On the Application of Gutta Percha in the Treatment of Diseases of
the Skin. By Robert I. Graves, M. D., F. R. S.—Dr. Graves
directs the attention of practitioners, in the treatment of certain forms
of cutaneous disorder, to the necessity of protecting the abraded and
tender surface of the skin, the cutis vera, from the contact and action of
the air and other hurtful agents. The effect of blood coagulating over
a cut or abraded surface is known to be beneficial, and not less ser-
viceable arc those secretions which are furnished by surfaces abraded
and in a state of inflammation. The premature and forcible removal of
all these discharges, which are to be regarded as natural coverings, is
always injurious, and tends to continue inflammation and irritation, and
consequently to defer healing and protract the disease.
Dr. Graves thinks that artificial substitutes for these secreted coverings,
or artificial coverings over them, may be useful in effecting the healing
of extensively abraded surfaces in cutaneous disorders. Of this nature
are solutions of collodion, which have been in occasional use for some
time; and more recently solutions of gutta percha in chloroform have
been employed with similar beneficial results.
It is well known that there are certain obstinate forms of cutaneous
disorder, in which, whether from the nature of the disorder, or the ex-
tent of skin abraded, denuded, and irritated, it is often difficult to effect
either cure or alleviation. Such are some forms of psoriasis, eczema,
impetigo, and leprosy. In treating affections of this kind, a covering
of gutta percha seemed to Dr. Graves well calculated to protect the
tender surface, and thereby to promote the healing process. After
various trials with this agent, the results have been such, that Dr.
Graves conceives that they ought to be well known. The therapeutic
application of gutta percha is mentioned by Dr. Neligan in his recent
work. But it may be useful here to give some notice of the method
from the account by Dr. Graves himself.
When the saturated solution of gutta percha in chloroform is spread
by means of a camel’s hair pencil over a portion of the skin, the solvent
fluid rapidly evaporates, leaving a delicate and extremely thin pellicle of
gutta percha firmly adhering to the part. The peculiar toughness of
gutta percha prevents this pellicle from being brittle, and therefore it is
much less liable than collodion to crack and fall off in small scales. On
the forehead or face, where it is not affected by friction of the clothes, it
remains firmly attached for five or six days, or even longer; but on other
portions of the surface it is often rubbed off much sooner. Over dry
eruptions of the skin it lasts longer than over those which are moist, and
over smooth and firm spots, of course, longer than over those covered with
rough morbid scales or loosely adhering crusts. Before the application of
this solution, therefore, the practitioner will do well to render the por-
tions of the cutaneous disease to which he intends to apply it, as free as
psssible from crusts or scales, by means of poultices, alkaline lotions, &c.
When the precaution is taken, he will find that the artificial cuticle
which he has applied with his brush will in certain cases act most sen-
sibly on the subjacent disease, diminishing inflammation and its conse-
quences, and powerfully contributing to the restoration of the healthy
structure of the skin.
Whether it acts by the equable pressure which the film of gutta percha,
suddenly coagulated from the fluid state, must exert on the surface to
which it becomes so firmly adherent, or whether its efficacy be rather
owing to other causes, it is beside the object of Dr. Graves in writing
this notice to discuss. He remarks, however, that the curative proper-
ties of such an artificial covering are not confined to the skin; for, in
the “ Gazette Medicale de Paris ” (April 10, 1852), is an account of
the successful application, by M. Dechange, of collodion in orchitis ; and
the modus operandi is said by him to consist in its compressing the
tissues, and protecting the parts from the action of the air, which he
thinks is a powerful element of phlegmasia. Without giving an un-
qualified assent to this explanation, Dr. Graves has no hesitation in an-
nouncing his firm conviction, that, in diseases of the skin, this solution
furnishes us with a new and active remedy, exerting effects quite different
from those produced by any topical application hitherto in use.
The transparency of this artificial membrane enables the surgeon to
watch the progress of the subjacent diseased skin, and its colorless na-
ture prevents it from disfiguring the face when the eruption occupies
that part. Its perfect cleanliness, too, is no small advantage, and
affords a very agreeable contrast when compared with the usual oint-
ments, &c.
The observations of Dr. Graves confirm what reasoning on this subject
would lead us to expect, that this application is more suited for dry,
scaly, tubercular, and chronic diseases of the skin than for acute affec-
tions attended with much oozing of fluid and comparatively active in-
flammation.
Still, its good effects are by no means limited to chronic diseases of
the skin, ot those of a scaly, dry nature; for, as will hereafter appear,
Dr. Graves has seen it decidedly useful in the spreading form of im-
petigo. His experience of this remedy makes him anxious to witness
its application in the first stages of erysipelas, as analogy leads him to
hope for good results in such cases.
Of course the patient must aid the efforts of the physician, and must,
as far as possible, abstain from every thing which tends to rub off or
injure the artificial cuticle; for its virtue ceases when its continuity
is broken and the external air finds admission to any part of the diseased
surface.
Early in the month of November, 1851, Dr. Graves was called to visit
Mrs. C., from---------. She was about fifty years old, full and plethoric;
the mother of a large family, and, until the disease of which she then
complained, commenced, generally healthy. About two years before,
she observed small spots of impetigo on her limbs and body, which suc-
ceeded each other, some healing while fresh ones appeared. During
summer she was nearly free from them, but last autumn they returned
with greater virulence than ever, and have since increased both in size
and numbers, some being larger than the hand, and attended with con-
stant oozing of fluid, which imperfectly coagulates, forming loose and
thin crusts. The itching at night was intolerable, and nearly deprived
her altogether of sleep. Dr. Graves employed the usual general and
topical treatment for a fortnight without alleviation of her sufferings,
when he thought of trying the saturated solution of gutta percha in
chloroform, and had it carefully applied by Mr. Nicholls of Dawson
Street, at first by way of trial, to one of the smaller spots, and on the
following days to each of the larger patches of eruption in succession.
The relief obtained was such that it appeared almost incredible, both to
the patient and her family. Her cure was accomplished in less than
three weeks; for, dreading the sudden stopping of so great a discharge
and so much cutaneous irritation, he proceeded cautiously, and towards
the end of the cure, when she returned home, he directed an issue to be
inserted in her arm, as a measure of precaution. She has continued well
up to the present time (11th April, 1852).
In this patient the attendants were at first obliged to re-apply the
gutta percha every second day, as it was rapidly detached and broken up
into large flakes by the discharge from the subjacent surface. Its
healing influence, however, speedily diminished the diseased secretion,
and then, the artificial cuticle remained longer adherent, and it was not
necessary so often to use the scissors for the purpose of cutting off the
loose portions of gutta percha membrane previously to applying a fresh
layer. The camel’s hair brush should be plunged, the moment it has
been used, into hot water, to prevent it from being consolidated by the
coagulated gutta percha.
This case caused a great sensation among the patient’s friends and re-
latives, and many were the inquiries made relative to the method of cure
employed. Dr. Graves confesses that his own astonishment at the result
was not less than theirs.
Since that time Dr. Graves has repeatedly used this application in
acne of the face, in which disease each of the pimples should be covered
with the solution, and the patient enjoined not to rub off the pellicle by
washing, &c.
In some this treatment alone causes a material and rapid diminution
of this tormenting eruption, and by perseverance in this plan, there is
every appearance in two of his patients that the tendency to throw out
the pimples is gradually ceasing.
Finally, in several cases of psoriasis Dr. Graves applied this solution
with great benefit. In this disease much care must be taken to prevent
the application being rubbed off by the clothes, and no woolen stockings
or rough garment of any sort should be allowed next the skin. I had
the satisfaction of curing in a fortuigbt a chronic psoriasis of the back
of the hands and arms in a lady who had been under homoeopathic treat-
ment for six months without deriving the least advantage from the infi-
nitesimal doses prescribed by the practitioner.
Since the preceding observations were written, Dr. Graves received
the following note from Mr. Moore. The additional information con-
cerning the effects produced by the application of collodion strongly
verifies the observations respecting the local antiphlogistic action of a
gutta percha pellicle:
tl M. La Tour has for some time advocated the doctrine that external
inflammation may be speedily subdued by withdrawing the affected sur-
face from the influence of the air. This he effects simply by a layer of
collodion, which, he says, rapidly assuages the inflammation of gout and
articular rheumatism. At the meeting of the Academy of Medicine, on
the 8th of February, M. La Tour related a case of peritonitis in which
the symptoms were dissipated within twenty-four hours, by the applica-
tion of a layer of collodion to the whole surface of the abdomen.”
Postscript, June 1, 1852.
My anticipation respecting the utility of an artificial cuticle applied
over the parts affected by commencing erysipelas, has, I find, been veri-
fied, as appears from the following paragraph taken from Dr. Neligan’s
able Treatise on Diseases of the skin :
11 Acting as an impermeable varnish, and probably producing some
effect, also, by the compression it causes, collodion has been successfully
employed by Spengler and Rapp, as a local application in erysipelas.
The parts are thickly coated with it by means of a camel’s hair pencil
and it is renewed as often as may be required in consequence of its
cracking and peeling off when dry.”
When Dr. Stokes heard of the success of Dr. Graves in other cases, he
resolved to try the gutta percha solution in small-pox, and the result of
two trials is most encouraging, and leads to the hope that at length a
means of preventing the formation of disfiguring scars on the face in
that disease has been discovered. Dr. Stokes has allowed Dr. Graves
to publish the two following cases treated by him at the Meath Hospital,
and noted by this clinical clerk, Mr. Robert P. White.
Anne Kenny, aged eighteen, was admitted into the Meath Hospital,
11th May, 1852. She was never vaccinated; her illness began on the
6th of May by rigors, headache, and pain in her loins, but without any
vomiting. On the 8th, the eruption appeared, and on coming into
hospital, the eruption was well formed and confluent on her face; the
fever of a typhoid character, with considerable prostration of strength;
she was much annoyed with pain and itching of her face. She was or-
dered wine and carbonate of ammonia mixture, and her face to be painted
with a solution of gutta percha in chloroform.
The solution was applied with a soft brush; the entire face being well
coated with it, and after an interval of a few minutes (just sufficient to
allow the previous coating to dry), a second coat of the solution was ap-
plied.
This application, she said, gave her great relief, and allayed the pain
and itching. On the 13th she was much better, and the solution was
again applied in the same manner.
22d May. She has proceeded most favorably; all the crusts have
come off the face in large pieces, and there is hardly any trace of the
disease remaining except a slight discoloration. During the whole time
of her illness, from the application of the solution, her face continued
moist, and there was no ulceration in any place.
Catherine Sherlock, aged twelve, was admitted 13th May (seventh
day of eruption). Her illness commenced by headache, pain in her
loins, and rigors, but without sickness of the stomach; she was never
vaccinated. On admission she had a good deal of fever of a typhoid
type; the eruption had come out well, was confluent, and had com-
pletely covered her face; she complained very much of pain and itching
of her face and head, which kept her from sleeping. The solution of
gutta percha was applied as in the former case, and apparently gave
her much relief, for she was easier afterwards, and ceased rubbing and
tearing her face in the manner in which she had been doing before.
Wine was also freely used as in Kenny’s case.
22d May. All trace of the disease has nearly gone, the crusts coming
off in large pieces, and the remaining marks of the disease being very
trifling when compared with the violence of the attack.
The same effect of the solution in keeping the face moist was also ob-
served in this case as in the preceding.
In communicating these cases, Dr. Stokes observed, as worthy of
notice, and probably connected with the beneficial result produced, that
the most remarkable effect of the gutta percha was to keep the face con-
stantly moist, and to prevent the formation of hard and irritating crusts.
He also mentioned a singular illustration of the effects of total exclusion
of air from the cutaneous surface as a preventive of the eruption in
small-pox. It was that of a man who, while in the Meath Hospital for
a scrofulous enlargement of the knee-joint, was attacked with this dis-
ease; the knee had been previously tightly strapped with adhesive plaster,
and on the disappearance of the eruption, it was seen, on removing the
strapping, that not a single pustule had been developed on the parts
which were thus covered.
It is scarcely necessary to add, that however useful solution of gutta
percha in chloroform, or any other topical applications, may prove, it
would be, nevertheless, absurd to expect from them a radical cure of
those chronic cutaneous affections which arise from constitutional causes,
whether strumous, syphilitic, or cancroid. As well might we look for
the cure of scarlet fever, smallpox, or measles, by means of remedies
applied to the skin solely with the view of relieving the eruption. Still,
in every chronic disease, it is manifestly desirable to diminish, by topical
means, the annoyance or disfigurement arising from the cutaneous affec-
tion. This relief cannot but be serviceable if it did nothing else than
afford time for the due and gradual employment of a well-directed con-
stitutional treatment. Dr. Graves saw this lately well exemplified in
the case of a young lady who had been under the care of an eminent
London surgeon for many months, and from whose medicines she had
derived no relief. She was the subject of a most disfiguring eruption,
agreeing in character with the lupus supiginosus of late writers; it occu-
pied sparsely the nostrils and cheeks, but on the forehead it formed an
extensive group of sores. Some spots it left hypertrophied after healing,
but in general its course was marked by white depressed seams. It had
been the seat of constant irritation, which the patient could not avoid
increasing by scratching during sleep, and consequently the surface of
the face usually exhibited a number of bloody points, adding to its
disagreeable appearance. The entire eruption healed after a six weeks'
application of the gutta percha, and she is now (what she had not been
for two years) free from any cutaneous irritation. Time alone can de-
termine whether relief will be permanent; but there can be no doubt of
the great value of the advantage already gained.
Dr. Graves observes that, in psoriasis and other chronic cutaneous
complaints unattended with any constitutional derangement, it is of the
greatest consequence to check the growth of each new spot. This the
gutta percha does most effectually in psoriasis, and when applied daily to
any recent points of irritation, it smothers, as it were, each nascent
jentre of future blotches.—Dub. Quart. Journ.