion of the
Society as to the nature of the eruption.
Most members, including the exhibitor, considered that the eruption
was artificially produced by the patient.
* * * * *
Public-domain text, read in full here on John Shaqi.
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