A Case op Symmetrical Yitiligo.* By A. H. Ohmann-Dumesnil, 
A. M., M. D., of St. Louis, Mo; — ***** ' 
This atrophic disease of the skin, although neither rare nor 
remarkable, except for the great ignorance entertained as to its 
etiology and treatment, offers, from time to time, cases which 
may prove of interest. All the standard works of dermatology 
dismiss the subject in a few words, with tho concluding remarks 
that no treatment has been found efficacious, that the prognosis 
is bad and that it is an incurable disease. 
The following case presented itself for treatment some time 
in 1881 and proved interesting in several particulars. The 
patient, A. F. G-., became the subject of the disease some time 
before seeking advice. About thirty-five years of age, he slated 
himself to be in excellent health, apparently. The white spots, 
two in number, one on each side of the chin, as shown in figure 1, 
Fig. 1. 
Note.—The shading in the lowerpart of the face has been made more pronounced 
for the sake of showing the spots with greater clearness. 
Symmetrical Vitiligo. 
were equidistant from the mesial line. Each spot was round and 
about the size of a silver dime, or a little larger. The skin had 
the peculiar white hue characteristic of the disease, with the 
* Reprinted from, the St. Louis Medical and Surgical Journal, January, 1884. 2 
dark margin, indicative of an excess of pigment cells peripherally. 
The beard growing in the area of these spots was “as white 
as cotton,” as the patient expressed it. They were spreading 
pretty rapidly and began to pi’esent a rather unsightly appear- 
ance, or one likely to attract the attention of individuals in the 
patient’s near vicinity. 
Although the immediate cause of the affection is known to bo 
an absence of pigment cells in the skin, it was supposed that a 
nervous influence might possibly have a part to play in this par- 
ticular case. Among the reasons which might render such a 
supposition probable, was the fact that the two spots were sym- 
metrical. As a rule, vitilig) is bilateral, but it is noD usually 
symmetrical. This symmetry is not only in respect to the situa- 
tion, but also to the size and extent of the spots and even to the 
area encroached upon by their growth. Another reason which 
might be adduced as corroborative, was the shape of the spots. 
All of these reasons seemed to warrant, at least, a supposition 
that the cause might be due to a trophic nerve disturbance, trans- 
lating itself into this affection of the skin ; and the fact that in 
these cases there is sometimes spontaneous recovery or arrest, 
would seem to give some color of probability to such a supposi- 
tion. Duhring inclines to this opinion, or at least that it is due 
to some defect of innervation. This, however, will not be more 
definitely settled until the true anatomy and distribution of the 
nerves of the skin shall have been demonstrated in an unequivo- 
cal manner. 
The treatment suggested consisted of three general methods, 
preference being given to them in the order named. The first 
method was based upon the supposed etiology of the disease and 
from it the best results were to expected. In any case it could 
produce no harm to the skin and consisted in the application of 
the galvanic current, an ascending one being preferred. This 
would stimulate the nerves in a manner not to be equalled by any 
other means and would be unaccompanied by any deleterious 
results. 
The second method proposed was a purely local stimulant to 
act upon the blood-vessels, induce a greater flow of blood and by 
that means endeavor to bring about a deposit of pigment-cells ; 
the flow, at the same time, decreasing the number existing at the 
periphery. For this purpose the acetum cantharidis was given 
the first place as a remedy. 3 
The third and last method was recommended as a dernier 
resort and purely as a cosmetic agent. This consisted in using a 
burning glass and endeavoring to tan the spots so as to acquire 
the same color as the normal skin possessed. A simple manner 
of accomplishing the same result is to dye the spot with an infu- 
sion of the “shuck” of the walnut, butternut or hickory nut. 
The patient lived at a distance and full opportunities of 
watching the case closely and of observing changes, were want- 
ing. However, he promised to carry out one of the first two 
methods faithfully and report what progress was made, if any ; 
and being a medical gentleman, his statements could be relied 
upon. He chose the application of acetum cantharidis as being 
the easiest of application and the more accessible method. 
He was told to hope but little, as the disease is considered 
ordinarily incurable, and that the spontaneous cures are very 
rare. Also that although the spots might not entirely disappear, 
an arrest of the process could take place. 
The last letter he wrote was in JSTov., 1883,and in it he stated 
that he was greatly improved. The spot on the right side is 
scarcely noticeable and the one on the left has oases of colored 
hairs which greatly obscure it. He adds by way of apology: 
“I have been negligent in treatment for some time, which you 
know is the lamentable obstacle in the treatment of chronic 
diseases.” 
The questions which naturally arise, are whether this ameli- 
oration is spontaneous or not; and, if due to the agent employed, 
would a persistence in its use eventually lead to a cure, or com- 
plete arrest in the process ? They can hardly be answered at 
present and indefinitely until investigations in the etiology of 
this disease and in the innervation of the skin, have arrived to 
such a state of perfection as to be demonstrable facts. The case 
was deemed worthy of presentation on account of its seeming 
not quite so obscure as the generality observed in respect to its 
etiology, and the partially successful result in its treatment. 
521 Walnut St.