TINEA CRURIS

This occurs most frequently among young men on the upper part of the thighs, on the perineum, on the buttocks, and sometimes on the scrotum. It is very persistent under most treatments, and is likely to occur from dirty suspensory bandages used by those who take part in athletics. This infection is rapidly transmitted from one to another by the carelessness of infected men in the use of toilets.

The most successful treatment is that which insists upon complete surgical cleanliness. The patient should come to the office for treatment bringing a clean set of underclothing. The affected areas and the regions surrounding them must be thoroughly cleansed with surgical antiseptic soap and water, and all the surrounding dry epidermis should be carefully removed, care being taken not to break the skin. A swab of cotton is next wet in the official formaldehyde solution, full strength, and is lightly and quickly swabbed over the affected areas. The patient should then be encouraged to endure the burning pain for three or four minutes, at the end of which time, or sooner if necessary, the part is swabbed with water. If the pain is still intense after a few minutes more, a 3 per cent. solution of phenol may be swabbed over the part. Soon the burning has ceased, and the skin may be gently dried, and then thoroughly covered with talcum powder, or better, with a starch and boric acid powder, equal parts. The patient should report in twenty-four hours for observation, and if any severe inflammation has been caused, which is rare if the above technique is carried out, some sedative ointment may be applied, perhaps best a 2 per cent. phenol ointment. At the end of a week the patient should be again examined, and any suspicious areas should be treated in the same manner. This method will generally cure this kind of ringworm in two weeks, at most.

ITCH-SCABIES

This disease is caused by the itch mite, which is not of such infrequent occurrence, even among cleanly people, as is generally supposed. Some individuals are tolerant to the irritation from this parasite, and do not develop annoying itching; con

sequently they may unwittingly harbor the disease and transmit it to others. Other individuals are so greatly annoyed by it that they quickly seek aid.

The burrow which is made by the female most frequently occurs between the fingers, but may occur on other parts of the body, on the elbows, or on the nipples, and sometimes more or less all over the body. When they occur on the legs, back and abdomen, scratch marks will always be found. Sooner or later, an eczema generally develops, or even small infected areas may occur, due to the scratching.

Many times the diagnosis is readily made; at other times the patient is treated for everything except for a parasitic disease. Scrapings from the burrows placed under a microscope will disclose either the mite or its eggs, if the disease is present. The parasite seems to be most readily transmitted by sleeping with an infected bed-fellow or in an infected bed, and of course it is readily transmitted by an interchange of infected clothing.

The preparation for the treatment consists of a hot bath with good strong soap, as ordinary laundry soap, and a thorough scrubbing with a nail brush of all infected areas, so as to open up the runs of the parasites. Then a sulphur ointment should be rubbed into the infected regions. The official Unguentum Sulphuris contains 15 per cent. of sulphur, and as this is too strong for most skins it should generally be diluted with an equal part of simple ointment (Unguentum). This treatment should take place just before bedtime, and after the treatment the individual puts on clean, old pajamas. On the following morning he puts on clean underclothing and thoroughly cleaned or positively non-infected outer garments.

This treatment is repeated for three successive nights, using the same ointment-besmeared pajamas. Each morning the patient may bathe for cleanliness. At the end of a week another treatment should be taken. Generally the scabies will be cured by this method. A more pleasant method of using sulphur is to dust washed sulphur over the body, rubbing it into the infected regions.

Another successful treatment for scabies is with balsam of Peru. This may be used pure and rubbed into the parts which

have been cleaned by scrubbing; or a combination is sometimes advisable, as precipitated sulphur 2 Gm. (30 grains), balsam of Peru 10 mils (21⁄2 fluidrachms) and petrolatum 30 Gm. (1 ounce).

Many other antiseptics have been used, as betanaphthol and cresol solutions, but none is better than those above described.

HEAD LICE-PEDICULOSIS

This condition, frequent among certain classes of school children and in those living in dirty tenements, has long been treated with kerosene oil, the kerosene being applied to the whole head and scalp, which is then covered for twenty-four hours. The dead lice are later removed with a fine tooth comb, great care being taken to clip out the nits. Of course the most satisfactory, quick treatment, if the patient is a boy, is to cut the hair close to the scalp.

More recently xylol has been suggested as a strong parasiticide. This colorless coal-tar liquid will burn the skin and scalp somewhat, but will not cause blistering, and seems to be death to the lice and their ova. Xylol is inflammable; therefore it should not be used near a fire or when there is artificial light other than electric. Sometimes xylol is diluted with an equal part of ether, but it is thus rendered no more efficient. A cotton swab is made and soaked in the solution or mixture, and then the scalp is gone over very thoroughly, and the strands of hair are pulled through the soaked cotton. Generally one or two treatments are sufficient to eradicate the parasites.

If scratching has caused eczema, or there are impetigo contagiosa spots, these conditions should be later treated, after the eradication of the lice. After the first radical treatment, the hair should be thoroughly washed on the following day, and then an ointment suggested, by J. E. Lane, of xylol (xylene) 4 mils (1 fluidrachm) and petrolatum 30 Gm. (1 ounce) may be applied to the irritated parts of the scalp that may be supposed to harbor the parasites.

The same xylol treatment is successful in eradicating lice from the pubic region or the axillæ.

HAIR

To perpetuate a growth of healthy hair requires good common-sense treatment. Ordinarily a shampoo once a month, or more frequently if the hair is subjected to dust and dirt or if there is much sweating of the scalp, is advisable. Daily good combing and proper brushing is also necessary. If for any reason the circulation of the scalp is not good, scalp massage, or rubbing the scalp is necessary to keep the circulation sufficient to prevent the hair from falling out.

Whether dandruff is a simple dry eczema of the skin, or is due to poor circulation, or is due to a germ, need not be here discussed, but the hair and scalp should be kept free from dandruff by brushing and shampooing. A simple soap, as ivory or castile, is frequently all that is necessary. More stimulating liquid soap, as green soap, may be used if deemed advisable, and if the head is greasy and the hair forms bundles from an extra amount of oil, a more drying treatment after the shampoo should be given, such as applications of bay rum or some other alcoholic preparation.

Whether or not dandruff is due to a germ, many times antiseptic hair tonics represent the most successful treatment of the condition. The following is such an antiseptic wash:

Apply to the scalp, with a small sponge, every other night.

The prevention of dandruff and falling of the hair means that the scalp must not become too dry or too oily. Drying is caused by too tight hats in men, and by curling irons in women, and disease of the scalp may occur from the use of dyes. Singeing does not prevent falling of the hair.

All the dead hair should be combed out when the hair begins to fall after a serious illness (as it frequently does), and this is all the treatment that is needed. It is not necessary to shave

the head; the hair is likely to come in as rapidly without shaving as it is with shaving. One of the causes of falling of the hair after severe illness is the ice cap, which is so frequently used on the head, and so many times without reason.

When the hair falls, the general nutrition of the body should be studied. Many times there is chronic disability, or there is disturbance of some of the endocrine glands, frequently a subsecretion of the thyroid. The diet and the condition of the skin should be studied. Sometimes the diet is deficient in some necessary element, perhaps calcium. An improvement of the general nutrition and of the circulation will often stop the loss of hair and cause its normal growth.

Seborrhea and the falling of hair seems to have some relationship to the sexual organs. Eunuchs do not become bald, and they are said not to have seborrhea.

WARTS

Warts may develop at any time, and occur singly or in groups, mostly on the hands, and mostly in children. It has been suggested that they may be due to a contagium. Warts may persistently recur, or, without any known cause, may suddenly and rapidly disappear within a few days. The administration of an extra amount of calcium has sometimes seemed to cause their disappearance.

The local treatment is escharotic, and there is no treatment more satisfactory than cauterizing with the high frequency current, or with an electrocautery or a thermocautery. The older acid treatments are still much used, as a drop of glacial acetic acid or of nitric acid, or a drop of full strength official formaldehyde solution. If the formaldehyde solution is used, the treatment should be repeated, a drop at a time every three or four hours for a day or two. Less active treatments are salicylic acid preparations, and an efficient solution is salicylic acid 2 Gm. (30 grains) in collodion 30 mils (1 ounce). The wart should be touched with this collodion mixture two or three times a day, for several days. Many other local treatments have been suggested, but none is better than the above.