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these cases, there can be very little, if any, doubt, inasmuch as other preparations of sulphur have been used with great advantage in the treatment of boils. These are the sulphite and hyposulphite of soda, and sulphuric acid. The former of these preparations I used quite extensively some years ago, and reported very favorably upon it as the best remedy with which I was then acquainted. Sulphuric acid is also well recognized as of service in this condition, and need not be dwelt upon here.
It is also hardly necessary to enter upon the consideration of the many agents used in medicine in which sulphur enters as a secondary constituent, in the form of sulphuric acid, but as they are among the most important remedies, they should be mentioned; such as the sulphates of atropia, copper, iron, magnesia, mercury, morphia, quinia, soda, strychnia, and zinc. It must be remembered that sulphur is a large constituent of the human frame, and not an unimportant one, and that the reason why the sulphates are among the best forms in which to employ the various other agents may be, and probably is, because they are already combined with one of the elements of the body. As an example of a wonderfully valuable combination of the compounds of sulphur in diseases of the skin, may be mentioned that known to many as Startin's mixture, with the following formula:
B. Magnesi sulphat. 3j;
Tinct. gent. 3j;
Aquæ, iij -M.
This is most potent in reducing the cutaneous congestion in such conditions as erythema multiforme, erythematous eczema, and urticaria, and is constantly employed in my private and public practice. The effective agent is certainly not the magnesia alone, for if given singly or in other forms the results are not the same: nor is it the iron, or the gentian, but it is the combination, and I cannot doubt that the sulphur element plays a very important part. The confirmation of the internal value. of sulphur is further found in the mineral waters which are impregnated with sulphuretted hydrogen, known as sulphur waters, such as those of Richfield, Sharon, Avon, the White Sulphur of Virginia, and many others in this country and abroad. All are familiar with the popular views both among the laity
and the profession, in regard to the efficacy of these waters in diseases of the skin. There is very generally some basis for popular opinion, and in this instance it is not very difficult to find. The error in it is in the want of discrimination of proper cases, which must ever obtain in such medical matters. These sulphur waters undoubtedly first obtained much of their reputation from their use externally in parasitic diseases, animal and vegetable, as will be mentioned later.
But these sulphur waters have also some power upon the system used internally, and, beyond question, are of a certain value used thus in some skin diseases: the waters act upon the liver and intestines, and are undoubtedly of service in the rheumatic and gouty habit. I have seen a certain amount of good from them in chronic eczema and acne, and have personally experienced the benefit of the White Sulphur taken internally alone in urticaria. But multitudes of patients with eczema, acne, and other skin affections go to these springs without benefit, and the many instances of psoriasis which I have seen who had previously been to these springs without permanent benefit, leads me to doubt their power over this disease.
I greatly regret that I cannot speak more definitely in regard to the internal use of these sulphurous mineral waters in diseases of the skin, for while I believe that as quickeners of the emunctories they are of some value, I have seen so many individuals who have failed of cure at them, that I cannot but think that the mode of their use has been faulty. Unfortunately, we have very little reliable information in regard to the actual powers of our mineral springs, for little trust can be placed upon the matter printed in the circulars and pamphlets furnished by the hotels, and we have almost no independent and well-weighed testimony, based on large experience. Even physicians, resident at springs both in this country and abroad, become prejudiced to such a degree as to hardly see any value in other springs save their own, and to attribute everything to the spring in which they have had experience. There is great need for the collection of reliable data on a scale sufficiently large to give deductions therefrom, which shall be of value. The writer has many a record, and secks daily to gather such from practice, but the reports are yet too conflicting to allow of any conclusions to be formulated. He will be greatly pleased to receive any assistance possible in this direction, and will be glad to learn of positive
proven facts of value in regard to these matters, as he intends to report on the matter when sufficient data are collected.
The external use of sulphur and its compounds is of more definite interest than the internal, because the facts are more conclusively demonstrable. First and chiefest of all must be placed the treatment of scabies, which, as previously remarked, has probably been the means of giving sulphur much of its reputation as curative of diseases of the skin. The itch is undoubtedly one of the diseases which is becoming extinct with advancing civilization, although in time past it formed a not inconsiderable share of cases with skin disease. It is to-day very much more frequent in some countries than in others. Thus, at the clinic of Prof. Hebra, in Vienna, one sees cases almost, if not quite daily, and in Paris it is so common that those affected with it are not admitted to the great Hôpital St. Louis, but merely receive a card which passes them through the rapid cure which will be described later on. In Glasgow, scabies formed one-quarter of the ten thousand skin patients in public practice. In this country, on the other hand, it is very uncommon, forming only between two or three per cent. of all the cases of general skin disease which I have seen in public practice. During our late war, however, the disease was much more prevalent, and good observers consider that the "army itch" was only this disease. It is also sometimes common in public institutions.
It is therefore principally as a local agent that sulphur has its chief reputation, and it is thus that it is often employed in general skin disease, with the hope or impression that in some way sulphur is "good for the skin," without any definite idea of what is to be accomplished.
Now, sulphur is an irritant to the skin, whether it is applied to abraded surfaces or rubbed well into the healthy skin, and this must ever be borne in mind when it is used. It is of value, therefore, only when a stimulant is required, or when its parasitic action is desired, and is consequently of service in comparatively few diseases of the skin. Foremost among these still stands scabies, for which it may almost be called a specific, for it certainly can, singly and alone, cure this eruption by destroying the cause-the itch insect.
The treatment of scabies has been now reduced to a very simple matter in most cases, and depends upon the very thorough
application of the parasiticide to every place occupied by the burrowing acarus. The plan generally adopted is that of Hardy, of Paris, which consists in soaping the body well for half an hour, following this with a warm bath for an hour, and then half an hour of thorough inunction. The sulphur ointment of the Pharmacopoeia, which is composed of one part of sulphur to two of simple ointment, is far too strong for most skins, and is very apt to excite an artificial inflammation which may readily be mistaken for a further eruption of scabies. It is well, therefore, not to have it used too long or too energetically on delicate skins; one thorough course, such as that above described, suffices for the cure of many cases; but it is well always to wait a few days to observe whether the itching returns, when the course may be repeated. I seldom, however, use the officinal ointment, but prefer to have one made of a strength suited to the individual case, generally about two drachms to the ounce, adding a drachm or two of storax, which is a parasiticide of very considerable value.
Precipitated sulphur is of no little value in acne, and many of the best applications used for this eruption depend largely for their efficacy upon sulphur. Such, for instance, as the following:
B. Sulph. precipitat. 3j;
Etheris sulphurici, 3iv;
B. Sulph. precip. 3j;
Tinct. camphoræ, 3ij;
The compounds of sulphur will also be found very efficient in acne, as, for instance, the hypo-chloride of sulphur, so much extolled by English physicians, used in the strength of one or two drachms to the ounce of the ointment, well rubbed into the face at night. Iodide of sulphur, used in the same way, in perhaps a little less strength, is also effective.
But all these applications are stimulating, and care must be taken not to carry this plan of treatment too far, for while we can by well-regulated stimulation urge the skin to healthy action, it is very easy to overstep the bounds, and we can have the harsh, irritated skin, which may be even more annoying to the patient than the eruption which we seek to remove.
Another compound of sulphur is also of very great service in acne, and this is found in a formula which I have mentioned already several times in print. This preparation is only mildly stimulating, and is one which can often be used with advantage even in quite inflamed faces. It is composed thus:
R. Potass. sulphuret.,
The ingredients are each dissolved in one half the water, forming clear solutions; they are then mixed, and a white precipitate takes place, which is to be shaken up and allowed to dry on the face.
In speaking of the value of local applications in such eruptions as acne, etc., it will be understood, of course, that internal, dietetic, and hygienic measures are to be used as well; these are of course foreign to the immediate purpose of this paper, which is only to show the importance of sulphur as an agent in dermatological practice, if rightly used.
Sulphur and its compounds have a not inconsiderable value in the treatment of the vegetable as well as animal parasitic eruptions. Sulphur will destroy the life of the parasite in favus, ringworm, and tinea versicolor, and may be employed with success in several ways. My preference is usually for sulphurous acid, as I have urged on several previous occasions. The mistake in the ordinary methods of using sulphurous acid is, I think, twofold: first, it is generally recommended to be used diluted with one or several parts of water. This I consider to be entirely unnecessary, and worse than useless, as it diminishes. the efficacy of the remedy. Pure, fresh, sulphurous acid I have not found too irritating even to the skins of females and children, to whom I constantly advise it. The reason for the common advice to dilute it rests, I think, upon the second error which generally occurs, namely, that the acid is not perfectly fresh but has undergone a decomposition, as it has a very great affinity for oxygen, whereby it is changed from sulphurous acid (SO) to sulphuric acid (SO,), which latter is of course irritating to diseased and delicate skins. To avoid this as far as possible, I always order a fresh, unopened package of sulphurous acid, as it comes from the manufacturers, in half pint and pint bottles, and have the patient fill a small bottle, say one containing an ounce, from this, and use from the smaller bottle, keeping the