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THE DUBLIN QUARTERLY JOURNAL OF MEDICAL SCIENCE. MAY 1, 1858. PART I. ORIGINAL COMMUNICATIONS. ART. IX . -- On a peculiar Discoloration .~ the ~S~kin in Females. By J. T. BANXS, M. D. T. C. D., King's Professor of Phy- sic ; Physician to the Whitworth and Hardwicke Hospitals, and to the Richmond Lunatic Asylum, &c. &c. MY attention having been for some time directed to the con- sideration of the subject of the discoloration of the skin in females, from the fact of my having hnder my care, in the Richmond Asylum, a young woman who presents this remark- able phenomenon, and being aware of the paucity of reported cases in which this strange appearance has been observed, it occurs to me that it may be of sufficient interest to place it on record, and, even if nothing more be gained, to add one more observation to those already existing in the annals of medicine. Before gi.ving an account of my own case, I propose to lay before the reader a brief historical sketch of the observations previously published, and, subsequently reviewing all that has been noticed in connexion with the phenomenon, we shall be in a position to show a certain amount of resemblance, at least so far as some associated symptoms are concerned. The nineteenth volume of this periodical contains a me- moir on " A peculiar black Discoloration of the Skin of the VOL. XXV. NO. ~o, N.s. S 258 Da. BA~s on a peculiar Discoloration Face," by the learned Editor, from which, although familiar to many, it will be necessary for me to refer in order to ~ive a complete idea of the actual state of knowledge of the subject at present within our reach. Since the publication of Dr. J. Moore Neligan's paper, Dr. Leroy de Mermourt has contributed five cases which have come under his immediate notice, and he has, moreover, made some highly interesting remarks derived from the observation of this phenomenon. The first account of discoloration of the face in a female, and by far the most remarkable, is to be found in the Philoso- phical Transactions for 1709, in a letter from Mr. James Yonge to Dr. Hans Sloane, Secretary of the Royal Society. her cheeks, which bleeding and a purge or two cured. She continued very well till about a month aherwards, when her face, so far as is..... usually covered with a vizard mask, suddenly turned black,, hke that of a IVeg~'o. This surpnzmg ace:dent much amaz d and frlghtened'the girl, especially after some foolish people persuaded her she was bewitched, and never to be cured: by prayers, exorcisms, they endeavoured to relieve and take off the fascination, which, proving ineffectual, the pas- sion and terror of mind increased to a great degree, even to distraction, and then they demanded my assistance." Mr. Yonge then proceeds to say :--" I directed a lotion for the face, which took off the diseolouration, but it returned frequently, but with no reg.ularity, sometimes twice or thrice in twenty-four hours, somet:mes five ~or six times. It appears insensibly to the glrl, without pain, sickness, or any symptoms of its approach, except a little warm flushing just before it appears. It easily comes away, and leaves the skin clear and white, but smuts the cloth that wipes it from the face ; it feels unehious, and seems like grease and soot or blacking mixt. It hath no tast at all, which is to me rather strange that a fuliginous exudation should be insipid. She never had the vnenses; is thin, but healthful; the blackness appears no- where but in the prominent part of her face. There are a thou- sand eye-witnesses to the truth, of this wonder, but I am not able to find or conjecture the cause of it, nor have I ever heard of the like. I shall be glad to know your opinion, and ready to make such further enquiries as you shall please to send, in order to discover the cause of this dark and strange pheno- ~nSn0n." of the Skin in Females. 259 In a second letter Mr. Yonge says :-- " The anomalar blackness of" the girl's face, of which I sent the history, is now divided into a few dark, clowdy specks, which appear but seldom, and nothing so livid as formerly." More than a century elapsed before we find another ex- ample on record of this rare affection. The next notice of this change of colour of the skin to be found in the annals of medical literature occurs in the " Ar- chives G~n~rales de M~deeine," 1831, in which Dr. Billard describes the affection under the name of " Cyanopathie Cu- tan6e." A girl, aged 16, residing at Corz~, presented on the face, the neck, and the superior part of' the chest~ a beautiful bhm " coloration,' extended chiefly on the forehead, the aloe nasi, and around the mouth. When the face was rubbed with a white cloth, it became stained with the colouring matter, leaving.... the skin of its natural hue; her lips were ruddy,- "l'embonpomt assez prononce ;' the pulse regular; and the appetite as in health. ^ The only morbid symptom was a dry cough, but without tale or dulness, and without aberration from the regular type of the heart's action. This girl had men- struated for two years, and there had been no deficiency. At this epoch she perceived that there was a blueness around her eyes, but exposure to the air sufficed for its removal. The hhPhenomenon reappeared when she worked in a confined and ot place; at the end of the year the whole forehead, and in- deed the whole face, had become blue, so that the attention of persons who met her was attracted. The catamenia were more abundant, and at the same time there were some sputa of blood, and subsequently hematemesis, but nevertheless, the regularity of the menstrual function was undisturbed. After the use of sulphur and decoction of sarsaparilla, an abundant sweat was observed, and contemporaneously there was a sen- sible diminution of the urine, and a considerable increase of the blue colour. The forehead, face, neck, chest, and abdo- men, presented shades of azure blue, the intensity of which, or their becoming pale, being influenced by the acceleration or retardation of the subcutaneous circulation. The linen of the patient was stained with blue. The sclerotic, the nails, the skin of the scalp, and the concha of the ear retained their usual colour; the buccal mucous membrane was of a pale blue; the tongue was almost always coated; but there was no febrile commotion in the system. Fifteen (lays later there was complete suppression of urine~ which continued for three days ~ the co- s2 260 Da. BAI~KS on a peculiar Discoloration lourlng matter became more abundant, and each night there was copious perspiration. The blue matter having been subjected to the action of reagents, and Dr. Billard, finding that of all those employed, and which were .f~ capable, of neutralizing the eolour, water rendered shghtly alkahne was the most innocent, bi- carbonate of soda was administered to the patient. After twelve days the skin of the body and extremities became quite white ; on the fbrehead, around the eyes, and on the nostrils, a blue tinge remained. The general state of the health was improved, still there existed a dry cough, and, from time to time, some hemoptysis, particularly at the approach of the catamenia. Whenever the girl was exposed to much heat, or when she experienced any disagreeable impression, she became more blue than when in a state of tranquillity. Near each menstrual ~period she felt a sensation of suffocation, palpitations of the neart occurred, and the cough became more severe; she spat and vomited black blood with effort, as in hematemesis. ~ hen the catamenial period had passed, and that she had vomited and expectorated a certain quantity of blood, she be- came pale, less oppressed in her breathing, and the blue colour almost entirely disappeared. On one occasion when this g{rl vomited blood, a quantity of the blue matter was deposited at the bottom of the vessel sufficient to stain it, but the colouring material was not collected. At the time Dr. Billard drew up his observations on this case, the patient was in a most satisfactory condition : the face was but slightly coloured, and the body and limbs did not re- tain a trace; the forehead and cheeks, however, became blue whenever she was fatigued, agitated, or thwarted. The colora- tion still became more vivid by heat, its intensity being always in proportion to the increase of" transpiration. As for the circulation, the pulse was small and regular ; palpitation occurred when she walked quickly, or was agitated ; the urine was abundant ; and the dry cough continued. Still there was no loss of flesh, nor was there any diminution of the appetite or strength. Finally, whether from the effect of treatment, or from a simple coincidence, there was evidently a decided improvement. The next observation upon this strange discoloration of the skin was published by Mr. Teevan, in the twenty-eighth volume of the " Medico-Chirurgical Transactions of London' (1845). The subject of Mr. Teevan's observations was a girl aged 15, who was seized with t~equently recurring headach of the Skin in Females. 261 and pain in the chest, the menstrual secretion being at the same time scanty. All treatment employed with a view to relieve these symptoms was unavailing. About three weeks afterwards a brown spot was.

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