and hence a thorough brushing and perhaps washing of the clothing is advisable. When the inflammation has occurred, the patient should be treated much on the plan, as to catharsis, diet, and alkalies, as though he had an acute urticaria. A useful lotion is magnesium sulphate, in strong solution. It is not often advisable to use the lead solutions so long recommended, as, if there is an abrasion, poisoning may occur. Besides mopping on the magnesium sulphate solution, powdered cornstarch applied to the inflamed area is advisable. Ichthyol preparations have been recommended, but are no improvement on the above simple treatment. If blisters occur, they should be treated as burns. The duration of the inflammation varies from a few days to nearly two weeks. PRIMROSE POISONING It is not generally recognized that the primrose can cause an acute inflammation of the skin resembling an acute eczema, and many patients are treated for eczema while the cause remains active in their house or garden, and the inflammation persists. It is the hands and arms that are most affected by this plant, and many a cure has immediately occurred when the plant was removed from the house. The irritation occurs only from contact. The treatment is the same as for any other acute eczema, but it is not permanently successful until the primrose is abolished, and all contact with the plant ceases. ECZEMA This common, multiform, troublesome disease of the skin requires investigation of the diet, of the excretions, of the ductless glands, of the clothing, and of the hygienic surroundings. Some foods and some drugs cause eczema in susceptible individuals. External poisonings are a frequent cause of eczema of the hands and face. The eczema of children is a study in itself. The proper diet for a child with eczema cannot be outlined; the child must be studied. Many times too much fat has been given; at other times too much sugar; at other times too much cereal. Consti pation in a child may be a cause of eczema, and insufficiency of thyroid secretion may cause moist eczemas in young children and dry eczemas in old age. The seborrheic eczema of the scalp of infants requires skilled treatment by one who has made a study of this subject. Again no one treatment is always successful. Some forms of eczema require local sedatives, and some local stimulation. A much used sedative is Lassar's paste, and a satisfactory formula is: Salicylic acid.. Starch.. Petrolatum. I Gm. 10 Gm. 10 Gm. 25 Gm. and various There are various other sedative ointments, sedative powders, as noted in the first part of this book under the headings of "Dusting Powders" and "Emollients." The stimulating ointments vary, and consist mostly of oil of cade, ichthyol, sulphur, and resorcin in various combinations. Which preparation is best and what strength is advisable can only be determined by the kind of eczema and the susceptibility of the skin to stimulation. CHAPPED HANDS Chapping of the hands is due to cold weather and an insufficient amount of oil or fat in the skin, and in cold weather the sebaceous secretions of the skin are at a minimum. may also occur from irritation of a dry, chilled skin. Chapping The preventive treatment is to keep the hands warm, and to rub on some bland oil or fat; cold cream and other animal fats are very satisfactory. Wool fat thinned with oil and water makes a good ointment for the dry skin of the hands. Some skins will tolerate glycerin in from 30 to 50 per cent. strength, while on other skins even dilute glycerin will cause irritation. Gelatinous lotions are often very satisfactory, and quinceseed lotions are much used. A useful preparation is made by melting Gm. of white wax with 4 Gm. of spermaceti and 15 mils of almond oil, and gradually adding 10 mils of glycerin, gently triturating, and then allowing to cool. Pusey suggests a tragacanth lotion as follows: Any perfume may be added to suit the individual desire. The boric acid, glycerin and water are mixed, and then the tragacanth gradually added, and the mixture shaken until it has dissolved. This combination makes a thick mucilage, but it can be made thinner by using less tragacanth. This preparation or some other mucilagenous lotion may be used to cleanse the hands, as soap makes chapped hands worse. Water, unless it is softened with bicarbonate of sodium, boric acid, or borate of sodium, is irritant to all eczemas as well as to chapped hands. CHILBLAINS Chilblains develop in cold weather in parts where the circulation is impaired or is insufficient. They frequently occur on the feet, especially if the shoes are tight, or they may occur on the fingers when the gloves are too tight, and can occur on any exposed part of the body, as the nose or ears. A part once chilled or suffering from chilblain is always more or less susceptible to cold, and recurrences readily occur. The unpleasant sensations are heat, burning, sometimes itching, and always more or less redness. These symptoms are likely to be worse when the individual goes into a warm room or becomes warm in bed. Sometimes the part may be quite inflamed, even to the extent of a mild subacute dermatitis. If the part is cold, brisk rubbing is of advantage, or putting the part into hot water benefits, i.e., anything that stimulates the circulation is of advantage. If the part is burning and hot, then it should be cooled. Sometimes the application of equal parts of tincture of iodine and tincture of opium is very soothing; also diluted glycerin and menthol preparations may soothe the parts. Any part that has the circulation impaired, as the toes and the feet, is improved by exercise; therefore not only massage, but exercise and use of the part of the body that has been chilled will tend to make the circulation better, cause better nutrition, and therefore less likelihood of a recurrence of the chilblains. Warm clothing of the susceptible parts of the body, as warm mittens and warm stockings, is preventive of this disturbance. The patient's general condition should be improved, and circulatory stimulants, iron, and extra food are often advisable. Electrical treatment that warms and stimulates the chilled part is often of benefit. Sometimes chilblains and a burning sensation of a part, or blanching of a part with later burning and increased heat, is due to Raynaud's disease, and a subthyroid condition often predisposes to chilblains. If breaking down of tissues occurs, the treatment is the same as that for blisters and ulcerations from blisters. If the skin is irritated, the same soothing lotions that are suggested for chapped hands are of benefit. ACNE It should be remembered that acne has been shown to be due in very many instances to the acne bacillus; also that intestinal putrefaction and toxins absorbed therefrom, and the toxins produced by the colon bacillus are predisposing and promoting causes of acne on any part of the body, and particularly on the face. It is necessary to correct all of the various functions of the body as well as to properly treat, locally, acne of the face. A disturbance of the menstrual function in young girls seems to be a particularly frequent cause of acne; and the age of puberty in boys seems to be a period when acne is frequent. Good healthy cleanliness of the face is essential in the cure of acne and the prevention of so-called "black-heads." Too hot water and too cold water used on the face may predispose to, or perpetuate, an acne. The exact local treatment is so varied, added to the necessary individual determination of the proper diet and the proper care of the bowels, that it cannot be outlined here. An acne patient should be studied by his physician or by a dermatologist. IMPETIGO CONTAGIOSA This infection of the skin is very frequent, and is generally caused by a staphylococcus. Multiple infections are caused by transplantation. When treated properly, this disease is quickly cured. It is essential that the scabs be softened with warm oil or with an alkaline wash, as bicarbonate of sodium water, and that all the crusts be removed, burrowing of the pus is thus prevented. The areas under the scabs should be thoroughly washed with peroxide of hydrogen solution and later cleaned with sodium bicarbonate solution, after which treatment ammoniated mercurial ointment, Unguentum Hydrargyri Ammoniati, which contains 10 per cent. of ammoniated mercury, should be applied in full strength, if there are not too many purulent spots. If there are many spots, the official ointment should be diluted one-half with petrolatum. If it is a young child's skin that is to be treated, a I per cent. solution of ammoniated mercury in some bland oil, as almond or olive oil, may be used. If this infection occurs in the hair, the part should be cleaned as above, and then the region may be soaked in this I per cent. mercurial solution of oil. It is needless to urge that to prevent re-infection the body should be thoroughly washed and then sponged with boric acid solution, and only clean, non-infected clothing should be worn. If the disease occurs on the hairy parts of the body, a thorough washing with boric acid solution is the best treatment, and the mercurial ointment may be applied to the spots. STY-HORDEOLUM A sty is ordinarily a staphylococcic infection, and is caused by anything that carries infection to the eye-lids, as dirty towels or dirty hands. Irritation of the eye-lids, caused by errors of refraction, promote the development of stys. It is difficult to abort a sty, and consequently applications of warm boric acid solution may hasten the development of the drop or two of pus, which, as soon as the yellowish spot is seen, should be evacuated, and the warm boric acid eye washes con |