of the skin, the local treatment is primary; but a modification of the diet and free bowel movements, even in such a condition, are valuable secondary treatments. When the skin is acutely inflamed, it should not be bathed with water, but should be cleansed with some bland, thin oil, as almond oil. All skin irritations are made worse by cold water, but are soothed by warm water, especially if to the warm water is added sodium bicarbonate, boric acid, or borate of soda. Water is made irritating and stimulating by the addition of sea salt. The amount of surface to be treated by external applications must always be considered, for a large area would permit absorption of an absorbable drug to an extent which a small area could not. The situation of the lesion must also be taken into consideration, for this not infrequently decides whether (if the cause be inherent to the skin itself) we shall use a strongly acting preparation for a short time, or a milder one for a long time. DUSTING POWDERS Dusting or protective powders are used to meet the following conditions: 1. Erythemata in general, and particularly in erythema intertrigo (chafing) and erythema solare (sunburn). 2. Hyperidrosis and bromidrosis (excessive and foul smelling perspiration). 3. Herpes. 4. Miliaria. 5. In certain forms of eczema which are acute and free from discharge. The official powders that prevent irritation of the skin, soothe irritated surfaces, and prevent excessive secretion of the skin are: Acidum Boricum (boracic acid) Acidum Tannicum Alumini Hydroxidum (Alumnol, not official) Amylum (corn starch) Bismuth preparations Calcii Carbonas Præcipitatus (precipitated chalk) Creta Præparata (prepared chalk) Iodine preparations Lycopodium Magnesii Oxidum (magnesia) Sodii Boras (borax) Zinc preparations Starch, fuller's earth and kaolin are good simple dusting powders. Bismuth Preparations.-The best preparation of bismuth for external use is the subgalate (dermatol). This is a yellow insoluble powder, which is more astringent than the other bismuth salts. Bismuth subnitrate should not be used on moist external surfaces, especially not on blistered surfaces, as bismuth poisoning can occur from such applications. It is less likely to occur when the subcarbonate is used. Boric Acid.-Boric acid is not as drying as other powders, adheres to surfaces, and is, mildly antiseptic. On moist surfaces it tends to promote rather than diminish secretions. Borax acts similarly to boric acid. Both preparations are very valuable, in saturated solutions, as mild antiseptic washes for any mucous membrane, and they tend to promote healing of all ulcerated surfaces and to promote the healing of wounds. Most talcum powders have boric acid as a base. When boric acid or borax is taken internally poisoning may occur. There is no excuse or justification, or any good indication for administering internally either boric acid or its sodium salt. Iodine Preparations.—Iodine powders are more or less germicidal and more or less protective. Large numbers of proprietary preparations are offered, and the official Thymolis Iodidum when well made, is a valuable drying, mildly antiseptic powder and often is an aid in the healing of wounds. This preparation contains 43 per cent. of iodine. Iodoform.-Iodoform is a bad smelling, yellow powder, mildly antiseptic but not germicidal. There is no excuse for using this drug internally, and it is absolutely unjustifible to use it externally on account of its obnoxious odor. It may be used in emulsion in oil as an injection into a tuberculous joint or tendon. Lycopodium. This light, yellow, odorless powder is soothing, and is much used as a dusting powder on excoriated surfaces. Zinc Preparations.-The most used are the precipitated carbonate, the oxide, and the stearate. The impure zinc carbonate is termed calamine. The precipitated carbonate and the oxide are excellent protective dusting powders. The zinc oxide is slightly astringent, and is most frequently used as the oxide of zinc ointment. The stearate of zinc has a soapy feel, is more adherent to the skin, and, therefore, gives protection against watery secretions or excretions passing over the part. Alumnol.-Aluminum betanaphtholsulphonate is a white powder, soluble in water. It is astringent and an antiseptic even in 1 per cent. solutions. When used as a powder it is generally diluted with some bland substance, as starch or chalk. Fuller's Earth.-Hess1 has shown that there is a distinct difference between kaolin and fuller's earth, kaolin having a greater amount of hydrous aluminum silicate, and fuller's earth having considerable more calcium. Fuller's earth has greater drying properties than kaolin, and therefore is efficient as a drying powder for external use, and also has been found of value for internal use in intestinal disturbances of children. Hess recommends for diarrhea of infants the administration of a teaspoonful of the powder, either in milk or in some other food, every hour or two. Sometimes to facilitate administration he adds a very small dose of saccharin. He thinks the powder of more value in inhibiting diarrhea than bismuth or chalk mixture. The powder may also absorb bacteria. Fuller's earth may be found more valuable than kaolin for insufflation in the throat in diphtheria carriers. EMOLLIENTS Emollients are bland oily or fatty substances which, though generally devoid of medicinal properties, are more or less mechanically sedative when applied to the skin. The method 1 1 Journal A. M. A., Jan. 8, 1916, p. 106. of application varies with the conditions for which they are used. The indications for the use of emollients are: 1. To aid massage. 2. To soften a dry skin. 3. To soothe chafed or excoriated surfaces. 4. To protect the skin from irritating discharges. 5. To soothe and protect burned areas. 6. To soothe in acute eczema and dermatitis. The large number of oily substances offered as soothing applications to the skin are entirely unnecessary; a few well selected preparations are sufficient. Organic (animal and vegetable) fat substances will become rancid and harbor microorganisms unless they contain a sufficient amount of an antiseptic. The mineral oils do not become rancid, and although not germicidal do not promote the growth of bacteria. Which kind of fat is best for a given condition or for an individual skin must be decided by the physician, namely: whether a mineral, vegetable, or animal fat shall be used. It does not seem logical to combine mineral and organic fats in the same ointment or preparation. The Pharmacopoeia prepares cerates and ointments. The former are harder preparations with a melting point higher than the temperature of the body, while the ointments are softer and generally melt at the temperature of the body. Some of the various fatty soothing preparations of the Pharmacopoeia are: Adeps Benzoinatus (benzoinated lard) Adeps Lanæ Hydrosus (lanolin) Oleum Gossypii Seminis (cottonseed oil) Oleum Lini (linseed oil) Oleum Oliva (sweet oil) Oleum Theobromatis (cacao butter) Petrolatum (vaseline) Petrolatum Album (white vaseline) Petrolatum Liquidum Unguentum Acidi Borici Unguentum Acidi Tannici Unguentum Aquæ Rosa (cold cream) Unguentum Zinci Oxidi Some of the Pharmacopoeial liquid preparations that are soothing to the skin are: Aqua Hamamelidis (extract of witch hazel) Glycerinum Glyceritum Acidi Tannici Glyceritum Boroglycerini Linimentum Calcis (carron oil) Liquor Ferri Subsulphatis is sometimes used as a strong astringent on external surfaces. Liquor Plumbi Subacetatis, diluted to 5 per cent. in water, may be used as a sedative on the skin when absorption cannot take place. Simple collodion and flexible collodion will protect a part, but it should be emphasized that broken skin lesions should never be sealed with collodion or in any other manner, even if surgically clean, as such sealing prevents normal respiration of the skin, sweats and softens the tissues, delays healing, and promotes infection. Picric Acid (Trinitrophenol) is used in saturated solution in water, or in ointments, as a dressing for burns. Ichthyol is used as a mild stimulant in certain conditions of the skin. Ichthyol.-Ichthyol is a thick brown oily liquid obtained by the distillation of bituminous shales which contain fossil fish. The name "ichthyol" signifies fish oil. Ichthyol occurs mostly as ammonium ichthyo-sulphonate, which has a distinct fishy odor and taste. A sodium compound, sodium ichthyo-sulphonate, is more solid than the ammonium preparation and has been more used in the preparation of pills or capsules for internal administration. Both preparations contain about 10 per cent. of sulphur. Ichthyol, in various forms, has been recommended for |