[Roprint from The St. Louis Medical and Surgical Journal. March. 1894.] 
A Case of Intermittent Pruritus.* By A. H. Oiimann- 
Dumesnil, St. Louis. 
Pruritis is one of the neurotic disturbances of the skin which 
has never lost interest for the student of cutaneous disorders. 
As it is embraced in the great class of diseases whose symptoms 
are entirely symptomatic and whose etiological factors have a 
greater or less obscurity clouding them, we are more or less at 
tracted in their further study; and this is one of the chief reasons 
why I desire to place upon record a case which is unique in my 
experience and of which I have not seen a similar record in my 
reading. To begin with, I will first detail the case, reserving my 
observations for further discussion to a later time. I desire to 
premise that the patient is still a resident in my city and is oc- 
casionally seen, and that, at latest accounts, the conditions which 
I am about to describe remain unaltered, although it is but just 
to remark that no treatment whatever has been attempted up to 
the present. 
Case —Mrs. W. is a woman of medium height who is well- 
nourished. She has a good suite of brown hair; that on the pubes 
and in the axillm being also of good growth. She is 29 years of 
age. Her menstruation was always normal and regular previous 
to her marriage, which took place when she was 16 years old. 
When 17 years of age she bore a child, which is now 12 years of 
age. At this time (that of delivery) she experienced quite an ex- 
tensive laceration of the cervix uteri. A series of domestic 
troubles culminated in her taking four ounces of tincture of 
opium on March 6, 1889. Through the strenuous efforts of the 
physicians called in to treat her she was saved, and her next 
menstrual period occurred on April 10 of the same year. 
It is from this time that her present trouble dates. She has 
been observed in her attacks, and they all resemble each other. 
Before, during, or immediately after menstruation she is the sub- 
ject of an intense pruritus which attacks the entire integumentary 
surface. The itching is equally severe everywhere and no 
amount of scratching will relieve it. An attack will continue for 
24 to 36 hours, although at first the duration was three days. 
Among the peculiarities observed during an attack is that the 
face assumes an intense red color, and in addition to this the 
*Read before the Section on Dermatology and Syphilography of the First Pan- 
American Medical Congress, lield in Washington, D. C,, Sept. 5. 1893. pupils contract to one-third the normal size. Another peculiarity 
is that the most violent scratching produces no lesions whatever. 
It sometimes happens that an attack of the trouble is missed, 
yet the patient will continue to menstruate normally at regular 
periods. Not long since (July, 1893) she was successfully op- 
erated upon for her laceration, but the attacks of pruritus have 
recurred since. 
This patient has never taken opium nor any narcotic since the 
poisonous dose referred to above, and she was not addicted to 
their use prior to that event. In fact, she has never taken med- 
icine of any kind at any time, unless it be a little extract of pep- 
ermint or a mild saline cathartic. 
A fact which has been observed is that the attacks grow milder 
every year, despite the circumstance that she has never been 
treated for the trouble. 
This woman is extremely nervous in disposition, She is rest- 
less, and when awake has a habit of tearing paper into bits, and 
has in general destructive impulses of a mild character. She is 
of a passionate disposition, and the sexual orgasm is of an in- 
tense character in her case. She is also inclined, in a great 
degree, to erotomania, being upon the very verge of being an 
erotomaniac, although not suffering from nymphomania. 
This ease offers some peculiarities which, to my mind, are not 
easy of solution. The etiological factors are far from being 
clearly defined. The pruritus cannot be said to depend upon any 
uterine disorder, for it did not occur anterior to the date of the 
opium poisoning. On the other hand, the ingestion of the nar- 
cotic cannot be directly called upon as a factor in the production 
of the itching. Whilst we know that opium and some of its 
alkaloids produce pruritus, this subjective trouble disappears 
upon the cessation of the action of the medicament. Of course, 
it may be said that the ingestion of such a large quanity of opium 
produced a certain effect upon the nerve centres and that this 
was perpetuated, but it is merely re-stating facts as they exist. 
The regularity of the appearance of the attacks, with a possible 
few exceptions, is analogous to some other conditions which have 
been observed in connection with certain cutaneous affections, 
notably recurrent exfoliative erythema. Or, closely resembling 
the recurrent attacks, at regular intervals, which are observed in 
certain diseases which are supposed to be of nervous origin, such 
as hay fever, epilepsy, etc. The fundamental cause of this peri- 
odical recurrence has never been definitely ascertained, and I 
must perforce be satisfied in simply recording an interesting con- 
dition and confess my inability to account for it in any manner 
which would prove either adequate or satisfactory.