THE 
TREATMENT OF NNEVUS 
BY 
THE INTRA-INJECTION OF ALCOHOL. 
BY 
THOS. H. HOLGATE, M.D., 
Attending Physician for Diseases of Children, Out-Door Department, Bellevue 
Hospital, New York City. 
Read before the Section on Pediatrics of the New York 
Academy of Medicine, April 11, 1889. 
[Reprinted from the Archives of Pediatrics, June, 1889.] THE TREATMENT OF NJVUS BY THE 
INTRA-INJECTION OF ALCOHOL. 
In perusing the literature on the treatment of vascular nsevus 
for the past twenty five years, it will be found that, in order 
to cause a metamorphosis or removal of the vascular structure, 
the treatment has been various, and has, I think, kept pace 
with the advancement of the science of medicine generally, as 
will be observed from the methods of treatment used, which 
will be named in their order as I have gathered them, from 
year to year, from the medical press, beginning with the local 
application of a strong solution of the perchloride of iron. 
The compound tincture of iodine locally applied dissipated two 
cases which were small in size, but it did not succeed in those 
of larger dimensions. 
Dr. Cumming used a plaster of tartar-emetic, one gramme 
to four of galbanum plaster, and succeeded in eight cases. 
Collodion and collodion with corrosive sublimate has been 
used successfully, and others have been destroyed by pencilling 
the surface of the nsevus with creosote. Vaccination on the 
nsevus has been resorted to with varying success. Caustic 
potash and strong nitric acid have been used, but leave a scar, 
which is not unfrequently as unsightly as the growth which 
was sought to be removed. Injection of the perchloride of 
iron into the structure has been successful, but is not without 
danger, as will be observed from the case of nsevus on the nose 
of a child treated by Dr. R. B. Carter in this way in 1865, 
with ten minims of the preparation, resulting in instant death. 
Although usually successful, others have had similar experi- 
ence in its use. 2 
Holgate : Treatment of Nsevus by Intra-Injection, etc. 
The passing of setons through the growth has cured some 
cases, and others have been cured by ligating the tumor be- 
neath pins passed through it. 
Excision has been resorted to, but is objectionable, on 
account of the excessive hemorrhage which occurs and the 
unsightly scar which is not unfrequently left. The double 
ligature has been used, by passing it through the tumor and 
tying it in halves, then surrounding the whole with another 
ligature. Passing needles heated to a blood red through the 
tumor a line apart, has been practised successfully, and the 
actual cautery has removed others. Making an incision into 
the tumor, cutting it out piecemeal with scissors, and con- 
trolling the hemorrhage with pressure, has been successfully 
practised. The passing of sutures soaked in a solution of 
perchloride of iron through the tumor has proved effectual, 
and also the injection into the tumor of a solution of tannin. 
The repeated injection of two minims of carbolic acid has 
cured some, and the electric cautery others. 
The 6craseur applied beneath harelip pins has successfully 
removed some, and painting twice a day with glacial carbolic 
acid with just water enough added to make a solution, or water 
four grammes, glacial carbolic acid thirty-two grammes, has 
proved curative. The elastic ligature applied beneath hare- 
lip pins passed through the tumor has proved effectual in 
removing them; also repeated scarification followed by a 
compress. Forty cases have been reported cured by electro- 
lysis. The passing of a silver wire around the nsevus beneath 
the skin and bringing it out at the point of entrance, then 
tightening the ligature by degrees, has been practised, and 
causes the tumor to subside without a scar. 
Dr. Bligh recommended painting daily with liquor plumbi 
subacetatis, and says it will cure in from one to two years, 
depending upon the size of the nsevus. Dr. Little succeeds 
by making punctures in the nsevus one-sixteenth of an inch 
apart, and Dr. E. Owen and Mr. Coates by injecting the 
tincture of iodine. 
The application of the ethylate of sodium, and also of the 
ethylate of potassium, introduced by Dr. Richardson, either 
of which will prove successful, by acting upon the part as a Holgate : Treatment of Nsevus by Intra-Injection, ete. 
3 
caustic, and is to be applied locally, from time to time, until 
the cure is effected. This, I believe, is the latest, excepting the 
one to be introduced to your notice to-night. 
Mr. George C. consulted me on November 5, 1885, in regard 
to a vascular nsevus on the external and lower aspect of the 
right ala nasi of his son, aged four years, which in size was 
about half that of a filbert, and gave to the child a very un- 
comely appearance. At birth it was a small port-wine mark, 
on a level with the surrounding skin, after which it gradually 
increased in growth to the dimensions named, and became 
pendulous at the lower margin of the ala. It had on several 
occasions bled quite profusely from the pendulous margin, the 
parents having found no little difficulty in arresting the bleed- 
ing. It was soft and compressible, but, on removing the press- 
ure, it immediately resumed its former size. 
On the 17th of November, Mr. C. brought his son to have 
the nsevus removed. It being located in so prominent a posi- 
tion, and not desiring so to operate upon it as to leave a scar, 
being in a difficult position to exert pressure upon the part by 
mechanical means to arrest hemorrhage if the method of scari- 
fication was adopted, I determined to try injecting the nsevus 
subcutaneously with ninety-five per cent, alcohol, and applied 
a clamp—as is used for operations on tumors of the eyelid— 
around it to arrest the circulation, then, with a hypodermic 
syringe needle, passed into it through its centre longitudinally 
near its base, I injected from five to seven minims of recti- 
fied spirit of wine, gradually withdrawing the nozzle or needle 
of the syringe as the injection proceeded, the result being the 
entire solidification of the tumor. 
On the 30th of November the nsevus had become softer 
and considerably shrunken, when I passed the needle of the 
syringe into the upper part of the tumor near its base, and 
again injected alcohol, in order to coagulate the blood in it 
and induce adhesive inflammation in the vessels at the source 
of its supply without again putting on the clamp. The tumor, 
as before, hardened, and the skin for some distance around it 
became pale. No untoward symptoms followed, the skin soon 
resumed its normal appearance, and on seeing it again on 
February 9, 1886, it was found to be reduced to one-eighth of 4 
Holgate : Treatment of Nsevus by Intra-Injection, etc. 
its former size, at which time and on April 21, in the same 
year, it was again injected. The ala nasi is doubtless the 
most difficult part of the surface of the body on which to 
treat a nsevus in this way. On account of the sparseness of 
cellular tissue beneath the skin, the blending of the skin so 
closely with the cartilage, and the part operated upon having 
so nearly resumed its normal condition, it was with difficulty 
that the needle of the syringe could be passed into or beneath 
the skin, consequently the two last operations were not as 
markedly successful as the ones previously, the tissue being 
less redundant and more difficult of penetration; the nsevus 
has been so reduced, and the skin covering it, it will be ob- 
served, has so nearly resumed its normal appearance, that an 
ordinary observer would not readily notice a difference in the 
two alee, unless his attention was specially called to it, and 
that without other treatment, excepting the painting of the 
part, from time to time, with glycerin during the process of 
absorption, and no scar is left, excepting in the part where it 
had previously ruptured spontaneously and bled. 
On December 10, 1886, Mr. P. called my attention to a 
nsevus on the anterior aspect of the chest of his boy babe, 
aged two months, which at birth was little more than a port- 
wine mark, but rapidly developed into a vascular nsevus, in 
dimensions nearly the size of the one last named. I exerted 
pressure around this by encircling it with a ring, in order to 
arrest the circulation to and from the part during the process 
of injecting the alcohol, and but one injection into the nsevus 
was given. I gradually removed the pressure shortly after- 
wards. The injection not only arrested its growth, but caused 
its disappearance as a tumor. At this date, January 20,1889, 
it is level with the surrounding skin, and three-fifths of the 
surface has resumed the normal color of the skin ; the remain- 
ing two-fifths has the usual port-wine color, which the mother 
thinks is gradually disappearing, and the operation has left 
no scar. 
I saw the case again, a few days ago, and found the remain- 
ing telangiectasis slightly increased, having encroached upon 
the part cured, and also upon the skin beyond the growth, as 
will be observed from the stated condition on January 20, and Holgate : Treatment of Nsevus by Intra-Injection, etc. 
5 
its condition now, April 11. The child since the former date 
has had scarlatina in a mild form, which may have had some 
influence in arresting its favorable progress, or the effect of 
the operation may have expended itself. Whatever the cause 
may be, I do not look upon it as lessening the efficacy of this 
method of treatment. The remnant, as I have stated, is a 
mere port-wine mark, and can be removed by further injec- 
tions or by very superficial scarification. I propose, however, 
to recommend the external application of alcohol to it twice a 
day, and, if successful, I will report it in future. 
I present to your notice an instrument having a ring at 
each end,—one six and the other eleven lines in diameter,— 
which an ingenious person can make from an ordinary knit- 
ting-needle, by which all the pressure needed can be exerted 
around a nsevus during the injecting process, and I would rec- 
ommend its use in all feasible cases, as it confines the alcohol 
and prevents it from being diffused for the time being further 
than within its confines, and causes it to have a more powerful 
effect upon the fluids and tissue within its area; and the alco- 
hol, by contracting the vessels beyond the nsevus, more effectu- 
ally prevents any coagula therefrom entering into the general 
circulation. 
In treating nsevus of larger dimensions more than one in- 
jection could be given at the same sitting, or at short intervals 
of time in different parts of it; the absorption in one part 
could be taking place while another part was being prepared, 
bearing in mind the effect of alcohol upon the system. This 
method has the advantage of being easy of application, and 
there are few practitioners who are not possessed of all the 
material needed; if not, it is readily procurable, and with 6 
Holgate : Treatment of Nsevus by Intra-Injection, etc. 
ordinary care it will, I think, not prove dangerous. In stating 
this, I have reference to necessary care being used that the 
syringe is perfectly void of air before injecting the agent. I 
have not tried this in the treatment of goitre, but believe, from 
its effect in these cases, that it may be tried with a reasonable 
hope of success. 
I have no knowledge of the treatment of nsevus by this 
apparently easy and efficient method previous to the eases here 
recorded and presented, and will be pleased to learn the result, 
through the medical press or otherwise, from others when it is 
more generally used. 
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