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To the Editor of the Philadelphia Medical Mufeum.

I

SIR,

On the Effects of Arfenic in three Cafes of Eruption.

WAS requested by a young gentleman, to give him fome advice and medicine, on account of an eruption that appeared upon various parts of his system, but particularly his abdomen. He informed me he had been fubject to it about fix months, and, upon the fuppofition that it was a trifling and accidental thing, and would disappear fhortly, he had done nothing for it, except washing it with a folution of the acetite of lead.

It took place fometimes merely upon rubbing the skin, and would then rise in small lumps resembling moschetto bites, which in the course of the day would fubfide, except leaving a small veficle filled with a thin whitish humour. By puncturing the cuticle this was discharged, and the part foon became perfectly well. Sometimes the eruptions would be circular, in the form of fmall ring-worms, with a space in the centre perfectly free from disease; at others, one fmall pimple would rife, and be attended with fuch an intolerable itching that it was impoffible to refrain from scratching; in a day or two a number of fimilar ones would appear around it, occupying a furface as large as a cent. Every form of the eruption terminated in a day or two in veficles containing a thin fluid, which in two or three more would burst, and the parts would then in a short time become entirely well. No one kind predominated or occupied particular parts, but they were interfperfed amongst each other. At first the abdomen was the feat of the difeafe, but it gradually extended itself over the lower, and then the upper extremities, leaving the neck and face untouched. Occafionally it would nearly cease to exist upon an arm, a thigh or a leg, for a week,

and afterwards break out with its usual violence. No method of treatment, except the last, had any material influence upon it; the difpofition to restoration, that would sometimes take place, appeared to be the effect of accident, for it was never permanent, and would discover itself in a degree, under every mode of cure, and even in the fhort intervals when no medicine was adminif tered.

I directed the patient to keep his skin perfectly clean, and he has frequently informed me, that, while he was under my care, he changed his linen very often, and washed himself at least twice a week, with Caftile foap and water. He was requested to live rather abftemious in his diet, avoiding falted and highly fpiced food, and fpirituous liquors, and to take a purge twice a week. After perfifting in this treatment during five weeks, he called upon me and mentioned that the disease was no better, and that it began to fpread in a confiderable degree on various parts of him. I gave him fome ungt. hydrarg. nitrat. and ordered it to be applied to the parts affected every evening. After using it for a length of time, without any benefit, it was discontinued, and a strong solution of corrofive muriate of mercury fubftituted. The refult of this application was fimilar to the preceding, for although the eruptions occafionally disappeared, they ftill broke out on other parts, fo as to exist in an increafing quantity conftantly. He afterwards used a great variety of topical remedies with no better fuccefs, and at length became afraid that he was infected with the itch; but his alarms were partly quieted, by recollecting that he had not communicated it to any of the perfons with whom he had flept. He was notwithstanding anxious for the exhibition of fulphur, and wifhed to be faturated with it, with which I complied, and directed him to use the ungt. fulph. in the ufual manner, after he had taken half a dram of the flowers daily for the space of a week, but he chofe to continue the dofe forty days. During a greater part of this period his perspiration was strongly impregnated with the medicine, fo as to be difagreeable to himself and others; and finding his fituation not to be improving, he

relinquished taking it. For a fmall time he took nothing of any kind, but perceiving the disease to become more general over him, he became exceedingly anxious to have something effectual done, and was willing to fubmit to any thing that brought with it the hope of benefitting him. I now determined on a flight falivation, to which he readily affented, and preferred impregnating his system slowly, without producing much affection of his falivary glands and fauces. He took a small quantity of hydrarg. muriat. mit. every evening, and in about a fortnight from his commencing it, his mouth became fore and a falivation enfued; this medicine was still continued in the fame dofe ten days longer, and then omitted. This treatment was not more effectual in removing his complaint than the former ones had been. The obftinacy of the disease increased his folicitude, and he determined to persevere in the use of medicines of fome kind, until a cure could be effected. I now directed him to take fulphurated antimony in pills, with a diaphoretic drink, which course he pursued fix weeks, when he discovered its inefficacy and discontinued it. A vegetable diet was likewise of no benefit. The Lisbon diet-drink was next reforted to, and taken for three months under every favourable circumstance; but this remedy was not attended with more fuccefs than those previously employed. I had read of the influence of arfenic in diseases of the skin, and had witneffed it in two inftances. Once in a fpecies of herpes, and, afterwards in a large old fore, whose venereal virus had been destroyed by mercury, but whofe cure could not be effected by it. As many of the ufual remedies had failed in this cafe, and the round of them nearly completed, I thought proper to refort to this powerful but fafe medicine; and preferring Fowler's mineral folution, I ordered ten drops to be taken three times a day for a week. The eruptions then began to disappear faft, and no frefh ones fucceeded; and after the difufe of the remedy for a few days, a dofe or two were taken daily for another week and then discontinued entirely. The disease now entirely ceafed, and the skin became perfectly pure and clear; the fmall yellow blotches which remained, where VOL. I.

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the eruptions had been, difappeared in a fhort time, upon the peeling off of the cuticle. It has been fome years fince this cure was effected, and my patient has continued ever fince perfectly free from his former difagreeable complaint.

During my attendance upon the above perfon, I was applied to in a cafe of a fimilar nature, and prefcribed fome of the medicines employed in the preceding one, none of which in this inftance had any effect except the mineral folution and mercury. After the folution had been taken a short time, the eruptions entirely difappeared, but returned, upon its being omitted. Being obliged to refort to mercury to remove another diforder which he had contracted, it was obferved, that the eruptions were removed, after a falivation had taken place a short period, but broke out again when it ceafed. Perceiving I was able to fufpend the disease, by the ufe of the folution, I fuppofed, that, when administered a long time, it would even remove the difpofition to it, especially as fome change might have been effected in his habit by the operation of the mercury. Accordingly I requested him to perfevere in the use of it a confiderable period. Finding himself again relieved for a longer space than he had ever been before, he imagined he was entirely well, and, contrary to my directions, laid aside the medicine, upon which the eruption again recurred. The yellow fever now occurred and induced him to leave the city, fince which time I have never 'heard of him.

Some young ladies of the Friends fociety, who devote much time in relieving the diftreffes of the poor, defired my attention. to a woman, who fuffered much from an affection of her face. She faid it commenced in June 1799, and was attended with confiderable ulcerations; that it varied during the remainder of the year, spreading occafionally over a part of the cheeks and nofe, and then nearly disappeared in the enfuing winter. During this period the employed a great variety of remedies, which her friends and acquaintances warmly recommended, but to no purpose. In the fpring the complaint increased, and with a view of being perfectly cured, fhe applied to a physician, who gave

her eight small powders of a white appearance, of which she was to take one every week, and confine herself rigidly to a mild diet. The medicine vomited and purged her so severely, that after having taken five dofes, fhe determined to omit them, being fo much exhausted by their operation, that she was fcarcely able to walk across the floor, and preferred, the faid, to die rather than make use of the refidue. Her fauces fwelled, gums became fpongy and teeth loofe, but no falivation enfued; when she discontinued them, her nose and cheeks were rather better, and became entirely well in the fall, remaining however a good deal fwelled and of a fiery redness, similar to the appearance that fometimes occurs in the faces of those who have been intemperate in the use of spirituous liquors. Such was the afpect of her face that it was with reluctance she ever left her house, being fo frequently expofed to the unpleasant remarks of those whom he would meet in the ftreets. She remained well one whole year, at the expiration of which, she fell down stairs, and hurt her ankle to fo great a degree as to occafion it to become ulcerated: when it was almost healed her face broke out again, her palate became highly diseased, and feveral pieces of bone came away from the roof of her mouth. Her palate was improved, when I was requested to visit her, March 1802, but her fituation in other respects was much more alarming, being infinitely worfe than fhe had ever been; there were confiderable ulcerations of her nofe, both externally and internally, and a similar affection of her cheeks, occupying one half of the right one, and about one fourth of the other, nor did her upper lip entirely escape. The fores were tolerably deep and white at the bottom, with edges that were turned up and hard; the inflammation around them extended to fome distance, and was of a bright fcarlet colour, attended with fuch excruciating pain as to deprive her almost entirely of reft. Her state was fo deplorable that we were both apprehenfive fhe would lofe the greater part of her nofe, nor could we form any opinion to what extent the ravages in other parts would proceed. A few of the fores had healed without any application whatever, but were

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