The latter symptom did not come on until three
years later. In the course of a year or two the lesions increased
in number, so that in four years the shoulder and arm were
thickly studded with them. During the next five years no
particular changes occurred either in lesions or in the degree of
pain. The region affected simply looked like a solid sheet of
variously-sized, closely-packed, confluent tubercles, hard and
dense. The tubercles were at all times painful to the touch, and
even the contact of air was sufficient to cause great suffering.
During the paroxysms, which occurred usually at several short
intervals every day, the skin changed color frequently and
rapidly, passing through various reddish and violet tints, at
times becoming purplish.
As a paroxysm came on the man was in the habit of gently pressing
and holding the arm closely to his body. At one time he endured
the attack in a standing posture, walking the floor, but usually
he seated himself very near a hot stove, in a doubled-up, cramped
position, utterly unmindful of all surroundings, until the worst
pain had ceased. Frequently he was unable to control himself,
calling out piteously and vehemently and beseeching that his life
be terminated by any means.
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