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ON THE USE OF SULPHUR AND ITS COMPOUNDS IN DISEASES OF THE SKIN.
By L. DUNCAN BULKLEY, A.M., M.D.,
FIFTY years ago such a paper as the present one would have seemed superfluous, for sulphur was universally recognized as "good for diseases of the skin," very little attempt being then made to separate and differentiate the maladies of this organ, which are now so clearly distinguished. It is not very long since a lecturer, with more art than knowledge, said that there were three classes of skin diseases: the first, sulphur would cure; the second, mercury would cure, and the third, the devil himself could not cure.
Modern dermatology has made vast advances since those days, and this branch, so far from being the terra incognita, has become one of the most, if not the most, developed branch of medicine; a larger number of distinct diseases are perfectly recognized as affecting the skin than any other organ, their differences clearly established, and the therapeutics of this branch will yield the palm to that of no other department.
There are, however, many difficulties inherent in the study of diseases of the skin, which have in time past prevented the general practitioner from acquiring a perfect knowledge of this branch; chief among these has been the difficulty of observing cases in sufficient numbers to become familiar with the appearances presented. This, together with the vastness of the subject, must still be an obstacle before many, but to those who will search for and improve the opportunities offered by the large classes of skin patients in the dispensaries of the cities, much of the apparent difficulty in recognizing and classifying diseases of the skin would pass away.
This much is premised, because in my attempt to indicate concisely the true value of sulphur in diseases of the skin, I VOL. XXXI.-13
shall be obliged to be very brief in allusion to diseases, and the whole value of my remarks, as applied to practice, will of course depend wholly upon accuracy of diagnosis in individual cases. To prescribe sulphur or arsenic simply because the skin is diseased, would be as irrational as to appropriate any other remedies to any special organ of the body, as, for instance, to give digitalis whenever the heart was affected. Four years ago the writer had the pleasure of presenting before this Association a study on the use and value of arsenic in diseases of the skin, in which he endeavored to clear up the subject, by defining clearly what arsenic would accomplish in certain diseases, and in what affections it was useless or harmful. The aim of the present study is similar in regard to sulphur and its compounds, which, while of much service if rightly applied, are worse than useless if wrongly employed.
In studying the subject we will, for clearness, separate the internal from the external use of the remedies considered, and will speak of each in turn. We have also to consider the following points: sulphur alone; next, as combined with other drugs; then of its compounds; and lastly, of mineral waters containing sulphur.
Sulphur is one of the oldest remedies used in medicine, and it was early employed in diseases of the skin. The reason of the great reputation of sulphur in this class of affections was undoubtedly because of the remarkable results which followed its use in scabies; and as the real nature of the disease and its cause was unknown, it was readily supposed that it should be equally effective in all skin affections; and it was also supposed that an agent which acted so well externally, should be of further assistance when administered internally. Numbers of books have, therefore, been written upon the external and internal use of this remedy, and of course vast claims have been made for it which, in the light of to day, appear ridiculous. But we will find that sulphur and its compounds still play an important part in cutaneous therapeutics when rightly and intelligently used.
Pure sulphur is seldom given alone internally, and is not generally thought to have much, if any effect, in diseases of the skin; its internal administration is commonly confined to its use as a laxative. I can, however, speak very highly of it in eczema about the anus and genital organs, especially when this is-as is most frequently the case-associated with constipated
bowels and piles. I have always employed it in connection with an equal part of the bitartrate of potassa, the precipitated sulphur being preferred. Of this, one to two heaping teaspoonfuls are given at night, stirred up with a teaspoonful or so of water; the addition of a syrup impairs its value. The benefit from this in eczema of the anus I can attest by a not inconsiderable number of cases. I have no suggestion as to the rationale of its action, except that it acts as a liver stimulant; nor have I much experience with it in any other disease of the skin than eczema. I have given it repeatedly when this eruption was situated elsewhere than on the anus; but as many other remedies were used, I cannot be certain as to its effects.
The lowest combination of sulphur with oxygen, sulphurous acid, SO,, is seldom used internally, but will be spoken of later in regard to its external uses.
Sulphide of calcium, CaS, has recently attained a considerable reputation in the treatment of skin lesions attended with suppuration, and to its value I wish to bear strong witness, as I have notes of over one hundred cases in which I have used it. The first suggestion of its use was in acne, and a number of observers have testified to its value in certain cases. I have administered it to sixty-nine patients with acne; sometimes alone, more often, perhaps, combined with local measures; but even then I have been able to test its efficacy, because it was used intermittently, and the changes could be thus readily observed. It certainly will not cure every case of acne, and on many it seems to have little, if any, effect. It is chiefly serviceable in those cases which have considerable of a pustular element, either as the acute small suppurating pimples of youth, or the larger masses of acue indurata; it is of but little service in rosaceous acne.
The somewhat similar affection-hordeolum-finds in the sulphide of calcium its best remedy, and in a number of cases I have seen the styes wither at once under it, and cease to be produced. Of its great value in this lesion, I can bear personal testimony, having taken it myself on a number of occasions, and with almost uniform success. In abscess of the external ear it has been highly praised.
Sulphide of calcium is also of decided value in furunculosis, not only in aborting the boils present or forming, but in checking the suppuration from those which have already discharged; this medicine also I believe remedies the habit or state of the
system, so that, in place of a succession of boils, as expected, a single one or two has completed the attack.
The effect is also striking in anthrax, and I have more than once seen a large mass of inflamed tissue, which would surely have suppurated, subside under its influence; and I have also seen a carbuncle which already exhibited points of pus, end in a marvellously short time by this means. I have given it in twenty cases of biles and carbuncles, generally, if not always, alone. It is also of great service in the boil-like masses-often of some size-which appear on the heads of even very small children during the summer. I could give a number of cases where this process was thus checked almost at once.
True, non-parasitic sycosis has in several instances been greatly benefited by sulphide of calcium internally, in my hands, though it is capable of carrying the case to a certain distance, and no further.
I have also used this remedy in a number of cases of suppurating bubo during the past year, and with striking results. My friend, Dr. Otis, has also recently reported good results in similar cases.
There is not a little difference in the different specimens of the sulphide of calcium, and not infrequently the drug will ap pear inert. When made into fresh pills, they should have a decided odor of sulphuretted hydrogen, and should leave a taste of the same in the mouth; they may also be followed by slight eructations of the same, and the stools should have the same odor.
The dose which I have most usually employed is one-quarter grain, four times daily on an empty stomach. I have generally used the pills, freshly made, with a small amount of the extract of gentian; but the gelatin coated granules are quite reliable. In children, I have commonly given it in suspension in water with a little glycerine, and have found it equally effective; the dose has been smaller, often a tenth of a grain to infants, four or five times daily. I have also given, with good effect, the smaller doses, as one-tenth of a grain, every two or three hours.
Sulphuret of potassa is also given internally, and probably will be found effective in the same conditions as those in which the sulphide of calcium is of service; but of this I have no personal experience.
That it is the sulphur which exercises the beneficial effect in