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CLINICAL REMARKS ON SOME CUTANEOUS AFFECTIONS. By W.
DAVIDSON, M.D., Physician to the Glasgow Infirmary.*

1. Ioduret of Sulphur for Porrigo.

Six cases are related. Two will suffice for us.

Case 1.-Charles Biggar, aged 10, a vagrant, was admitted on the 1st February 1840. Scattered over the whole of the head were numerous thick greyish patches of scabs, which, when removed, left the surface underneath perfectly bare and shining, but, in a day or two, numerous small pustules made their appearance, accompanied with considerable itching. The eruption appeared in the form of small pustules four years ago. In this case, the scabs were first softened by the constant application of poultices for two days; the head was then shaved. An ointment, composed of five grains of the bichloride of mercury to one ounce of axunge, was tried from the 5th February to the 12th, without any improvement. The following was then employed :

Iodur. sulphur.
Axungiæ

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This ointment was applied daily to the head; and in a few days a decided amendment was remarked.

On the 5th March, the following report was taken.-Pustules and scales are now completely gone, but there are some bald patches on head in the situation of eruption; no itching; surface of skin pretty natural; general health good. He was dismissed in a few days afterwards.

Case 2-Duncan M'Intyre, aged 10, a singer, admitted 30th December, 1840. The whole head, particularly the forehead, was covered with a thick dry greyish white crust, accompanied with itching, but without discharge. The disease was of four years' duration, and was represented to be of a very inveterate kind. General health good; bowels regular; tongue clean; pulse 80.

R. Iodur. sulphur. - Dij.

Axungiæ

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3j. Misce.

14th January, 1841, or a fortnight after the use of the ointment, the eruption is reported to be quite gone, and the skin covering the scalp natural in appear

ance.

As a precautionary measure, it was continued till the 22d, when he was dismissed.

Dr. Davidson observes :

"Porrigo, in all its forms, is often a very unmanageable disease, and even when cured is very liable to return. In private practice, and in the hospital, I have tried almost all the external remedies recommended by authors, but have found none so efficacious as the ioduret of sulphur, having repeatedly succeeded in curing the patient permanently with it, after a long trial of other agents. At the same time, it must be remarked, that the evidence derived from the treatment of this disease in an hospital is liable to this objection, that the future history of the case is frequently lost sight of, and there are consequently no means of ascertaining whether or not the disease returns.

The 1st and 4th cases seem to be examples of porrigo scutulata, and both had all the appearances of considerable inveteracy; and I may here remark, that slight cases are rarely sent to this hospital. This species is generally considered the most difficult of cure, and even though the tendency to pustulation be removed,

* London and Edinburgh Journal of Medical Science, No. 12.

there is little dependence to be placed on this sign, until the skin becomes natural in colour, or the hair is beginning to grow.

The 2d, 3d, 5th, and 6th cases seem to be examples of porrigo favosa; the yellow pustules and inerustation, the fetid discharge, the matting of the hair, and the pediculi are all characteristic of this species. It is in general a more manageable disease than the p. scutulata, and is more under the power of the ordinary agents employed in its cure. At the same time, it not unfrequently proves somewhat intractable. In the treatment of porriginous affections, the following is a more particular account than what is given in the short history of the cases. The head is first well washed with soap and water, the hair is then cut as short as possible with scissors, a poultice is applied, and continued for a day or two if necessary, to soften the crusts, which being removed as thoroughly as possible, the hair is closely shaved. In general, the ointment is not applied until the head has been shaved, but if pediculi be present, it is employed from the commencement, in order speedily to extingush these vermin. The proportion of ioduret of sulphur employed has varied from 20 to 40 grains to one ounce of axunge; but, in general, the latter quantity may be safely used from the beginning, unless there be some unusual inflammatory action present for it seldom excites any particular pain or irritation. As a general rule, the daily application of the ointment will be sufficient, but, in some cases, it is advisable to use it twice a day, in order to facilitate the cure.

Alteratives, or any particular internal treatment, have rarely been resorted to, when the general health was tolerably good. Laxatives have occasionally been prescribed, and a mild farinaceous or milk diet."

We can speak from personal observation for the last two or three years, to the merits of the ioduret of sulphur ointment in the treatment of porrigo. We have found it, on the whole, more serviceable than any other application. In cases of porrigo decalvens we have seen it particularly useful. We employ it of greater strength than Dr. Davidson appears to do. One drachm of the ioduret to seven drachms of lard has been our customary formula, nor have we ever seen that over powerful.

2. Ioduret of Sulphur for Lepra and Psoriasis.

Case-Margaret Phillips, aged 11, admitted 14th January, 1841. The extremities were covered with circular patches of small shining white scales, which, being detached, exposed a red and somewhat elevated surface. The eruption, which was confined to extremities, made its appearance in the form of small white scales, and had existed for three years. The patient stated, that it has disappeared three or four times, after various remedies had been discontinued. General health was pretty good, tongue clean, bowels regular. Cap. sol. arsenic. gtt. vj. bis in dies.

R. Iodur. sulphur. gr. xx. Axungiæ, 3j. Misce.
App. ung. part. affect. omni note.

Hab. baln. calid. secunda quaque nocte.

25th January. The strength of the ointment was increased to 40 grains to the ounce of axunge. She was completely cured by 3d February, but remained in the house for eight or ten days longer, expecting her friends from the country to take her home. On the 13th February, she was seized with severe conjunctivitis, accompanied with iritis of right eye, which was subdued in about a fortnight; but the lepra showed no symptoms of return at her dismissal.

Case.-John M'Lennan, aged 35, a labourer, was admitted 19th June, 1841. Scattered over trunk and extremities was an eruption, which appeared about eleven weeks ago, in the form of irregular slightly elevated red patches, on the surface of which a thin white scale rapidly formed. Eruption was at first accompanied with slight itching, and the scales being scratched off were rapidly re

produced. Around the knee and ankle joints the patches were more continuous, and the scales considerably thicker than over other parts of body. When scales are removed, the subjacent surface is smooth, dry, and slightly inflamed. He was a patient in ward 10, for a similar affection, about two years ago, when he got well under the use of baths, ointments, &c. General health good.

Hab. baln. tepid. omni nocte.

R. Iodur. sulphur. ij. Axungiæ 3j. Misce.

Abrad. cap. Hab. pil. 1. coloc. comp. om. noct.

The ointment was used every night after the bath, and, on the 23d June, the scales were completely removed over whole body, and the prominence of the red patches greatly diminished.

25th. The amendment was progressing, but a few new papulæ, covered with very thin scales, had appeared on lower extremities, which extended to back and abdomen, accompanied with itching.

Cont. ung. et balneum. Hab. sol. arsen. gtt. x. ter in dies.

July 8th.-Eruption almost gone, a few papulæ have appeared on abdomen, general health good.

July 12th.-Eruption quite gone, a few reddish stains on skin only remaining.

A case of Lepra Vulgaris is given. It is not remarkably satisfactory.
Dr. Davidson remarks:-

"The ioduret of sulphur does not seem to have so much power over lepra and psoriasis as over porrigo; although, in my experience, it has succeeded more frequently than any other agent that I have tried, with the exception of blistering by cantharides. Lepra alphoides, being a milder disease than lepra vulgaris, is more under its influence, as well as the milder forms of psoriasis, particularly in children but the species named inveterata would prove somewhat intractable to this as well as to other remedies, as I had occasion to witness in a patient, who, although benefitted considerably, was not cured; he was unfortunately carried off by fever before the result was ascertained.

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Three other patients affected with lepra and psoriasis have been treated in the Infirmary during last August; two of them have been completely cured, the other is still under treatment, but nearly well; all of them of several years' standing, and having employed a variety of medicines before admission. In one of the cases, a female, who had been using large doses of arsenical solution before her admission, which she was obliged to lay aside, the comparative effects of the ioduret of sulphur, and the acetum cantharidis were tested, the first upon the lower extremities, and the second on the arms. From the result of this and other trials, I am satisfied that the latter is the more powerful as a local agent in this disease. The acet. canth. however, was found too weak when prepared according to the formula in the Edinburgh Pharmacopoeia; the proportion of cantharides was therefore doubled. It is proper, however, to state, that strong pyroligneous acid was alone used, without the addition of the acetic. Some other formulæ were tried for the purpose of producing ready vesication, such as an ethereal and an alcoholic solution of cantharides, which succeeded moderately well in some cases; but the speedy evaporation of the menstruum seemed to prevent their thorough action. The following preparation, which was applied with a small brush, answered the purpose pretty well, viz. one part of cantharides to three of a mixture of equal parts of castor oil and alcohol, especially when the flies were suspended in the oil, as suggested by Dr. Leslie, apothecary to the Royal Infirmary. The following liniment, however, which is a modification of the Emp. Canth. E. P., is superior to any preparation that I have tried. It is sufficiently soft during warm weather to be applied with a brush, but requires to be heated when the temperature of the air is low.

R. Axung. Ol. Rapii, P. Cantharid. ā 3j.

In order to succeed with either of these vesicating agents, the skin ought

to be previously softened either by means of the warm bath, or sponging with warm water."

3. Blistering for Warty Excrescences on the Skin.

Case-Neil M Kinnon, plasterer, aged thirty-five, admitted 14th December, 1840. Left lower extremity was twice as thick as right; cellular texture presented the appearance, and gave the sensation of being much hypertrophied, offered much resistance to the fingers when pressure was made, and only pitted slightly. The ham and the two upper and posterior thirds of leg were covered with deep rather fleshy warty excrescences, traversed by deep irregular longitudinal fissures : but in the popliteal space they were transverse. A patch of a similar nature, but dark-coloured, and resembling icthyosis, about the size of the hand, existed over the lower part of the leg at flexion of the ankle joint.

The colour of the patches was generally brownish red. Over anterior part of same leg there were numerous pretty large yellow scabs, and the skin covering the whole of inner and upper part of thigh, was of a dark livid colour, as was also a patch over inner part of the right thigh, which, at one period of the disease, was also encrusted with seabs. The patient ascribed the affection to a fall. It made its appearance in the form of warts on the lower and inner third of the leg about five years ago. He stated that he was cured in this Hospital about two years ago, but that the limb retained its blue appearance, which he says was always the precursor of the warty excrescences. His general health was good, pulse and bowels regular, tongue clean.

App. sol. arsenical. part. affect. quotidie.

Cap. pil. 1 colocynth. comp. omni nocte.

28th Dec.-Warty excrescences are in much the same state. R. Chlor. zinci 3j. Aquæ 3ij. Solve.

App. sol. part. verrucos. Cap. Tk. Canth. gtt. xx. ter in dies.

The strength of the solution of chloride of zinc was gradually increased, until it amounted to three drachms of this salt to an ounce of water, on the 20th January, 1841, while he had been taking the arsenical solution internally from the 11th of the same month; but there was only a slight improvement, there being still an enormous thickness of warty structure. On the 22d January, a blister was ordered to a portion of the leg, which acted well, and produced a large detachment of warty substance. The blisters were repeated every two or three days until the whole affected surface had been more than once vesicated. Severe strangury was several times produced, even by the tela vesicatoria, which was employed on two or three occasions in this case.

On the 14th February he was dismissed, the right leg appearing to be quite free from warty excrescences, and there remaining on the left only a slight thickening of the skin near the ankle, where the disease resembled icthyosis.

CITY OF DUBLIN HOSPITAL.

NEW METHOD OF REDUCTION FOR DISLOCATION OF THE HIP.*

Two cases are reported.

Case 1.-J. M., aged 40, of slight make, and relaxed state of muscular system. The accident happened four hours before admission. The dislocation was on the dorsum of the ilium.

Dub. Med. Press, Sept. 1, 1841.

Considering the relaxed state of the muscular system, it was thought, that this might be a favourable case for trying the method of reduction proposed by M. Colombot. The patient was placed standing, and instructed to bend the trunk forwards, so as to support the thorax on a table, the opposite edge of which he grasped with his hands. Mr. Williams now standing on the outer side of the affected limb, bent the leg at a right angle with the thigh, grasping the dorsum of the foot with the right hand, while with the left hand placed at the upper and posterior part of the leg, he exerted a gentle and continued pressure, in which he was aided by the hand of an assistant, placed on his own and at the same time attempted to dislodge the head of the bone, by directing the thigh somewhat forwards and inwards. After a short time the head of the femur was found to have descended so considerably on the dorsum of the ilium, that it was estimated to be nearly on a level with the acetabulum. The thigh was now suddenly rotated outward, but it was found that the dislocation was not reduced.

This and a second similar attempt having failed, and as from the condition of the muscles, reduction in the ordinary way promised to be attended with little suffering to the patient, the lacs were applied, and extension being made to a very moderate amount, the dislocation was reduced with the utmost facility. Nothing subsequently occurred worthy of notice.

Case 2-This was more successful. The patient, an athletic corn porter, dislocated the femur on the dorsum of the ilium five hours before admission.

Immediately, an attempt was made to reduce the dislocation, the lacs were applied in the usual way, and extension made by three powerful assistants, but it was found impossible to overcome the resistance of the muscles.

About seven hours after the accident, Mr. Williams saw the patient, and resolved to again try M. Colombot's method, which was done precisely as in the preceding case the mode of extension already described, was persevered in for about three minutes, with the effect of causing a scarcely perceptible change in the situation of the head of the femur on the dorsum of the ilium; the limb was now rotated outwards, as in the preceding case, and the head of the femur re-entered the acetabulum, with the characteristic and in this instance extraordinarily loud report. The patient experienced scarcely any pain except at the moment when the reduction was effected on rotating the limb outwards. Immediately after the operation the symmetry of the limb was perfectly restored. From the second to the fourth day the dislocated limb was, by measurement, fully three-fourths of an inch longer than the opposite one, but this elongation disappeared by the 6th day, and on the 18th August, the patient, as regarded the accident, was prepared to leave the hospital, but remained to have a small encysted tumor removed from the back of his leg.

The plan is evidently worth a trial.

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