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HISTORY OF A REMARKABLE CASE OF POLYARTHRITIS DEFORMANS. Bt henry S. STARK, A. B., M. D. The history of this case is interesting, firstly because such an aggravated type of so common a disease discount lexapro online is rarely encountered, and secondly because there is a suspicion that a morbid condition of the spinal cord, causing get discount lexapro tropho- neurotic disturbances of nutrition, co-exists with the primary lesion. Senator recognizes two varieties of lexapro discount program this affection, the "senile" and the "peripheric," the former attacking the large joints, as the hip joint, while the latter attacks by preference the small joints of the fingers and toes and pri- marily the large. toe. It is difficult to decide from the his- tory of this case with what variety we are here dealing. Recently Remak, Benedikt, and Charcot have directed attention to the nervous system as the original seat of arthropathia, and their researches led them to believe that the peripheric variety especially of this affection was of neurotic origin, resulting from irritative states of the spinal marrow. Remak therefore called this variety " arthritis myelitica." Another element which would point to a neuropathic origin in my case is the rapid and extensive muscular atro- phy, which might not be satisfactorily explained by the im- mobility of the articulations and consequent muscular inac- tion, but cheap lexapro no prescription might reasonably be supposed to be due to lesions somewhere in the nervous apparatus. According to the patient's statements, he was confined to bed thirty years be- fore this symptom developed, and it ran a complete course in three years and a half, leaving him almost a living skele- ton. Still a third symptom which points to a neurotic lesion is the occurrence of the attacks in symmetrical joints. The history of the case is a typical one of "arthritis deformatis" as is described in such familiar text-books as those of von Ziemssen, Eichhorst, and Flint. Mr. B., aged fifty-nine, single, farmer, native of New York State. There is no family history of tubercular, specific, ma- lignant, or nervous diseases, but a marked rheumatic diathesis characterizes the family through several generations. Tlie patient himself denies a venereal history, but confesses to a slight alcoholic and tobacco habit. He had none of the cheap lexapro online exan- themata common to childhood, but enjoyed generic lexapro price drop the best of health until he was seven years discount lexapro card old, when he had a swelling of tlie right ankle which only lasted a few days. Two years after he was attacked with what his physician called "inflammatory rheumatism " of the right hip joint. This attack rapidly spread to both knees and ankles, and was cheap lexapro alternative attended by swelling and a high fever. This lasted six weeks, when he entirely recovered. He remained well until 1847, when he became subject to attacks of pain in the region of the heart, which lie believed were dne to overexertion, from which attacks he soon recovered without ever a recurrence. It was in 1848, when he was eighteen years of age, that the present affliction first manifested itself. At about this time he occasionally complained of stiffness lexapro price per pill of the joints, especially the hips, on rising in the morning. During the course of the day this symptom would disappear. One morning in July of this year, while out walking, the ball of the right toe prescription discount lexapro suddenly be- came painful, buy discount lexapro "as though a nail were being driven into the bone." This continued the next day, when both ankles and knees became greatly swollen, and the skin reddened. He suf- fered great pain and lexapro price generic had a high fever. He was attended by a local physician, who prescribed large and frequent doses of calo- mel, and later on iodide of potassium, with local applications of setons, blistering plaster, and dry cups. Soon the knees became distended with " water," as his physician styled it, which gradu- ally disappeared without surgical assistance. With the absor[)- tion of the fluid the fever abated, and in the autumn of the average cost generic lexapro year he left his bed and walked about with the aid of a cane or crutches. During this attack his hair fell out, but rapidly regrew. The patient states that from this time on his knees and hips gradually became stiffened, that this symptom continu- ally increased in severity until the year 1855, discount lexapro when his joints were so rigid and immovable that he was entirely deprived of all power of locomotion, discount lexapro coupons and he was forced to take to bed, where he has remained to the present time, a period of thirty-four years, during which time he has never been on his feet. In 1860 he had lexapro price comparison an inflammation of the left eye, which soon disappeared ; in 1869 he had a recurrence of the inflammation, but in both eyes. From this latter date his sight gradually failed him, and in the course of ten weeks was entirely de- stroyed. Four years ago he weighed 155 pounds ; now his weight is 68 pounds. This loss in weight, the patient states, only oc- curred within the lexapro price last four years. There are no cheap lexapro canada disturbances of the bladder or rectum. He states that he never had a bed- sore, although his attendants used no further precautions than ordinary cleanliness. Since 1855 he has been subject discount lexapro no prescription to muscular twitchings, which he is conscious of whenever he lies quiet ; he states that this twitching is peramhulatory, no part of his body being ex- empt. His appetite for venery has not diminished. He con- siders himself perfectly well, except that he is " crippled," and

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