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healthy skin, there were pea to cherry sized blebs, excoriations where trie blebs had been ruptured pigmented macules where they had healed; dime to palm sized erythematous macules: papules single, in groups. pokies game free download — the whole making a most characteristic pic- ture. Very little change occurred during the follow- ing week. At the end of tliis time trie lesions were smaller in size on trie chest and upper extremities, 1 Read before lire Michigan State Medical Society. MEDICAL RECORD. [January 2, 1897 while they seemed to increase in size upon the lower extremities, several large blebs forming on the legs. From this time until March 23d the appearance of the skin remained about the same, new lesions appearing as the old ones disappeared; blebs, however, being fewer in number and much smaller, while vesicles were very numerous. At times the eruption would online pokies free follow the course of real online pokies 5 dragons a cutaneous nerve. At no time during the course of the disease were the palms, or fingers, or feet, or neck affected. On April 18th my patient sailed for Europe entirely free (for the time being) of his skin affection. Case II. — Mr. A , twenty-six years old, a mer- chant, online pokies 5 dragons a man of good habits, with a good family record, was referred to me by Dr. E. L. Shurly in 1S89 for a skin disease that had troubled him over live years. At no time during this period had the skin been en- tirely free of the eruption. The lesions had been principally vesicular, quite small, dome-shaped, and clustered in groups of from three t" a do/en, with clear contents. Pruritus always preceded the eruption from four to crown casino melbourne online pokies twelve hours and continued until the vesi- cles were ruptured. The sites selected for the out- break seemed to be the extensor surfaces, although many lesions were found on the back and abdomen. The hands, feet, face, and neck were free. I found on my first examination, besides the lesions named, a number of dollar-sized infiltrated, red, scaly patches on the extremities and groups of free pokies games for android pustules that had de- veloped from the vesicles, patches of excoriation sur- rounded by vesicles or pustules, and here and there a group of small papules. The disease was worse in warm weather and itching was intense in all the le- play pokies for real money sions. A careful examination of the patient failed to elicit anything that would give me a clew to the etiology of the disease. I found that very small quantities of any stimulant would make the trouble worse, and within a very short time. My patient used neither tobacco nor liquor. As he derived no benefit from several months' treatment, I suggested that he take an ocean voyage and while abroad to consult Kaposi. No diagnosis was made by Kaposi, but his treatment was about the same as had already been used, no benefit resulting. Mr. A went to England, where he consulted Malcom Morris, who pronounced the disease dermatitis herpetiformis and sent him to the ars :nic springs in the south of France. N'o benefit was derived from the springs and he returned to me, and business calling; him to Chicago I referred him to Dr. Hyde, who concurred in the diagnosis, and suggested a line of treatment which was followed for some time without any benefit. My patient married and his disease disappeared, and he has remained well ever since. I have reported these cases as a text. It is now over a decade since Dr. Duhring first called attention to the pokies game free online disease under consideration, and, despite the fact that a few prominent online pokies using paypal dermatologists have refused to recognize it pokies games online for free as an entity, the consensus of opinion freeware pokies game downloads oi competenl observers places it as a disease of the skin, in the totality of its symptoms entirely online pokies paypal distinct from any other dermatological affection. It is true free pokies slots no downloads that in different attacks the lesions and their behavior ma) be the same as if occurring in pokies games for android some other dis- ease of the skin, and, if they are watched but a short time, or are seen only in a single attack, there may be a liability of not recognizing the affection and plai ing it facebook pokies game as an eczema, pemphigus, oi erythema multi- forme. The disease is not .1 verj common one. I have records of twelve cases, five of which have come under my care during the last two years. This is no evidence that the disease is becoming 0101 quent, but only that I am coming to recognize as dermatitis herpetiformis what earlier in my practice has been regarded as some other affection of the skin. With the exception of two of my cases (one of which was that pokies online real money of a paralytic, the other that of a sufferer with choreaj, all of my patients were in apparent good health, and while some of the attacks lasted for months, and even longer, no effect was produced upon the gen- eral health other than would naturally result from the loss of sleep and the irritation of the intense pruritus, always present no matter what the lesion was. The disease is a dermatitis, and is manifested by multi- form lesions, either in the same attack or in different attacks in the same individual. In one of my < .wrs the first lesions were blebs and the disease was diag- nosed and treated as pemphigus, and, it being seen in that stage only, it could not be recognized as any- thing else. Later, however, erythematous patches and small vesicles occurred, and it then had the appear- ance of an eczema, and the intense pruritus was favor- able to such diagnosis. A careful study of the lesions at this time showed a peculiarity in their behavior which is not found when they occur in other affections. It was noted that they came in crops, and that they were grouped. A crop of patches of vesicles or papules of the size of a pea to that of a ten-cent piece, covering an extremity or over the thorax or back, would appear during a night, the patches made up of three or more individual le- sions. Later these gave place to crops of erythematous patches, the size of a pea to that of a dollar, which in turn were supplanted by vesicles or free online pokies 5 dragons papules and sometimes by pustules. Severe pruritus was always present, no matter what the lesion was. It is easy to see how a single attack of the disease with a single anatomical lesion, such as a bleb or vesicle, might be mistaken for some other machine pokies affection, but recurring at- tacks with different lesions should stamp the affection as dermatitis herpetiformis, if the lesions have the behavior stated. The course of the individual lesions is acute, but that of the disease is chronic, and relapses are the rule. The etiology of the disease is obscure, but from the similarity of the symptoms and lesions to affections such as pemphigus, herpes zoster, and erv- thema multiforme, in which pokies online disturbance of the ner- vous system, either sensory, trophic, or vasomotor, seems to stand in a causal relation to the disease, we are led to the supposition that dermatitis herpeti- formis should be traced to a similar origin, t'orrob- orative symptoms, however, are found in only a few- cases. In one of my cases paralysis has occurred, and one patient suffered from chorea, but the others failed to manifest by any symptom evidence pointing to any pathological condition of the nervous system that might stand as a cause of the outbreak. Dr. James McF. Winrield, in a paper read before the Pan-Ameri- can Medical Congress, reported a series of fom in which glycosuria was present, and he used this fact as an argument in favor of the nervous origin of the disease. It is undoubtedly true that some cases trace their origin to pathological conditions of other organs than the nervous, and are cured permanently by the re- ino\ al ot these a mditions.

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