Page:Archives of dermatology, vol 6.djvu/14

2 manent, and that the disease was continuing to assert itself in the face of all treatment.

Throughout the autumn the patient complained of occasional distinct attacks of weakness, malaise, loss of appetite, and other similar symptoms, in consequence of which she began to lose not only flesh, but her spirits, which before had never wavered, and gave up hope. Smaller lesions continued to come and go, while a number of the older and larger ones were slowly undergoing absorption and so disappearing. The face and leg tumors were now discharging a copious yellowish, greenish, puriform, bloody, exceedingly offensive fluid, which was poured forth from the forehead in such quantity as to necessitate repeated daily dressings. It was found that chlorinated soda solution best served the purpose of suppressing the heavy and sickening odor, and that a thick layer of oxide of zinc ointment and cosmoline with carbolic acid was most grateful. Lotio nigra was also used at times with favorable result, and appeared to modify the amount of the secretion.

Towards the latter part of December it occurred to me that very small doses of corrosive sublimate might possibly act beneficially, although, remembering the disastrous results from arsenic and iodide of potassium, it was given tentatively and with some misgivings as to the effect. A prescription containing compound tincture of cinchona and one-sixty-fourth of a grain of the mercurial was ordered. Three or four doses only were taken when alarming symptoms of ptyalism began to manifest themselves. Several weeks passed before the mouth recovered, leaving the lower incisors and several other teeth in a precarious state. Ulceration occurred, which it seemed to me must be attributed to the disease rather than to the mercury. A few weeks after this the right tonsil became swollen and tender and covered with a whitish deposit, which was followed by ulceration and a most fetid, stringy discharge. These latter symptoms increased from day to day, the tonsil soon completely disappearing, and being succeeded in the course of a month by an ulcerated cavity about an inch in diameter and a half-inch in depth. The fetor was insufferable. This ulceration, although at first obscure as to its nature, was without question a symptom of the disease.

According to the notes recorded on December 1 she had lost about thirty pounds since September. She began to have a nightly fever, together with flushes of intense heat and burning in the palms and soles, followed by copious perspiration and general debility. These symptoms manifested themselves gradually and continued almost uncontrollable for a month. An attack of suppression of urine lasting thirty-six hours, followed by a violent outbreak of urticaria, similar to an experience six months previously, occurred during the latter part of November.

Jan. 1, 1879, found her failing appreciably in general health, and confined to bed. The cutaneous lesions up to this time were behaving most capriciously, as had been the case during the entire autumn; but apart from the steady increase in size of the forehead