SWEATING OF THE FEET AND AXILLÆ-LOCALIZED Excessive perspiration of the axillæ is very frequent, especially among women, and sometimes the odor is very objectionable. Sweating of the feet is more frequent with men than with women, and sometimes the odor is simply disgusting. There can be no excuse for men and women making themselves obnoxious if they are suffering from this disagreeable condition, as the disagreeableness to others can be prevented, but only by constant care on the part of the individual. Sometimes the curative treatment of these conditions is very successful; at other times all treatments are unsuccessful, and the patient's personal care of the condition must be persistent and continuous. From 2 to 5 per cent. solutions of the official Liquor Formaldehydi for bathing the axillæ and for washing the feet often prevent the profuse secretion, and are absolutely successful in inhibiting the disagreeable odor. Various drying powders, combined with thin clothing, proper socks and proper shoes (rubber-soled shoes should not be used by persons whose feet perspire freely) may be more or less successful. A good drying powder is: Or equal parts of alum and talcum powder may be used. Alcoholic and tannic acid washes, and chromium trioxide and potassium permanganate solutions have all been used with more or less success. A few Roentgen ray treatments may be very successful. Stillian1 has recommended a 25 per cent. solution of aluminum chloride to be swabbed on the sweating areas every second or third day, the solution being allowed to dry on the part. Three applications he finds sufficient, until there is a recurrence of the condition; in inveterate cases he would have the solution used 1 Journal A. M. A., Dec. 30, 1916, p. 2015. once a week. Too frequent or too profuse use of this solution causes irritation of the skin. Aluminum hydroxide may be used as a dry dusting powder. INGROWING TOE-NAIL The first treatment of this condition is to see that the stockings or socks are large enough, and that the shoes are large enough not to cause the toes to be pressed together. The local treatment consists in frequent applications of peroxide of hydrogen to stop the infection, cauterizing exuberant granulations with a drop of liquified phenol, if such treatment is necessary, and then inserting hydroxide of aluminum powder between the nail and the inflamed toe. Cotton should be gently pressed underneath the corner of the nail to prevent its digging into the flesh. Sometimes the thickened edge of the nail should be thinned so that it will be more flexible. At times the condition is so serious as to require more radical surgical treatment. INFLAMMATION OF THE MIDDLE EAR-OTITIS MEDIA Inflammation of the middle ear is very common and occurs very frequently, following influenza and infections of the nasopharynx. It often follows measles and scarlet fever, and is frequently due to mistaken treatment of the nose and nasopharynx by improper nasal douching. Nasal douching is generally a mistake unless it is done by slowly pouring the solution into the nostril from a small vial or from a spoon, or by snuffing the fluid through the nostrils to the nasopharynx; but douching apparatus and the goose-neck nasal douche are menaces to the ears. The most frequent germs of infection occurring in the middle ear are the streptococcus and the pneumococcus. When pain occurs in an ear and does not quickly subside, or if after subsiding the hearing of the ear is impaired, an aurist should see the patient, unless the physician in charge is himself expert in diagnosing the condition of the ear drum. If possible, a drum should not be allowed to perforate from fluid or suppuration occurring in the middle ear. The drum should be incised as soon as it bulges. The pain will immediately cease, and the danger of forcing infection into the mastoid will be minimized. Also, a clean cut incision in the drum will readily heal to make a perfect drum, while a perforated drum may never perfectly heal. Various solutions are used as ear drops to soothe the inflamed drum and to quiet the pain. Suggestions for simple solutions are as follows: This should be warmed and a few drops allowed to run into the ear, and then a small pledget of cotton should be gently inserted into the external canal. Or, Boric acid. Water.... 2 Gm. 50 mils .up to 100 mils This should be warmed and half a teaspoonful poured into the ear once in two or three hours, held there for a few minutes, then allowed to run out, and cotton placed in the canal as before. Or, Liquid phenol.. Water... 1 mil 20 mils .up to 50 mils This should be warmed and several drops allowed to run into the ear every three or four hours, and then cotton placed in the canal. Also the following is often efficient: Warm and use as ear drops every three or four hours. These soothing measures should not be allowed to befog the careful investigation by the physician as to whether or not the drum needs incision. The treatment after incision, and if there is actual suppuration, should be supervised, if not actually carried out, by an ear specialist. LEUCORRHEA Leucorrhea is of very frequent occurrence, due many times to some systemic condition; debility, tire, over-standing, and poor circulation are often causes of vaginal discharge. It is not purposed to here discuss the local causes of leucorrhea. Necessary examinations should be made, and proper treatment should be given in each case; but in young girls before subjecting them to pelvic examinations, their general condition should be studied, and if found at fault, corrected. Some women take too frequent douches; others take them too infrequently, unless they take sitz baths. Long periods of vaginal douching are inadvisable. The simplest douch is one of boric acid or borax (1 or 2 per cent. solution) with or without bicarbonate of sodium. There is no harm in a saturated solution of boric acid, if there is much purulent discharge and much odor. Such a douching may be given once or twice a day, depending upon the conditions present. Douches of yeast solutions are valuable (one yeast cake dissolved in a pint of warm water). If it is advisable to use a stronger astringent solution once a day or once in two or three days, the following is a useful formula: Zinc sulphate.. 5 Gm. 10 Gm. 500 mils (1 pint) A stronger astringent solution is a 12 per cent. solution of copper sulphate. Weak glycerin or boroglycerin suppositories, or suppositories containing tannic acid or ichthyol are often of value in curing a leucorrhea. Of course if the vaginal discharge is caused by pelvic or uterine inflammation, the cause must be treated. PART XIII PRACTICAL ADVICE TO YOUNG PHYSICIANS SOME TRUTHS ABOUT DRUGS In spite of all the various physical, dietary, psychical and special treatments that may be needed for a given patient, prescriptions for drugs are frequently necessary to overcome abnormal conditions. A drug may be needed to stop pain, to produce sleep, to increase elimination, to quiet nervous irritability, to inhibit or to stimulate the activity of some organ or gland, and to promote general nutrition. While many patients, both in acute and chronic conditions, need no drugs, there are but few diseases that do not require some aid from medication, although that medication may be of the simplest kind. If the patient requires no medicinal treatment he should not be given drugs, unless he is one of those who must take something for its mental effect, then some harmless mixture may be given. If it is necessary to write a prescription and to administer drugs, it is essential to know what drugs are useful and have activity, and what preparations of each drug are the most valuable. Also, a drug should not be used that is not known to have some definite, safe activity. It is essential that a drug should not be prescribed or administered to an individual except by one who understands the condition of the patient and the action of the drug he prescribes. It is also self-evident that a patient should be individualized, and a mixture of drugs which may be well adapted to one individual is likely not to be at all appropriate for, or advisable to administer to, another individual, although he may have the same disease. Consequently, mixtures kept ready prepared, so-called stock mixtures, whether in drug stores, hospitals, or dispensaries, or as proprietary mixtures, do not represent good treatment for the individual sick. On the other hand, it may be advisable, as some of the Pharmacopœial preparations represent, to have in stock a definite, palatable preparation that offers so much of a given drug in each |