Case 2.—Mr. H——, aged 37 years, manager of a factory, came to me on April 2nd, 1902. His general health was very good. The disease had been present five years, and began on the right fore-arm and a little later attacked the left. He has never been free since it first appeared, but thinks some patches have faded and others come out. In the last winter he had been decidedly worse, for the patches had certainly increased during the last few months. On the fore-arms, they were nearly symmetrical, and were quite so at an earlier stage. The lesions were yellowish or pale red patches; the simple ones were elongated, but the compound ones irregular in outline; they were from 3/4 to 1-1/2 inches long. The surface, with a lens, could be seen to be very slightly roughened, but this was not perceptible to the finger—but when pinched up there was decided thickening, though they were not raised. There were no patches on the back of the arms or fore-arms and none on the trunk, but there were similar patches on the inside of the thighs and on the legs, some of them larger than the arm-lesions but less distinctly patchy. There was a large, irregular area on the back of each thigh, and a few roundish ones scattered about the limbs. The face was quite free, there was no seborrhœa capitis and there was no itching or other sensory symptoms in the patches. He was one of ten brothers and sisters who were in good health, except one who died of syphilitic paralysis. His father died aged 71 years, and his mother, aged 63 years, was alive and well. He was given salicin, gr. xv ter die, and a lotion of glycerine of lead and liquor carbonis detergens. I saw him again on July 3rd, when the eruption had cleared up considerably, much of it having faded, leaving only a slight stain, but here and there it was still yellow and slightly rough. He was much better when he took the medicine regularly, but when he stopped it some of the eruption returned. The salicin was increased to 20 grains. I did not see him again until July 23rd, 1904. He then said he took the medicine for three months from July 3rd, 1902, and then stopped it. He had used the lotion a little longer. On the back of the legs there were large patches nearly covering the entire area, but not much in front. It was more distinctly red here than elsewhere, and there was very little thickening. There were only one or two patches on the left thigh, but a dozen or more on the left. The trunk still remained free. The initial patch was on the right wrist seven and a half years previously, but had disappeared. Some few fresh ones still developed occasionally. He was told to continue the salicin and rub on 10 per cent. vasogen iodine.
Case 3.—Mr. H——, aged 56 years, butcher, came to me with skin lesions of which he had only been aware three weeks, but they may have been there longer as he had to get up so early to attend the markets that he rarely saw his own skin. He was a stout healthy-looking man, but he had syphilis in 1879 and had then suffered from iritis; he was under treatment for two years. He suffered from constipation and had done so since he had enteric fever as a young man. Urine had no albumen nor sugar. He came of a long-lived family, his father having died at 86 and his mother at 74. He had seven brothers and sisters alive out of thirteen. The lesions were few in number and situated symmetrically over the lower ribs on each side, the patches sloping obliquely downwards from the back to the front. One on each side was 6 or 7 inches long and compound. There was a single one much smaller (2-3 inches) symmetrically situated in a line with the large patch, and there were three or four others above the major patch on the back. There was one distinct patch over the left scapula and about half a dozen fainter ones about the back; a few faint ones were present on the back of each arm and forearm. The lower limbs were free. The patches were erythematous in aspect, the larger ones brightish red, the others paler. The surface was very faintly roughened to the touch, and there was very distinct thickening when the skin was pinched up, but they were not raised above the surface. The borders of some of the patches were well defined, while others shaded off gradually.
He was given salicin internally and, to rub in, 10 per cent. vasogen iodine.
On February 11th there was decidedly less thickening on the left side but no noticeable difference on the right. He complained of indigestion, so the salicin was stopped and bicarbonate of soda given him, with tincture of nux vomica. On March 17th the thickening was much less and the patch on the left forearm was gone. On May 8th it had all cleared up and only left slight staining. As he has not come again he has probably remained well. The resolution of the patches was in this case probably, to be chiefly attributed to the vasogen iodine.
Case 4.—Mr. M——, aged 54 years, a gentleman in good circumstances, was brought to me on June 2nd, 1903, by Dr. Lovell. All his family were long-lived. His grandfather was killed by an accident aged 93 years, but his father died of cardiac disease, aged 67 years. The disease the patient suffered from commenced early in April, i.e. two months before I saw him, on the right leg, and by June had extended all over the lower limbs and on the trunk, nearly all over the back, but there was scarcely any on the front. On the forearms, the patches were more on the extensor than the flexor surface. The eruption consisted of irregular, pale, erythematous patches from a square inch to the palm in size, with distinct infiltration in most of them. On the back, they were arranged symmetrically in the direction of the ribs, i.e. sloping downwards and forwards from back to front. In the early stage, on the back, they could be traced to commence as minute papules at the hair-follicles, and gradually the intervals between were filled up until infiltrations with a uniform surface were formed. Some itched, but none severely, and many did not itch at all.
Salicin 15 grains three times a day, with 5 minims of tincture of nux vomica, was prescribed. On June 23rd I saw him again, and there was then distinctly less thickening on the thighs and legs and the eruption was somewhat less bright in some parts. The longitudinal patches over the scapula were still thickened, but there was less infiltration in the patches on the upper limbs and on the forearms they were yellower.
In response to my inquiry Dr. Lovell wrote me on November 29th, 1904, that he saw the patient on July 19th, 1903, and the eruption appeared to be gradually fading away. He next saw him for a sore throat in January, 1904, and the patient told him that the skin affection had gradually left him. He had had no other treatment than taking the salicin which I prescribed. This case is the most satisfactory and rapid in its involution under treatment, as it was also the most rapid in its evolution, and came earlier under my observation than any of the others.