CURATIVE MEDICINE.

PART X.

SKIN DISEASES.

This class of affections embraces diseases of the skin, hair and nails, and therefore includes maladies which occasion much distress and deformity, but are seldom dangerous to life.

Classes of Skin Diseases.—Skin diseases are easily recognized, but there is sometimes difficulty in distinguishing between the different forms. They divide themselves thus:

1. Those of an eruptive (erythematous) character.

2. The catarrhal, in which the conditions resemble those belonging to inflammation of the mucous membrane.

3. The vesicular, which is composed of small blisters.

4. The pustular, made up of pustules or small boils, containing pus or matter.

5. The papular, in which pimples appear, containing neither water nor pus.

6. The scaly eruptions in which the affected parts are covered with dry, whitish layers of epithelial cells.

7. Skin diseases caused by animal or vegetable parasites, of which the itch is a remarkable illustration.

SKIN REDNESS (Erythema).

Symptoms.—Erythema is the name applied to the redness due to a superficial inflammation of the skin. It is the mildest form of skin disease, and is apt to affect fat people in hot weather. Infants are liable to be affected with it behind the joints.

Treatment.—See Nettle Rash

NETTLE RASH (Urticaria).

Symptoms.—This is an eruptive affection which sometimes comes out quite suddenly, and is attended with a most troublesome itching. It is

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THE SKIN.

    a. Epidermis or cuticle.         d. Blood-vessels.
    b. Dermis or true skin.          e. Oil cells.
    c. Nerve prologations.           f. Glands.

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        ECZEMA.                            ECZEMA.
       Scaly form.               First Stage of Simple Eruption.

characterized by the formation of "wheals" or rounded patches of elevated skin, whiter than the surrounding parts, which are slightly reddened at the margins.

Causes.—It may arise from the bites or stings of insects; from the eating of certain fish, especially shellfish; or from reflex irritation, and other causes.

Treatment.—It is greatly aggravated by scratching, and, like simple erythema, is relieved by dusting with finely-powdered oxide of zinc and starch, with lycopodium, or even with rye flour. Lotions of lead water, benzoic acid and borax are also sometimes useful. If fish or other unwholesome food is the cause of the trouble, it must be got rid of by emetics and purgatives, and other causes of irritation should be sought out and corrected likewise

MOIST TETTER OR ECZEMA.

Symptoms.—Eczema, sometimes called moist tetter, is a catarrhal inflammation of the skin usually attended with a breach of surface. It presents at first irritable, raw, red patches, with occasional little blisters which soon break and a fluid is discharged, which in drying forms crusts or scabs. Later on the patches become dry, scaly, and often cracked. This is a form of skin disease which is often seen in young infants, in whom it sometimes receives the name of milk-crust. The pain, burning and itching of eczema are intense, and yet it is only aggravated by scratching. It is especially apt to appear about the flexures of the joints, as, for example, in the hollows of the elbows and knees.

Remedies.—At first soothing lotions, such as lead water, and zinc, or camphor in fine powder with starch, do the most good, but later, ointments of the ammoniated mercury, or very dilute ointment of the red oxide of mercury, of, for example, ten grains of the oxide to an ounce of lard, are useful, and still later, when the skin is dry, itching and scaly, tar ointment may be resorted to. When of gouty origin eczema is apt to be benefited by the internal use of colchicum, and the other varieties often yield readily to arsenic, which may be given in the form of five drops thrice daily of Fowler's solution after the first acute stage has passed.

SHINGLES OR HERPES.

Symptoms.—Herpes, which is a good type of the vesicular affections of the skin, is characterized by little blisters which come out in small groups, and when appearing about the mouth and nose, constitute the cold-sores with which almost every one is familiar.

Shingles Proper.—A severe form called herpes zoster, or the "shingles," comes on with smarting and burning pain in a belt half way around the body of large patches of the eruption. It is distressing and tedious, often lasting a month or six weeks, but rarely dangerous. The popular idea that it will prove fatal if it goes all around the body is without foundation.

Treatment.—The only treatment is to apply anodynes and soothing lotions, such as the morphia and lead water recommended in erysipelas, and administer opiates to relieve the pain.

PEMPHIGUS.

Character.—pemphigus is another vesicular eruption, characterized by the formation of large blisters, from half an inch to two inches in diameter, resting on slightly reddened surfaces, and mostly attended with severe itching. These blisters sometimes appear on the fingers, but commonly attack the lower limbs. They generally indicate a more or less impoverished state of the system, in which iron, quinine, strychnine and good nutritious food are called for.

Remedy.—Arsenic is also very useful, and locally soothing ointments or absorbent powders may be employed.

PUSTULAR ERUPTION (Impetigo).

Character.—Impetigo is the most common of the pustular eruptions, and is characterized by the formation of separate pustules, somewhat like those of small-pox. They may attack any part of the body, but are most apt to appear upon the face and limbs. This disease, like ecthyma, which in many respects it resembles, seems as if it were an aggravated form of impetigo, and is especially frequent among children, although adults are not exempt. Ecthyma is always associated with general debility, defective nutrition, or hygienic neglect.

Remedies.—The treatment is by good food, tonics, with cod-liver oil, and strict attention to cleanliness. Soothing applications, such as Goulard's cerate, should be made first to the pustules, but later on a very mild mercurial ointment is more effectual.

BOILS.

Causes.—Boils, those common and exceedingly troublesome inflictions upon mankind, are classed under the head of pustules. With all the advances we have made of late years in pathology, the cause of boils still remains undiscovered. Sometimes they seem to be due to high living, and in other cases poor diet appears to determine the advent of a troublesome series of these parts. One boil is very apt to precede a crop of fifteen or twenty, although there is no certainty that this will be the result.

Treatment.—1. The best way of managing a boil is to poultice it with flaxseed or bread and milk, containing laudanum to ease the pain. If the boil is small, the poultice may be spread upon a piece of oiled silk, which prevents it from becoming dry, and held in place by a bandage, or by a square piece of linen upon each corner of which has been daubed a little spot of adhesive plaster, the stick of plaster being melted in the flame of a candle for the purpose. This holds a dressing of any kind on a broad, flat surface of the body, as, for instance, the skin of the back, very satisfactorily.

2. When the boil softens in the centre, and the fluctuation of matter can be detected, or its yellowish color can be seen under the skin, some twenty-four hours of suffering may be saved by having it lanced, and the pain of the cut may be abolished by freezing the surface with ether spray, or by stroking it with a little bag containing a mixture of ice and salt. In certain cases it is important to lance a boil early, so as to prevent the burrowing of the pus toward some important structure; but ordinarily, if the sufferer dreads the knife, there is no actual necessity for using it, and the boil may safely be left to break of its own accord, under the poultice, one, two or three days later than the time when it is ripe for lancing.

3. Lancing the little pimple, with which a boil first commences, exactly through the middle, which can be done almost painlessly under the ether spray, will nearly always cut short this troublesome affection. Ten or twelve grains of quinine daily, so as to produce slight cinchonism for a week, occasionally breaks up a course of boils, but is by no means an infallible remedy.

CARBUNCLES.

Character.—Carbuncles chiefly differ from boils in the larger area involved in the inflammation, from which a core of dead connective tissue, called a "slough," several inches in diameter, may come away. Carbuncles are apt to come on the nape of the neck, and on the back, but may appear on any part of the body. A large carbuncle will sometimes keep a patient in bed for a month or six weeks, and the pain and exhausting discharge wears out the strength so much that it may cause death; if a second of large size appears, after the first begins to heal, as it is not very unusual, it quite frequently proves fatal.

Treatment.—Poultices of flaxseed meal, bread and milk, powdered slippery elm bark, or of yeast; anodynes to relieve pain; and six grains of quinine daily, with other tonics to support the strength, constitute the appropriate treatment. Early and free incisions into the inflamed tissue, made after freezing the part, are probably of great service.

PIMPLES.

The papules or pimples are solid elevations of the skin, containing neither water like the vesicles, nor pus like the pustules. They are three in number, including strophulus, the red gum or tooth-rash peculiar to infants, lichen or prickly heat, and prurigo.

Strophulus.—This consists of an eruption of innumerable small, reddish pimples, which occur for the most part on the face, neck and arms of young children. The irritation and general disturbance is slight. The eruption is usually caused by digestive derangement of some kind, as, for instance, that of cutting a tooth, and passes away with the cessation of its cause.

Treatment.—The only treatment necessary is some mild, saline laxative, and a lotion of very weak solution of carbonate of soda, five or ten grains to the ounce, with a teaspoonful of glycerine, to allay the itching if that appears to be very troublesome.

Prickly Heat or Lichen.—This is very common in hot weather, in the simple form of reddish pimples, which itch a great deal but usually subside on the approach of the cooler season. It sometimes takes on a severe form, and may even become chronic.

Treatment.—In mild cases tepid baths, plain and easily digested food, an occasional saline laxative, with a tablespoonful of infusion of gentian, and five grains of bicarbonate of potash or soda internally, three times daily, will effect a cure. To relieve the itching, solutions of borax, vinegar or carbolic acid may be used with advantage. In aggravated cases the more powerful tonics, with tablespoonful doses of cod-liver oil and one-sixteenth of a grain of arsenic three times a day must be resorted to.

Prurigo Symptoms.—This is characterized by an eruption of pale, slightly elevated pimples, mostly situated on the trunk of the body, and attended with very intense irritation, especially at night, so that the marks made by the patient's nails in scratching can almost always be seen, and aid in recognizing the malady. It is frequently the result of the presence of the vermin with which so many dirty people are infested.

Remedies.—Cleanliness, by the aid of strong alkaline baths, and the use of an ointment of carbolic acid, or of white precipitate, with the administration of tonics and good food will generally effect a cure. Sometimes, however, the disease, unless it is carefully treated early, proves very obstinate, being kept up in great measure by the constant scratching, which it is very difficult for the patient to abstain from.

TETTER (Psoriasis).

Character.—Psoriasis is the most important scaly eruption; in certain of its varieties it probably constituted one form of the leprosy of the Bible. It is characterized by the appearance, at first, of oval or rounded patches of slight irritation, then upon these an eruption of scales, which grow dense and white toward the centre. Afterward the spot expands from its outer edge, where the skin is often reddened and slightly raised above the level of the surrounding surface. This is the skin disease to which the name of "dry tetter" is commonly applied. In the worst or inveterate form, the whole body may be covered with these white scales, except the face, the palms of the hands and the soles of the feet. Even these do not always escape. The incrustation of scales in this variety of psoriasis is thick and dense. When it has lasted for some time the skin chaps and breaks, after which there is severe soreness with exudation of fluid from the broken surface, intense irritation and itching, with great general and physical exhaustion, lasting for many weeks, or perhaps months. In rare cases it may even prove fatal. In the milder form, It is especially apt to appear very symmetrically upon the knees and elbows, and is most common between the fifteenth and twenty-fifth year of life. It is prone to recur in a patient who has once manifested it, but is not contagious. Often it is hereditary, and may be associated with a gouty or rheumatic taint in the system.

Treatment.—The treatment consists of careful attention to diet, avoidance of alcoholic stimulants, and the administration of arsenic in the form of Fowler's solution, five drops thrice daily. Externally soothing lotions or ointments are required in the first stage, and mild mercurial or tar ointments are of service after it has become chronic.

SCALP DISEASE (Pityriasis).

Character.—Pityriasis is a squamous disease especially apt to affect the scalp when it appears in the milder form, giving rise to the shedding of an immense number of bran-like scales, resembling an exuberant crop of dandruff.

Treatment.—Frequent washing, with the use of a borax lotion, or white precipitate and tar ointments, will generally remedy the trouble. A rare variety of pityriasis, affecting the whole body and generally proving fatal when in the chronic form, is also described.

The skin diseases dependent upon syphilis have already been detailed, and those of scrofula are chiefly of the types above mentioned, aggravated by the taint existing in the system.

WARTS, CORNS AND BUNIONS.

Hypertrophies of the skin are all unusual diseases, except warts and corns, which are common enough to make up for all the rest. The coming and going of warts on the hands is as much a mystery now as in former ages, when the most ridiculous remedies were gravely prescribed.

Wart Remedy.—Warts can be destroyed by caustics, of which nitric acid is the most severe and effectual, and chromic acid perhaps the least painful. When arising from the poison of syphilis, they are sometimes extremely sore and troublesome, so much so as to require removal by surgical operation.

Causes and Treatment of Corns.—Corns are similar to warts in their structure, except that they have a much thicker layer of epidermis over their surface. They are almost always produced by the pressure of tight shoes, and may be avoided by caution in this respect. They can usually be prevented from giving much trouble by carefully trimming out the centre of the corn at short intervals, or by wearing one of the various forms of perforated corn-plasters in common use. In cutting corn, the incision should never go through the epidermis, so as to cause bleeding, since dangerous inflammation has thereby been set up. Often filing a groove across the top of the corn with a coarse, half-round file, answers every purpose, and is not attended with any risk.

Bunion Treatments.—A bunion is generally made up of a corn on the side of the great toe, and an irritated synovial sac or bursa beneath it. It is also the result of wearing too tight a shoe, especially such as are too narrow at the point. When inflamed, it should be soothed with lead water and laudanum; a loose shoe, or one with a piece cut out of the side, being worn. After the reduction of the inflammation, benefit may be obtained by painting with tincture of iodine. A bunion should never be neglected, as it is liable to suppurate, leaving a troublesome indolent sore, which may for years cripple the patient, even if permanent lameness does not result.

ITCHING (Pruritus).

Character.—pruritus is a very common disease of the skin, which is characterized by itching without any eruption or other apparent change in the appearance of the part affected. Children and elderly people are particularly apt to suffer thus, and the localities involved are generally those about the orifices of the body.

Causes.—Sometimes, like prurigo, it may be traced to the irritation caused by vermin, usually the pediculus corporis or body-louse, which may be gotten rid of by attention to cleanliness and the application of weak mercurial ointment, a tincture of lark-spur, or various other home remedies. When not thus produced, the cause must be sought in some deterioration of the general health.

Treatment.—As local applications, lotions of borax, half an ounce to the pint, or of carbolic acid, one or two teaspoonfuls to the pint, and ointments of zinc with camphor, belladonna or morphia are useful.

FRECKLES.

Freckles consist of a deposit of oxide of iron from the blood, just beneath the epidermis or in its lower layers. They may often be dissipated by painting with tincture of iodine, or by a cautious use of the weak solution of nitro-muriatic acid.

DISEASES OF SKIN GLANDS.

Seborrhea.—In seborrhea there is an excessive production of secretion, made up of oily matter and cast-off epithelial cells, which accumulates upon the surface in the form of thin, yellowish scales. It is especially common on the skin of young infants.

Treatment.—The layers of scales may be removed by the use of white castile soap and warm water, and if there is no inflammation of the skin, a mild carbolic or white precipitate ointment may be used to prevent their return.

Flesh-worms.—Acne, commonly called pimples or flesh-worms, coming, as it does, upon the face just at the time when young people of both sexes begin to feel most anxious about their personal beauty, gives rise to a far greater amount of unhappiness than many of the serious maladies to which flesh is heir. It is an inflammation of the sebacious glands of the skin upon the face and back, and elsewhere, which comes on in successive crops, and gives rise to the spotted and pimply countenances which are often so unsightly or even repulsive.

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Description.—These sebaceous glands, one of which is well delineated in the accompanying wood-cut, are generally situated, as there indicated, by the side of a hair, and if inflamed, caused by the pressure they exert when distended, an inflammation of the surrounding derm constituting the pimple of acne. In the figure is exhibited a hair in its follicle, highly magnified. At 7 and 8 appear the curious little muscles which have the power of erecting the hair in conditions of sudden fright or horror. They are, as is well known, much more active in animals—for instance, the cat— than in mankind. 9 and 10 indicate a large, and 11 a small, sebaceous gland, both opening on the skin by the side of the shaft of the hair at 12. The small, black spot generally visible near the centre of an acne pimple is popularly supposed to be the head of a flesh-worm, which can be squeezed out by pressure at the sides of the papule. In reality, however, the yellow thread which looks like the body of a worm, is only the hardened secretion of a sebaceous gland, the top of which, being exposed to the air, has collected dust and dirt, and so become black.

Treatment.—No advantage is gained by squeezing out these little plugs of fatty matter, as in most cases the bruising of the parts more than compensates for any benefit afforded by the relief of internal pressure in the pimple from retained secretion. A great many local applications for the cure of acne are offered for sale, some of which are composed of powerful poisons, and are liable to do great and permanent injury. A safe and often useful lotion is made of precipitated sulphur, variously combined with mucilage of sassafras-pith, glycerine and camphor; or an ointment of precipitated sulphur, with vaseline, a drachm to the ounce, or white precipitate with vaseline, half a drachm to the ounce, may be employed.

Accessory Treatment.—The most important part of the treatment is attention to any general derangement of health, especially of the digestive apparatus, or, in females, of the menstrual function.

Diet.—Errors in diet will often bring out a crop of acne, and articles of food which contain fried butter or fat of any kind, appear to be apt to have this effect. Pastry of all varieties, particularly mince-pie, buckwheat and other hot cakes, sausage, cheese and nuts should all be avoided, as well as spirituous and malt liquors in every form. Although the treatment and hygenic care, as thus advised, will generally diminish the activity of the eruption, they may not always effect a cure, and consolation must be sought in the fact that it seldom persists unless kept up by imprudence, after the period of maturity in the organism has been attained.

SKIN DISEASES DUE TO VEGETABLE PARASITES.

Causes.—It is now generally admitted that the fungus growths found so constantly in and among the epithelial scales of the epidermis are the causes, and not the mere accompaniments, of a curious group of skin maladies. The development of fungus not only invades the skin, but affects also the hair and the hair-follicles. Though the variety of vegetable growth differs in the different diseases, each presents the same general features, consisting of microscopic threads named mycelium, corresponding to the stem of a larger plant like a grape-vine, and microscopic seeds sometimes produced in bunches like grapes, and called spores. The full recognition of the fact, as it is believed to be by the present writer, that the fungous[sic] growth is the essential cause of the whole disease is vitally important, because upon it depends the system of preventing these maladies from spreading to healthy persons, by total destruction of the spores or seeds of the respective diseases.

A Case in Point.—In the instance of a member of the author's family, a little girl was infected with the fungus of Favus just underneath the tip of her chin, probably from spores left by some diseased child on the sill of a car window, from which she had been looking out, and at the time of being attacked with this complaint, which was fortunately recognized at once, and put an end to by appropriate treatment, she was in perfect health.

RING-WORM OF THE HEAD.

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Symptoms.—Tinea tonsurans or ring-worm of the head is the most common of these vegetable parasitic diseases. It shows itself as a dry, scaly patch, rounded or oval in outline, which gradually grows larger and larger, the hairs dying and dropping out at the centre, so that ultimately a bald spot of from half an inch to two inches in diameter is left. The same fungus which produces this malady in the head sometimes develops among the hair of the beard, producing what is called tinea sycosis or barber's itch, and upon the other parts of the body where it is denominated tinea circinata or common ring-worm, with which, however, no worm has anything to do.

Further Symptoms.—Ring-worm of the scalp cormmences usually as a little pimple, which soon spreads and takes on its characteristic ring-like appearance, showing a circle of minute scales, pimples and vesicles at the circumference of the patch. As the disease advances the hairs included in the circle become dull, dry, twisted and easily broken off, whilst the epidermis and stumps of the hairs become covered with a greyish-white powder, consisting chiefly of the vegetable growth.

Illustration.—If one of these broken hairs is put into a drop of caustic potash solution, and examined under a high power, such as 250 diameters, of the microscope, its shaft can be seen as represented in the figure, penetrated with the mycelium of the fungus, called the tricophyton tonsurans, and floating around may often be detected separate spores of the same plant as indicated at the upper part of the woodcut on both sides of the hair.

RING-WORM OF THE BODY.

Tinea circinata, which is also denominated herpes circinatus and ring-worm of the body, begins like that upon the head with a small pimple, but soon spreads with great rapidity, and the rings of eruption may attain a diameter of four or five inches.

Characteristic.—The great characteristic by which this affection can almost always be recognized is its healing up in the middle, so that the appearance is presented, after a time, of a patch of healthy or slightly reddened skin, surrounded by an angry, red ring about a quarter of an inch wide. Such an arrangement of the eruption is peculiar to ring-worm and suggests that the fungus in its growth at the centre of the ring has exhausted some material found in the skin which is necessary for its development. Were this not the case it would almost certainly continue to flourish in the middle, as well as at the edges, so that the course of ring-worm affords a strong argument in favor of that part of the germ theory which supposes that the immunity conferred by one attack of small-pox, for instance, is due to the exhaustion in the entire system of some ingredient necessary to the growth of the specific small-pox fungus.

BARBER'S ITCH.

Character.—Tinea sycosis, or barber's itch, is the variety of the disease in which its vegetable cause happens to develop upon the chin of an adult, male patient. A great amount of irritation is usually set up, perhaps, from the roots of the hairs constituting the beard, extending more deeply into the substance of the true skin, and the plant therefore producing a deeper-seated inflammation of the parts as it grows down along the sides of the hair-follicles, than in the non-hairy portions. Hence large papules, and even pustules resembling those of acne in its aggravated state, are apt to be formed, and the itching and burning, as well as the disfigurement, are occasionally very troublesome to the patient. Perhaps among the vegetable parasitic diseases there is none to which persons are more liable to be exposed than this tinea sycosis or, as it is commonly called, the barber's itch.

Causes.—As before observed, any one of the innumerable epidermic scales, continually shed from human integument and constantly floating in the atmosphere around us, whence they are deposited with other materials in the form of dust, may be freighted with spores, or seeds enough of the fungus which causes tinea, to infect thirty, forty or fifty individuals should they meet with proper conditions for growth and reproduction. If persons fully realize this truth they can, of course, readily understand that all the ordinary precautions usually resorted to in barber's saloons, to wit, those of having separate cups, razors and brushes for each individual customer only diminish the danger of infection, and by no means insure a certainty of escaping the disease, for not only is the air of the room liable to carry separate epidermic scales, which may each convey the infection, but many of the operations connected with the process of shaving are still more likely to be the means of communication. For instance, the razors which are employed, even if they be individual property, are all sharpened with the same strap, upon which may have been spread, a few moments before you enter to be shaved, a few score epithelial cells from a case of tinea, one or two of which, should they accidentally adhere to the surface of your razor, as it certainly is quite possible for them to do, would be amply sufficient to implant the disease upon your face. In like manner the towels which are used, the brushes and combs, and even more certainly the hand of the barber himself, may prove the most efficient carriers of contagion which could possibly be devised.

Precautions.—In order to prevent the spread of these vegetable parasitic diseases the precautions already suggested must be rigidly enforced. All articles of clothing which have been worn in contact with parts of the body where the parasite grows should be purified by immersion in boiling water, or, if the nature of the material does not permit this, by baking at a heat of 250 Fahrenheit. All bed linen, bandages, brushes, combs and towels, or other articles suspected of similar contact, should be treated in the same way; and, of course, should be used by no other person until thus purified. The patient, if a child, should be kept by itself as far as possible, and those having charge of the case should thoroughly wash themselves after handling the parts affected. It is probable that the use of a strong carbolic acid soap, or of sulphite of soda or chlorinated soda solution would add to the security against attack, and with such precautions there is little danger that the malady will be transferred to others. Of course after proper treatment has once been put into operation, the danger of infection is still further diminished.

Treatment.—1. The essential point in treatment is to apply to the roots of the hairs a preparation which will kill the fungus, just as weeds are destroyed in an asparagus bed by sowing the ground with salt. In order to do this, the hair—if any exists—should first be removed, and the surface made as clean as possible. When the hair is not very thick, or has already been nearly destroyed by the disease, a cure may perhaps be effected by lotions or ointments of sulphuric acid, carbolic acid or salicylic acid. An ointment of verdigris is a favorite home remedy, and often succeeds after causing a good deal of unnecessary irritation.

2. Tincture of iodine, applied twice a day for fourteen days, and the spot then covered with the ointment of corrosive sublimate, of about two grains to the ounce, is an effectual method of treatment, which may be employed with great caution in obstinate cases. Where the hair is very thick and strong it is sometimes necessary to pull it out with tweezers, as will be directed in speaking of favus, although this severe operation is, happily, not often required.

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SCALD HEAD.

Character.—Tinea favosa or favus, called also scald-head and honeycomb ring-worm, is characterized by its peculiar dry, sulphur-yellow crusts, in the form of little cups about a quarter of an inch in diameter. In advanced cases, however, these cups run together, so that their well-defined form can, perhaps, with difficulty, be recognized, except at the edge of a patch. A peculiar mouse-like odor is emitted from a child's head bearing a good crop of favus, this being probably produced by the spores of the fungus coming in contact with terminal branches of the olfactory nerve of the observer. On careful inspection, each cup is usually seen to surround a hair, and there is commonly little trouble in. detecting the fungus spores and mycelia on microscopic examination.

Causes.—Although this disease is more frequently met with upon the heads of neglected, ill-nourished children than elsewhere, there is little doubt that any one of these spores of the achorion schoenleinii, as the fungous cause is denominated, might, under favorable circumstances, germinate and give rise to an abundant crop of favus in the hair, beard, or skin of the most vigorous individual upon whom they happened to be deposited.

In some cases the fungus of favus attacks the nails, developing beneath them and by the pressure which it causes producing their absorption and perforation. Much local inflammation about the root of the nail is thus set up.

Treatment.—The treatment of favus consists in removing the crusts by softening with a poultice, cutting or shaving off the hair, and then rubbing in thoroughly sulphur or tar ointment. If the spot is small a weak solution of corrosive sublimate may be painted over it, but this powerful poison requires very careful management. In obstinate cases it may be necessary to pull out the hair, either by the process of avulsion, where a cap made of adhesive plaster is suddenly torn off the head, bringing the hair with it, or by extracting six or eight hairs at a time with tweezers. This latter operation, called epilation, is denominated by Sir E. Wilson "the purgatory of avulsion," and condemned as little less cruel.

Brown Patches.—Tinea versicolor or, chloasma depends on the growth in the epidermis of a fungus similar to that of ring-worm, but bearing its spores in heaps like bunches of grapes. The disease, which is seldom troublesome, is characterized by brownish-yellow, slightly scaly, irregular patches, which appear on the front of the chest and sides of the neck. It may also affect other parts of the body. As it does not penetrate deeply into the epidermis it is easily cured by painting with tincture of iodine, tincture of chloride of iron, or solution of sulphurous acid.

ITCH (SCABIES).

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Causes.—Scabies or the itch, the most important skin disease caused by an animal parasite, was called in former times, when its true cause was but little understood, the seven-years' itch, because it was so hard to cure. At present it is universally admitted that the whole cause of this most annoying malady is the itch insect, or itch-mite, which is represented in the cut lower on the page as it appears under the microscope if magnified about two hundred diameters. From the irritation set up by the parasite, and still more from the scratching to which it drives the unfortunate patient, vesicles, pimples and pustules are formed and grouped together in every variety.

Symptoms.—1. The itching, which is terribly severe even in daytime, is generally much worse at night after becoming warm in bed. The favorite haunts of the insect upon its human domain are the hollows of the elbows and knees, the front of the wrist and the backs of the hands just between the roots of the fingers; but it is also found in other portions of the body where the skin is tender. The palms of the hands and the soles of the feet are not infrequently infested, notwithstanding the integument is thick in these parts. In a vast majority of cases showing discrete or separate eruption on the palms and soles it is due to either scabies or syphilis, and the presence of itching in the former and its absence in the latter of these two diseases enables us to distinguish them with great certainty.

2. The accompanying eruptions of scabies vary somewhat in their character according to situation. Thus the prurigo of itch is generally best defined upon the forearms, the lower part of the abdomen, and the upper and inner portion of the thighs. A vesicular eruption is more frequent about the fingers and breats of thin-skinned people, and pustules are met with in children especially on the hands, feet and hips.

3. In searching for a specimen of the insect, which can be seen quite distinctly with a good magnifying glas-s, it is well to look for one of the pimples, which has, extending from it, a little whitish line about the eighth of an inch long and generally somewhat curved. This is the burrow of the female insect, in which she has laid her eggs and is raising a happy little family to follow her example and live off the fat of the land they inhabit. If the top of the burrow is scratched through very carefully at its outer end with the point of a fine needle, and then the tiny round dot which may be found there picked out on the needle and transferred to a slip of glass, positive evidence of the nature of the disease can be at once detected by suitable examination under a microscopic or hand-magnifier.

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Illustration.—The adjoining figure represents one of these burrows of the acarus scabies or itch insect, and in it is seen the mother of the family at the upper extremity, whilst eggs and young in various stages of development are depicted in different portions of the gallery excavated for their accommodation in the epidermis of their hospitable host.

Treatment.—The treatment of scabies should be by applications which, whilst they tend to kill the insects, will increase as little as possible the irritation of the skin. If this irritation is not already too great, the patient should go into a warm bath and scrub himself with brown or soft soap for half an hour; he should then lie in the bath for another half hour, and after being thoroughly dried, rub himself with the compound sulphur ointment all over, except the head, for twenty minutes, allowing the ointment to remain on the body all night.

This whole process should be repeated every night for three times, which will probably end the lives of the itch insects and so terminate the malady.

Disinfection.—In order, however, to avoid being reinfected from the clothing upon which some of the acari or their eggs may remain, every article that will bear washing should be thoroughly boiled, and those pieces of apparel which would be injured by water should be several times pressed with a hot iron, so as to completely destroy the parasites.

Further Treatment.—When the skin is very irritable the application of Peruvian balsam or the styrax ointment should be tried at first, and it ought to be remembered that even in those whose skins are not remarkably tender the sulphur ointment if used very vigorously is apt to produce an eczematous eruption, which, however, quickly subsides on the cessation of the application.

LICE.

Treatment for Lice.—The three kinds of pediculi or lice which infest the head, the body and the pubes of man, differ in their appearance under the microscope, being apparently each best fitted for the special part it has to play in tormenting the human family. They can all be defeated in this great business of their lives by strict attention to cleanliness, frequent bathing, and the application of mercurial ointment diluted with five times its bulk of lard. For the purpose of avoiding salivation, this ointment should not be used directly after a bath, nor rubbed in very strongly, nor, in fact, allowed to remain in contact with the skin any more than necessary.


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Last Modified: Monday, 13-May-2013 15:31:46 EDT