Many foods cause poisoning only in certain conditions of the alimentary tract and in certain conditions of the blood. The blood may at certain times contain substances that for the moment are harmless, but that are likely to produce protein poisoning when certain other substances reach the blood. Also many foods and drugs may not cause skin reactions or symptoms of any poisoning when the liver and kidneys are intact, but if either is diseased poisoning more or less readily occurs. This is particularly true with liver insufficiency, as the liver detoxicates many otherwise irritating substances, particularly the alkaloids of many drugs. The greater activity of drugs administered hypodermatically is due to the fact that they do not pass through the liver and therefore are not partially neutralized as they are when administered by the mouth. The interrelation of the skin and kidneys is an interesting physiologic fact. If the skin is dry and cannot secrete, or, if it is seriously inflamed as in scarlet fever or in general erysipelas, more work is thrown on the kidneys and congestion readily occurs, and albuminuria and even nephritis may result. On the other hand, if the kidneys are chronically diseased and the skin properly secretes, the patient is not readily poisoned. But if the skin becomes dry and does not properly secrete, the patient is quickly poisoned and the disease of the kidneys soon becomes fatal. Patients with dry, insufficiently acting skin, whether of the ichthyosis type or of the dermatitis exfoliativa type, are likely to develop kidney disturbances. With serious burns of the surface of the body there is likely to be duodenal inflammation and more or less kidney disturbance. ITCHING-PRURITUS 1tching may occur with any irritation of the skin, and is very frequent in disease of the liver and in insufficiency of the kidneys. A jaundiced patient is always troubled with pruritus, which is caused by the attempt of the skin to excrete bile pigments and more salts than usual. In this condition one of the most efficient treatments is frequent warm, alkaline baths, to dissolve and wash off the irritating crystals that collect on the surface of the skin. Focal infections can cause itching of different parts of the body, and even a chronic appendicitis may cause perineal and genital itching which ceases on removal of the appendix. Other localized itchings often cease when the focal infection is removed. A frequent cause of itching is intestinal worms, and localized itching of the anus and perineum is often due to pinworms. Abnormal sweatings and secretions from sinuses or infected areas may cause itching. Treatment. It is almost superfluous to urge that a cause for the itching should be sought, and if possible, removed, and that local causes should be radically treated. Any particular food or drug that causes pruritus should of course not be taken. Subthyroid secretion is a cause for itching, and when that condition is present the administration of small doses of thyroid is curative. Acute pruritus, like protein poisoning and urticaria, should primarily be treated as follows: All food should be temporarily stopped; a quickly acting purgative given, either castor oil or a saline; an alkali should be given, as sodium or potassium citrate, in 2-gram (30-grain) doses every three or four hours until the urine is alkaline, or the bicarbonate of sodium may be given in 1-gram (15-grain) doses every three hours; large amounts of water should be drunk; and alkaline baths should be taken. If it is presumed that the cause was irritation of the gastrointestinal tract, it is well to give bismuth subcarbonate with sodium bicarbonate for several doses. Another cause of itching is a disturbed metabolism, and if there is muscle and nerve irritability it may show parathyroid disturbance. These patients often are improved by the administration of calcium in some non-irritant form, as lime water, or as calcium glycerophosphate, or better, if there is no contraindication, as milk. The diet for some days for these poisoned individuals should be milk (if it agrees) or cereals. Later vegetables and fruits that are known not to cause irritation may be given, and finally animal proteins in small amount, i.e., meat once a day, if it is known that meat ordinarily causes no disturbance. Local applications, besides the alkaline baths and drying of the skin with soft towels used mop-like and not by rubbing, should be cooling powders, and nothing is better than cornstarch. Severe local itchings are always benefited by bicarbonate of sodium solutions, alcohol or cologne sprays, 3 per cent. phenol solutions, 1 per cent. menthol solutions, and spirit of camphor. Or localized spots of irritation may be painted with the syrupy mixture produced by rubbing camphor and chloral together, in equal parts. In general itching the underclothing should be of silk or linen, and if the weather is cold, such flannel or thicker garments as are needed may be put on over them. It is hardly necessary to urge that all skin parasites must be excluded; all poisoning by plants or poisoning by vapors or irritants received during the individual's work must be prevented and excluded. There is generally some removable cause for acute and subacute localized eczema, if it can be found. General eczema is probably most frequently caused by some internal disturbance. In all itching conditions the animal proteins should for a time be excluded from the diet, and in inveterate cases the skin protein tests should be made to determine, if possible, what protein poison is causing the irritation of the skin. PRURITUS VULVÆ The cause of this very troublesome irritating condition must be sought. It may be due to an irritating discharge from the vagina, to a fissure, to a fistula, to an eczema, to diabetes, or to pinworms or other parasites. It may also be reflexly due to some focal infection, and chronic appendicitis is occasionally a cause of the condition. Applications of yeast, alkaline lotions, and menthol solutions may be of value. Sometimes painting with iodine is curative, and sometimes the high frequency electric currents are valuable. At times, especially if there are irritating exudations from the glands of the region, the best cure is by means of the x-ray. Bathing the parts with water and soap is often inadvisable, and alkaline washes or almond or other bland oils for cleansing are preferable. URTICARIA The treatment of urticaria is on the same plan as above outlined for acute pruritus, and the cure is generally rapid. The treatment consists of a cathartic; abstention from food; drinking plenty of alkaline water, as a Vichy, artificial or natural; the administration of alkalies, and often of calcium; and local applications of powder, and alcohol or menthol sprays. In urticaria, baths are often not advisable, as there is likely to be more itching after bathing. So-called "giant urticaria" shows serious poisoning, and added to the above treatment should be large doses of either quinine or antipyrine, alkalies to the point of alkalizing the urine, and a calcium. The cause of the "giant urticaria" should be sought and the patient, if possible, not again subjected to the probability of another attack. Angioneurotic edema is very closely associated with so-called giant urticaria. Sometimes the condition is very serious, especially if it occurs in the mouth and throat. It is probably always due to some intestinal disturbance, often a protein poisoning, or to poisoning from some localized infection. One of the most successful immediate treatments is epinephrine, either given hypodermatically, or as a soluble tablet, or in solution, on the tongue. When this condition occurs in the mouth and throat, suffocation may be caused, and the patient is safer in a hospital where tracheotomy, if needed, can be done. After the attack is over a focal cause should be sought, and if none is found, various protein and food tests should be made to prevent, if possible, a recurrence of this condition. MOSQUITO BITES To prevent the bites of mosquitoes a few drops of the following mixture may be placed on the face and hands: Oil of cedar.... Oil of citronella. 5 mils 10 mils 10 mils A drop of the spirit of camphor, a strong menthol solution, alcohol, strong ammonia, or a 5 per cent. phenol solution, will generally prevent the itching, when applied to the bite of any insect. A solution of sodium salicylate 1 Gm., formaldehyde solution I mil, and water up to 100 mils will attract and kill flies. Ι IVY POISONING The poisonous juice of the Rhus Toxicodendron (poison ivy, poison oak, mercury) is the same as that of poison sumach, and a very minute portion may cause an inflammation of the skin. This poison, toxicodendrol, is contained in the leaves, is of a resinous nature, and is non-volatile, in spite of the declaration by many susceptible individuals that they cannot pass by a plant without being poisoned. Therefore, direct or indirect contact must occur. The hands and face of course are the parts most affected, but it is easy to transplant the irritant by the hands to other parts of the body. The softer and more pliant the skin, the quicker does the irritation develop, and a minute amount of the resin will cause vesication. While most individuals are susceptible to this common poison, some can handle it with impunity without danger of poisoning. Some few individuals do not develop symptoms of poisoning for several days after exposure to the plants. Internally the rhus toxicodendron, which has been unnecessarily termed a drug, and was formerly officialized in the Pharmacopoeia, is, except in minute doses, an irritant and a poison. Symptoms after absorption are dilated pupils, faintness, irregular pulse, increased perspiration, muscle weakness, tremblings, and even convulsions. Later symptoms are those of kidney and bladder irritation. Protections against poisoning from the ivy are rubber gloves and fats or oils smeared over the parts of the body which might be exposed to contact with it. If contact with this plant is known to have occurred, immediate washing the exposed parts with hydrogen dioxide solution, then scrubbing with soap and water, then with equal parts of alcohol and water, and later (after the thorough cleansing of the exposed parts) a hot bath is the preventive treatment advisable. It must be noted, however, that the outer clothing may carry the irritant poison, |