The dermatitis produced by East Indian satinwood ('chloroxylon swietenia') / by J. Theodore Cash.

  • Cash, John Theodore, 1854-1936.
Date:
1911
Catalogue details

Licence: In copyright

Credit: The dermatitis produced by East Indian satinwood ('chloroxylon swietenia') / by J. Theodore Cash. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    found that a prolonged rest having been permitted, re- application of the alkaloid not only developed its local effect, but that the other arm, to which no recent applica- tion had been made, became hot and irritable at the site of the previous dermatitis. Although relatively strong unguents (1 in 5, 1 in 10 of alkaloid) were used in the experiments detailed, those of much lower alkaloidal proportion, as 1 in 30, 1 in 50, sufficed to cause a return of dermatitis when applied to a previously affected area. Fig. 1 is derived from a photo- graph taken forty-nine hours after the application of 0.05 gram 1 in 30 ointment (=0.0017 gram actual alkaloid) to an area of the forearm which had been unused for nine weeks. The results hitherto recorded deal with slight and moderate types of cliloroxylonine dermatitis in which the condition remains localized to the area of contact and the tissues in close proximity, but it is important to illustrate an observation in which remote effects were undoubtedly J produced. No application had been made to the left arm for thirteen weeks. The skin in the selected area on the flexor surface was unabraded, though somewhat dry and inelastic. Into this area on February 15th, 1911, inunction of 0.05 gram of ointment containing 0.005 gram of clilox-oxylonine hydro- chloride with 0.045 gram paraffinum molle, was made at 4 p.m. Except for a turn of fine linen round the limb, no dressing was applied. Four hours later itching commenced at the seat of contact; at 10.30 p.m. the irritation was intensified, a burning, stinging sensation extending beyond the original area. At 11.30 a few papules were showing on a flushed and raised general surface (enveloped in a light silk handkerchief, fastened with safety pins to the sleeve of the pyjama). Rest was much disturbed, as on five occasions the would-be sleeper was roused by stinging pain, great heat, and almost unbearable itching. February 16tli, 8 a.m. (16 hours): Swelling, with dark flush, papillae prominent; a few papules, no vesicles; condition extends from 2 cm. below flexure of elbow down to the wrist. The arm was purposely used freely during the ensuing day, the discomfort and sensation of heaviness becoming very marked in the afternoon. Twenty-six hours: Swelling and redness now 4 cm. above the elbow on the flexor surface, and thence passing over on to the extensor aspect. There are many papules and oozing points, also formed vesicles, the latter being mainly in lower third of forearm. The limb is brawny, pits on pressure; no pulse can be detected at the wrist. Diameter of limb at marked point 3 cm. above wrist fold is 20.8 cm., or +3 cm. of the normal. Feeling of weight with burning and tension, occasionally lancinating pain and itching. The discomfort of the dependent limb was such that a sling had to be em- ployed. In the evening (twenty-eight hours) swelling of the left upper eyelid was observed, a distinct hard nodule being located towards the inner canthus ; considerable oedema of the lid developed in the course of the evening. Tumefied swellings also developed before bedtime in the helix of the right ear, which became hot and occasionally painful over the mastoid on the left side, also under the right ramus of the lower jaw, the swelling being in the substance of the skin and not in the submaxillary gland. The ensuing night was a time of great