AGGRAVATION OF DERMATITIS CAUSED BY MIXTURE OF HALOGENS

After two somewhat disastrous experiences when without my knowledge one halogen had been added to another, it seems wise to draw the attention of prac¬ titioners to the possible results of such combinations. The first recognized instance in my practice occurred in 1918, when on November 27 I was asked to attend a woman 68 years old who had scratched the lower part of her leg with a toe-nail. A blister followed, and her family physician applied tincture of iodine. This procedure appeared innocent to me at the time. The lesion developed in intensity and increased in size. At the time of my first examination there was a superficial semigangrenous area, 1 cm. in diameter, with separation of the cutaneous layers and with an angry surrounding erythema. Black lotion and a paste of zinc and peruvian balsam were prescribed. On November 29 the lesion had not increased in diameter but had increased in elevation. It remained greenish and was covered with a glairy fluid. The use of black lotion was continued, and scarlet red was substituted for peruvian balsam in the paste. On November 30 a slight diminution in all the septic characteristics was noted, but a 5 per cent oily solution of dichloramine-T was substituted for the black lotion. On December 3 it was evident something had happened. The ulcer was larger and just as foul, and there was a wide halo of angry infiltration. Enzymol was prescribed for the ulcer, with a return to black lotion and scarlet red paste. Treatment with ichthammol ointment was instituted for the lymphangitis. By December 5 the ulcer had grown in diameter, and the lymphangitis had increased to an even greater extent. Vaccines were administered. On December 11 the ulcer had become decidedly larger, and its foulness had redeveloped. Enzymol was again used. A wash containing iron and potassium tartrate was advised in place of the black lotion, and peruvian balsam was substituted for the scarlet red in the paste. On December 15 the patient volunteered the information that she was a victim of petit mal and under a physician's orders had been taking 90 grains (5.85 Gm.) of sodium bromide daily! In other words, I was dealing originally with a dermatitis medicamentosa (from bromine), to which my predecessor had added iodine, adding "fire to the flames," and in superimposing chlorine (dichlora¬ mine-T) I had poured gasoline on the conflagration ! The physician who recom¬ mended the bromide was asked to substitute solution of potassium arsenite U. S. P., and an ointment containing 1 part fuchsin, 5 parts oil of eucalyptus and 29 parts wool fat was applied to the ulcer. By December 24 everything had changed. The lymphangitis was gone and the ulcer was rapidly healing ! And so ended this chapter of errors. My second experience with this unfortunate admixture of the halogens occurred in 1936.