Skin Diseases and Related Disorders
Household Remedies for Itching—Chafing and Chapping—Hives, Cold Sores and Pimples—Ringworms, Warts and Corns—Eczema and other Inflammatory Disorders.
No attempt will be made to give an extended account of a list of skin diseases, but a few of the commoner skind disorders which can be readily recognized by the layman will be noticed. Although these cutaneous troubles are often of so trivial a nature that a physician's assistance is unsought, yet the annoyance is often sufficient to make it worth while for the patient to inform himself about the ailment. Then the affections are so frequent that they may occur where it is impossible to procure medical aid. Whenever an eruption of the skin is accompanied by fever, sore throat, headache, pains in back and limbs, vomiting, or general illness, one of the serious, contagious, eruptive diseases should be suspected, particularly in children, and the patient must be removed from contact with others, kept in isolation, and a physician immediately summoned.
ITCHING (Pruritus).—Itching is not a distinct disease by itself, but a symptom or sign of other skin
general disorders. Occasionally it must be treated as if it were a separate disease, as when it occurs about the entrance to the bowel (anus), or to the external female sexual parts (vulva), or attacks the skin generally, and is not accompanied by any skin eruption except that caused by scratching, and the cause be unascertainable. Itching, without apparent cause, may be due to parasites, as lice and fleas, and this must always be kept in mind; although debilitated states of the body and certain diseases, as gout and diabetes, are sometimes the source. Commonly, itching is caused by one of the many recognized skin diseases, and is accompanied by an eruption characteristic of the particular disorder existing, and special treatment by an expert, directed to remedy this condition, is the only reasonable way to relieve the itching and cure the trouble. Read About Pulex Irritanx
general disorders. Occasionally it must be treated as if it were a separate disease, as when it occurs about the entrance to the bowel (anus), or to the external female sexual parts (vulva), or attacks the skin generally, and is not accompanied by any skin eruption except that caused by scratching, and the cause be unascertainable. Itching, without apparent cause, may be due to parasites, as lice and fleas, and this must always be kept in mind; although debilitated states of the body and certain diseases, as gout and diabetes, are sometimes the source. Commonly, itching is caused by one of the many recognized skin diseases, and is accompanied by an eruption characteristic of the particular disorder existing, and special treatment by an expert, directed to remedy this condition, is the only reasonable way to relieve the itching and cure the trouble. Read About Pulex Irritanx
It may not, however, be improper to suggest means to relieve such a source of suffering as is itching, although unscientific, with the clear understanding that a cure cannot always be expected, but relief may be obtained until proper medical advice can be secured. The treatment to be given will be appropriate for itching due to any cause, with or without existing eruption on the skin, unless otherwise specified. If one remedy is unsuccessful, try others.
For itching afflicting a considerable portion of the skin, baths are peculiarly effective. Cold shower baths twice daily, or swimming in cold water at the proper time of year, may be tried, but tepid or lukewarm baths are generally more useful. The addition of saleratus or baking soda, one to two pounds to the bath, is valuable, or bran water obtained by boiling bran tied in a bag in water, and adding the resulting solution to the bath. Even more efficient is a bath made by dissolving half a cupful of boiled starch and one tablespoonful of washing or baking soda in four gallons of warm water. The tepid baths should be as prolonged as possible, without chilling the patient. The bran water, or starch water, may be put in a basin and sopped on the patient with a soft linen or cotton cloth and allowed to evaporate from the skin, without rubbing, but while the skin is still moist a powder composed of boric acid, one part, and pulverized starch, four parts, should be dusted on the itching area.
Household remedies of value include saleratus or baking soda (one teaspoonful to the pint of cold water), or equal parts of alcohol, or vinegar and water, which are used to bathe the itching parts and then permitted to dry on them. Cold solution of carbolic acid (one teaspoonful to the pint of hot water) is, perhaps, the most efficacious single remedy. But if it causes burning it must be washed off at once. Dressings wet with it must never be allowed to become dry, as then the acid becomes concentrated and gangrene may result. Calamine lotion is also a serviceable preparation when there is redness and swelling of the skin. When the itching is confined to small areas, or due to a pimply or scaly eruption on the skin, the following ointments may be tried: a mixture of tar ointment and zinc ointment (two drams each) with four drams of cold cream, or flowers of sulphur, one part, and lard, twelve parts.
CHAFING AND CHAPPING.—Chafing occurs when two opposing skin surfaces rub together and are irritated by sweat, as in the armpits, under the breasts and beneath overlapping parts of the belly of fat people, and between the thighs and buttocks. The same result is caused by the irritation induced by discharges constantly running over the skin, as that seen in infants, due to the presence of urine and bowel discharges, and that irritation which arises from saliva when the lips are frequently licked. The latter condition of the lips is commonly called chapping, but it is proper to consider chafing and chapping together as the morbid state of the skin, and the treatment is the same for both.
Chafing occurs more often in hot weather and after violent exercise, as rowing, riding, or running, and is aggravated by the friction of clothing or of tight boots. It may, on the other hand, appear in persons who sit a great deal, owing to constant pressure and friction in one place. The parts are hot, red, and tender, and emit a disagreeable odor when secretions are retained. The skin becomes sodden by retained sweat, and may crack and bleed. The same redness and tenderness are seen in chapping of the face and lips, and cracking of the lips is frequent.
In chafing the first requisite is to remove the cause, and then thoroughly wash the part with soap and water. Then a saturated solution of boric acid in water should be applied with a soft cloth, and the parts dusted with a mixture of boric acid and powdered starch, equal parts, three times daily. If the lips are badly cracked, touching them, once daily, with a stick of silver nitrate (dipped in water) is of service.
HIVES; NETTLERASH (Urticaria).—Hives is characterized by the sudden appearance of hard round or oval lumps in the skin, from the size of a pea to that of a silver dollar, of a pinkish-white color, or white in the center and often surrounded by a red blush. The rash is accompanied by much itching, burning, or tingling, especially at night when the clothes are removed. The peculiarity of this eruption is the suddenness with which the rash appears and disappears; the itching, the whitish or red lumps, the fact that the eruption affects any part of the body and does not run together, are also characteristic. Scratching of the skin often brings out the lumps in a few minutes. The swellings may last a few minutes or hours, and suddenly disappear to reappear in some other place. The whole trouble usually continues only a few days, although at times it becomes a chronic affection.
Scratching alters the character of the eruption, and causes red, raw marks and crusts, but the ordinary swellings can be seen usually in some part of the body. Rarely, the eruption comes in the throat and leads to sudden and sometimes dangerous swelling, so that suffocation has ensued. With hives there are no fever, sore throat, backache, headache, which are common to the contagious eruptive disorders, as measles, scarlet fever, etc.
Indigestion is the most frequent cause. Certain articles of diet are almost sure to bring on an attack of hives in susceptible persons; these include shellfish, clams, lobsters, crabs, rarely oysters; also oatmeal, buckwheat cakes, acid fruits, particularly strawberries, but sometimes raspberries and peaches. Nettlerash is common in children, and may follow any local irritation of the skin caused by rough clothes, bites of mosquitoes and fleas, and the stings of jellyfish, Portuguese man-of-war, and nettles.
Treatment.—Remove any source of irritation in the digestive canal, or externally, and employ a simple diet for a few days, as bread and milk.
A dose of castor oil, one teaspoonful for children; one tablespoonful for adults, or some other cathartic is advisable. Locally we use, as domestic remedies, a saturated solution of baking soda (or saleratus) in water, or equal parts of alcohol or vinegar and water to relieve the itching. The bath containing soda and starch (p. 141) is the most useful treatment when the nettlerash is general. Calamine lotion is one of the best applications which can be employed for this disorder. It should be sopped on frequently with a soft cloth and allowed to dry on the skin.
Calamine Lotion
| Zinc oxide | 1/4 ounce |
| Powdered calamine | 1/4 " |
| Limewater | 6 ounces |
Mix and shake before applying to the skin.
If choking is threatened, give an emetic of mustard, one teaspoonful, and warm water, half a pint.
PIMPLES; BLACKHEADS (Acne).—This eruption is situated chiefly on the face, but often on the back, shoulders, and chest as well. It is a disorder which is seen mostly in young men and women at about the age of puberty. It consists of conical elevations of the skin, from a pin head to a pea in size, often reddened and tender on pressure, and having a tendency to form matter or pus, as shown by a yellow spot in the center of the pimple. After three to ten days the matter is discharged, but red elevations remain, which later become brown and disappear without scarring, except in rare cases.
"Blackheads" appear as slightly elevated black points, sometimes having a yellowish tint from which a little, thin, wormlike mass may be pressed. Pimples and blackheads are both due to inflammation about the glands of the skin which secrete oily material; the mouths of the glands become plugged with dust, thus retaining the oily secretion and causing blackheads. Then if these glands are invaded by germs producing pus, we have a pimple, which usually results in the formation of matter as described above. Constipation and indigestion favor the occurrence of pimples and blackheads; also a poor state of the blood, or anæmia.
Treatment.—Tea, coffee, tobacco, and alcohol should be avoided, together with veal, pork, fats, and cheese. The bowels must be moved daily by some proper cathartic, as cascara tablets containing two grains each of the extract. The dose is one to two tablets at night. The blackheads should be squeezed out with a watch key, or with an instrument made for the purpose, not finger nails, and pimples containing matter must be emptied after being pricked with a needle (which has been passed through a flame to kill germs on it). If there is redness of the skin and irritation associated with pimples, it is sufficient to bathe the skin with very hot water and green soap three times daily, and apply calamine lotion (see p. 145) at night. In other cases, when the skin is not sensitive, and zinc or mercury has not been used, the employment of sulphur soap and hot water at bedtime, allowing the suds to dry and remain on the face during the night, is to be recommended. An ointment consisting of half a dram of precipitated sulphur with half an ounce each of powdered starch and vaseline applied each night, and hot water used on the face three times daily are also efficacious. Sulphur lotion is better than sulphur ointment.
COLD SORE; FEVER BLISTER.—Cold sores occur usually about the lips or at the angles of the mouth, although they may appear anywhere on the face. Cold sore has a round, oval, or irregular outline, from the size of a pea to that of a quarter of a dollar, and is seen as a slightly raised patch on the skin on which is a group of very minute blisters, three to twelve in number. Cold sore may be single or multiple, and near together or widely separated on the face. Having first the appearance of a red patch, it later becomes covered with a brown crust from the drying of the contents of the tiny blisters. Cold sore often gives rise to burning, itching, or tingling, the disfigurement usually causing more annoyance, however, than the pain. The duration of the trouble is from four to twelve days.
Cold sores are commonly induced by indigestion and fevers, and also are occasioned by local irritation of any sort, as from nasal discharge accompanying cold in the head (from which the name is derived), by the irritation produced by a pipestem or cigar, and by rubbing the skin.
Treatment.—Picking and scratching are very harmful, and cigar or pipe smoking must be stopped. Painting the sore with collodion, by means of a camel's-hair brush, is poor treatment in the early stages. Better use spirits of camphor, and afterwards, if there is much itching or burning, sopping the eruption with calamine lotion (p. 145) will relieve the discomfort.
PRICKLY HEAT (Miliaria).—This is a common eruption of adults in hot weather, and very frequently attacks children. It consists of fine, pointed, red rash, or minute blisters, and occurs on parts of the body covered by clothing, more often on the chest. The eruption is caused by much sweating, leading to congestion and swelling of the sweat glands. Burning, stinging, and itching accompany the disorder. The condition must be distinguished from the contagious skin eruptions. In the latter there are fever, sore throat, backache, headache, and general sickness, while in prickly heat there is no general disturbance of the system, or fever, unless the eruption comes out in the course of fevers, when it is of no significance except as one of the symptoms of fever.
Treatment.—The treatment of prickly heat, occurring in hot weather, consists in avoiding heat as much as possible and sponging the surface with cold water, and then dusting it with some simple powder, as starch or flour, or better, borated talcum. To relieve the itching, sponging with limewater or a saturated solution of baking soda (as much as will dissolve) in water, or bran baths, made by tying one pound of bran in a towel which is allowed to soak in the bath, are all good remedies.
RINGWORM OF THE BODY; RINGWORM OF THE SCALP.—This skin disease is caused by a vegetable fungus and not by a worm as the name suggests. The disease on the body and scalp is caused by the same parasite, but ringworm of the body may attack adults as well as children, and is readily cured; ringworm of the scalp is a disease confined to children, and is difficult of cure. Ringworm is contagious and may be acquired from children with the disease, and therefore patients suffering from it should not be sent to school, and should wear a skull cap and have brush, comb, towels, and wash cloths reserved for their personal use alone. Children frequently contract the disease from fondling and handling cats and dogs.
Symptoms.—On the body, ringworm attacks the face, neck, and hands. It appears first as small, red, scaly spots which may spread into a circular patch as large as a dollar with a red ring of small, scaly pimples on the outside, while the center exhibits healthy skin, or sometimes is red and thickened. There may be several patches of ringworm near each other and they may run together, or there may be only one patch of the disease. Ringworm of the scalp occurs as a circular, scaly patch of a dusty-gray or pale-red color on which there are stubs of broken hairs pointing in different directions, and readily pulled out. The disease in this locality is very resistant to treatment. There are no crusts or itching as in eczema.
Treatment.—The application of pure tincture of iodine or carbolic acid to the spots with a camel's-hair brush, on one or two occasions, will usually cure ringworm on the skin. On the scalp the hairs should be pulled out of the patch of ringworm, and each day it should be washed with soap and water and a solution of boric acid (as much acid as the water can dissolve), destroying the cloth used for washing. The following ointment is then applied: sulphur, one part; tar, two parts; and lard, eight parts. It is desirable to secure the services of a physician in this disease, in which various remedies may have to be tried to secure recovery. If untreated, ringworm is likely to last indefinitely.
FRECKLES, TAN, AND OTHER DISCOLORATIONS OF THE SKIN.—Freckles appear as small, yellowish-brown spots on the face, arms, and hands, following exposure to the sun in summer, and generally fading away almost completely in winter. However, sometimes they do not disappear in winter, and do occur on parts of the body covered by clothing. Freckles are commonly seen in red-haired persons, rarely in brunettes, and never on the newborn. Their removal is accomplished by the employment of agents which cause a flaking off of the superficial layer of discolored skin, but after a few weeks the discolorations are apt to return. Large, brown spots of discoloration appearing on the face are observed more often in women, and are due to disorder of digestive organs of the sexual organs or to pregnancy; they also occur in persons afflicted with exhausting diseases. Tan, freckles, and discolorations of the skin generally are benefited by the same remedies.
Treatment.—Prevention of tan and freckles is secured through nonexposure of the unprotected skin to the sun, though it is doubtful whether the end gained is worth the sacrifice, if carried so far as to the avoidance of the open air and sunlight whenever possible.
Boric acid (sixteen grains to the ounce of water) is an absolutely harmless and serviceable agent for the removal of skin pigmentations. The skin may be freely bathed with it night and morning. Corrosive sublimate is the most effective remedy, but is exceedingly poisonous if swallowed accidentally, and must be kept out of children's way, and should not be applied over any large or raw surface of skin or on any mucous membrane. Its application is inadvisable as soon as any irritation of the skin appears from its use. The following preparation containing it is to be painted on the skin with a camel's-hair brush, night and morning:
Poisonous Sublimate Solution
| Corrosive sublimate | 7 grains |
| Alcohol | 11/2 ounces |
| Glycerin | 11/2 " |
| Oil of lavender | 10 drops |
Mix.
The following lotion is also efficacious:
| Zinc oxide | 30 grains |
| Powdered starch | 30 " |
| Kaolin | 60 " |
| Glycerin | 2 drams |
| Rose water | 2 ounces |
Mix.
Directions.—Shake and paint on spots, and allow the preparation to dry; wash it off before each fresh application.
It is best to use only cold water, rarely soap, on the healthy skin of the face. Warm water favors relaxation of the skin and formation of wrinkles.
IVY POISON.—The poison ivy (Rhus toxicodendron), poison sumach (Rhus venenata), and poison oak (Rhus diversiloba of the Pacific Coast, U. S. A.) cause inflammation of the skin in certain persons who touch either one of these plants, or in some cases even if approaching within a short distance of them. The plants contain a poisonous oil, and the pollen blown from them by the wind may thus convey enough of this oil to poison susceptible individuals who are even at a considerable distance. Trouble begins within four to five hours, or in as many days after exposure to the plants.
The skin of the hands becomes red, swollen, painful, and itching. Soon little blisters form, and scratching breaks them open so that the parts are moist and then become covered with crusts. The poison is conveyed by the hands to the face and, in men, to the sexual organs, so that these parts soon partake of the same trouble. The face and head may become so swollen that the patient is almost unrecognizable. There is a common belief that ivy poison recurs at about the same time each year, but this is not so except in case of new exposures. Different eruptions on the same parts often follow ivy poisoning, however.
Treatment.—A thorough washing with soap, especially green soap, will remove much of the poison and after effects. Saleratus or baking soda (a heaping tablespoonful of either to the pint of cold water) may be used to relieve the itching, but ordinary "lead and opium wash" is the best household remedy. Forty minims of laudanum and four grains of sugar of lead dissolved in a pint of water form the wash. The affected parts should be kept continually wet with it. Aristol in powder, thoroughly rubbed in, is almost a specific.
WARTS.—Warts are flattened or rounded outgrowths from the outer and middle layers of the skin, varying in size from a pin head to half an inch in diameter. There are several varieties.
Seed Warts.—These have numerous, little, fleshy projections over their surface, which are enlarged normal structures (papillæ) of the middle layer of the skin, together with the thickened, outer, horny layer.
Threadlike Warts.—These are seen along the edge of the nails, on the face, neck, eyelids, and ears.[Pg 154] They are formed by the great prolongation and growth of the projections, or papillæ of the middle layer of the skin just described.
Flat Warts, raised but slightly above the surface are more common in old people.
Moist Warts occur where they are softened by secretions of the body, as about the sexual organs (in connection with diseases of the same), and about the anus (or opening of the bowel). They are of a white, pink, or red color, and consist of numerous, little, fleshy projections, usually covered with a foul-smelling secretion.
Warts most commonly appear on the hands of children, but may appear on any part of the body and at all ages. They may disappear quickly or remain indefinitely. They are not communicable from one person to another.
Treatment.—Warts may be removed by painting them frequently with the fresh juice of the milkweed, or with acetic acid or tincture of iodine. These remedies are all harmless, but somewhat slow and not always effective. Application, morning and evening, of a saturated solution of "washing soda" (impure bicarbonate of potash) will often remove a wart.
CORNS.—Corns are local, cone-shaped thickenings of the outer layer of the skin of the feet, due to pressure and friction of the shoes, or opposed surfaces of skin between the toes. They are not in themselves sensitive, but pain follows pressure upon them, as they[Pg 155] act as foreign bodies in bearing down upon the sensitive lower layers of the skin. Continued irritation often leads to inflammation of the skin around and beneath the corn with the formation of pus. Ordinarily, corns are tough, yellowish, horny masses, but, when moistened by sweat between the toes, they are white, and are called "soft corns."
Treatment.—Comfortable shoes are the first requisite; well-fitting and neither tight nor loose. Pressure may be taken off the corns by surrounding them with felt rings or corn plaster. To remove the corn the foot should be soaked for a long time in warm water, in which is dissolved washing soda, and then the surface of the corn is gently scraped off with a clean, sharp knife. Another useful method consists in painting the corn, night and morning for five days, with the following formula, when both the coating and corn will come off on soaking the same for some time in warm water:
| Salicylic acid | 30 grains |
| Tincture of iodine | 10 drops |
| Extract of Cannabis Indica | 10 grains |
| Collodion | 4 drams |
Mix.
When the tissues about the corn become inflamed the patient must rest with the foot elevated and wrapped in a thick layer of absorbent cotton saturated with a hot solution of corrosive sublimate (one tablet to the pint of water) and covered with oil silk or rubber cloth. Pus must be let out with a knife which has been laid in boiling water.
If corns are removed by the knife the foot should be previously made absolutely clean, the knife boiled, and the paring not carried to the extent of drawing blood. The too-close removal of a corn may lead to infection of the wounded tissues with germs, and in old people, and those with feeble circulation, gangrene or erysipelas may result. Soft corns are treated by removal of the surface layer, by soaking in washing soda and hot water and scraping as above stated, and then the corn should be dusted with a mixture of boric acid and zinc oxide, equal parts, and the toes kept apart by pads of absorbent cotton.
CALLUS AND CRACKS OF THE SKIN.—Callus consists of round or irregular, flattened, yellowish thickenings of the upper or horny layer of the skin. The skin becomes hypertrophied and resembles a thick, horny layer, caused by intermittent pressure of tools, shoes, etc. The whole palm of the hand or soles of the feet may be the seats of a continuous callus. Callus is not harmful, except in leading to cracks of the skin near the bend of joints, and, rarely, in causing irritation, heat, pain, and even the formation of pus in the skin beneath. Callus usually disappears when the exciting cause or pressure is removed.
Treatment.—The hands and feet should be soaked continuously in hot baths containing washing soda, and then should be covered with diachylon (or other) ointment. This may be done each night; or collodion (one ounce containing thirty grains of salicylic acid) may be painted, night and morning for several days, on the callus, and then, after soaking for some time in hot water, the surface should be scraped off with a dull knife and the process repeated as often as necessary to effect a cure. Fissure or cracks of the skin caused by callus are treated in the same manner: by prolonged soaking in hot water, paring away the edges, and applying diachylon ointment or cold cream to the part. Inflammation about callus must be cared for as recommended above for inflamed corns.
BOILS.—A boil is a circumscribed inflammatory process, caused by the entrance of pus-producing germs into the skin either through the pores (the mouths of the sweat glands) or along the shafts of the hair, and in this way invading the glands which secrete a greasy material (sebaceous glands). In either case the pus germs set up an inflammation of the sweat or sebaceous glands, and the surrounding structures of the skin, and a small, red, itching pimple results. Rarely, after a few days, the redness and swelling disappear, and the pus, if any, dries and the whole process subsides. This is called a "blind boil." But usually the boil increases in size for several days, until it may be as large as a pigeon's egg. It assumes a bright-red sharply defined, rounded shape, with a conical point, and is at first hard and then softens as pus or "matter" forms. There is severe pain of a throbbing, boring character, which is worse at night, and destroys the patient's sleep and appetite. There may be some fever. The glands in the neighborhood may be enlarged and tender, owing to some of the pus germs' escaping from the boil and lodging in the glands.
If the boil is not lanced, it reaches its full development in seven to ten days with the formation of a central "core" of dead tissue and some pus, which gives to the center of the boil a whitish or yellowish-brown appearance. The boil then breaks down spontaneously in one or more places (usually only one) and discharges some pus, and, with a little pressure, also the white, central core of dead tissue. The remaining wound closes in and heals in a week or two. Boils occur singly or in numbers, and sometimes in successive crops. When this happens it is because the pus germs from the previous boils have invaded fresh areas of skin.
Causes.—Boils are thus contagious, the pus germs being communicated to new points on the patient's skin, or to that of another person. Local irritation of the skin, from whatever cause, enables the germs to grow more readily. The existence of skin diseases, as eczema ("salt rheum"), prickly heat, and other sources of itching and scratching, is conducive to boils, as the pus germs contained in ordinary dirt are rubbed into the irritated skin. Whenever the skin is chafed by rough clothing, as about the wrists and neck by frayed collars and sweaters, etc., boils are likely to occur. Also when the face and neck are handled by barbers with dirty hands or instruments, a fruitful field is provided for their invasion. While boils are always the result of pus germs gaining entrance to the skin glands, and, therefore, strictly due to local causes, yet they are more prone to occur when the body is weakened and unable to cope with germs which might do no harm under other circumstances.
The conditions favoring the occurrence of boils are: an impoverished state of the blood, errors of diet and indigestion, overwork, dissipation, and certain diseases, as typhoid fever, diabetes, and smallpox. Boils are thought to occur more frequently in persons with rough skin and with a vigorous growth of dark hair. They may be situated on any part of the body, but certain localities are more commonly attacked, as the scalp, the eyelids, cheeks, neck, armpits, back, and buttocks. Boys and young men are generally the sufferers.
Treatment.—The importance of cleanliness cannot be overestimated in the care of boils if we keep their cause in mind. Dirty underclothes or fingers used in squeezing or otherwise handling the boil, may carry the trouble to fresh parts. Any sort of local irritation should be removed; also all articles of clothing which have come in contact with the boils should not be worn until they have been washed in boiling water. There is no single remedy of much value for the cure of boils, although pills of calcium sulphide (each one-tenth grain) are commonly prescribed by physicians, every three hours.
The most rational measure consists in removing the general causes, as noted above, if this is possible. When the patient is thin and poorly nourished, give food and cod-liver oil; and if the lips and skin are pale, iron arsenate pills (one-sixteenth grain each) are to be taken three times daily for several weeks. A boil may sometimes be arrested by painting it with tincture of iodine until the boil is almost black, or with a very heavy coating of collodion. If a boil continues to develop, notwithstanding this treatment, one should either use an ointment of vaseline containing ten per cent of boric acid spread on soft cotton over the boil, or, if the latter is very painful, resort to the frequent application of hot flaxseed poultices.
When the boil has burst, and pus is flowing out on the surrounding skin, it should be kept very clean by frequent washing with hot water and soap and the application of a solution of corrosive sublimate (one part to 1,000) made by dissolving one of the tablets, sold everywhere for surgical purposes, in a pint of warm water. This will prevent the lodgment of the pus germs in the skin and the formation of more boils. Poultices mixed with bichloride (corrosive sublimate) solution are less likely to encourage inoculation of neighboring areas.
The poultices should be stopped as soon as the pain ceases, and the boil dressed as recommended above,[ dusted with pure boric acid and covered with clean absorbent cotton and bandage. After pus has begun to form in a boil recovery will be materially hastened by the use of a knife, although this is not essential. The boil should be thoroughly cleaned, and a sharp knife, which has been boiled in water for five minutes, is inserted, point first, into the center of the boil, far enough to liberate the pus and dead tissue. By this means healing is much more rapid than by nature's unassisted methods. Pure carbolic acid, applied on the tip of a toothpick, thrust into the head of a boil, is generally curative. When many boils occur, consult a physician.
CARBUNCLE.—A carbuncle is similar to a boil in its causation and structure, but is usually a much more serious matter having a tendency to spread laterally and involve the deeper layers of the skin. It is commonly a disease of old persons, those prematurely old or debilitated, and occurs most frequently on the neck, back, or buttocks. It is particularly dangerous when attacking the back of the neck, upper lip, or abdomen.
Carbuncle often begins, with a chill and fever, as a pimple, and rapidly increases in size forming a hot, dusky red, rounded lump which may grow until it is from three to six inches in diameter. Occasionally it runs a mild course, remains small, and begins to discharge pus and dead tissue at the end of a week and heals rapidly. More commonly the pain soon becomes intense, of a burning, throbbing character, and the carbuncle continues to enlarge for a week or ten days, when it softens and breaks open at various points discharging shreds of dead tissue and pus. The skin over the whole top of the carbuncle dies and sloughs away, leaving an angry-looking excavation or crater-like ulcer. This slowly heals from the edges and bottom, so that the whole period of healing occupies from a week to two, or even six months. The danger depends largely upon blood poisoning, and also upon pain, continuous fever, and exhaustion which follow it. Sweating and fever, higher at night, are the more prominent signs of blood poisoning.
Carbuncles differ from boils in being much larger, in having rounded or flat tops instead of the conical shape of boils, in having numerous, sievelike openings, in the occurrence of death of the skin over the top of the carbuncle, and in being accompanied by intense pain and high fever.
Treatment.—Carbuncle demands the earliest incision by a skilled surgeon, as it is only by cutting it freely open, or even removing the whole carbuncle as if it were a tumor, that the best results are accomplished. However, when a surgeon cannot be obtained, the patient's strength should be sustained by feeding every two hours with beef tea, milk and raw eggs, and with wine or alcoholic liquors. Three two-grain quinine pills and ten drops of the tincture of the chloride of iron in water should be given three times daily.
The local treatment consists in applying large, hot, fresh flaxseed poultices frequently, with the removal of all dead tissue with scissors, which have been boiled in water for ten minutes. When the pain is not unbearable, dressings made by soaking thick sheets of absorbent cotton in hot solution of corrosive sublimate (1 to 1,000 as directed under Boils, p. 161) should be applied and covered by oil silk or rubber cloth and bandage. They are preferable to poultices as being better germ destroyers, but are not so comfortable. When the dead tissue comes away and the carbuncle presents a red, raw surface, it should be washed twice a day in the 1 to 1,000 corrosive-sublimate solution, dusted with pure boric acid, and covered with clean, dry absorbent cotton and bandage.
ECZEMA; SALT RHEUM; TETTER.—Eczema is really a catarrhal inflammation of the skin, with the exudate (fluid that escapes) concealed beneath the surface, or appearing on the surface after irritation has occurred. The many varieties are best classified as follows:
(1) Eczema of internal origin, including cases due to morbid agencies produced within the body, cases due to drugs, and possibly reflex cases.
(2) Eczema of external origin, including cases caused by occupation, by climate, or by seborrhea.
Eczema of internal origin almost invariably appears on both sides of the body at once, as on both cheeks, or both arms, or both thighs. Its border shades into the surrounding skin, it is dotted with papules (or heads) filled with fluid, and its surface is clean and not greasy. As it spreads, the symmetry of distribution is lost. Among the morbid agencies producing this variety of eczema are the products of indigestion. Among the drugs producing it is cod-liver oil.
Occupation eczema occurs first on exposed parts, as the hands, arms, face, and neck, in those who handle irritant dyes, sugar, formalin, etc.
Climatic eczema includes the "winter itch," common in this latitude, appearing on wrists and ankles in the form of clean, scaly patches, often ringed.
The seborrheic variety spreads from the scalp to the folds of the skin. Its borders are sharply defined, and its crusts and scales yellowish and greasy. It spreads from a center in all directions at once.
Treatment.—The treatment of eczema puzzles a physician, and only specialists in skin diseases are able easily to diagnose the subacute or chronic forms. It may appear different, and need different treatment almost from day to day, and consequently only general suggestions can be made for home management of a case of this disease.
The outlook is always good; and even in the case of weak and debilitated patients, there is excellent chance of cure.
The diet must be regulated at once. Meat should be eaten in small quantities once a day only, and none but very digestible meats should be eaten, as fowl, beef,[Pg 165] and lamb. Sugar and sweet food need be cut down only when there is indigestion with a production of gas. Fresh air and exercise are imperative. Five grains of calomel, at night, followed by one heaped tablespoonful of Rochelle salts dissolved in a full tumbler of water the next morning before breakfast, should be repeated twice a week till marked improvement is seen. Meanwhile, external treatment must be pushed.
Generally speaking, ointments must not be used on weeping or exuding surfaces; all scales and crusts must be removed from the surface; and acute patches must be soothed, chronic patches stimulated. Water is harmful and increases the trouble; but it is necessary to use it once, in cleansing the affected area, in the form of soap and water. If there are thick, adherent crusts, a poultice of boiled starch, covered with a muslin cloth, will loosen them in a night. Thickened or horny layers on the palms and soles may be covered with salicylic plaster (ten per cent strength), which is removed after two days, and the whole part soaked in warm water, when the horny layer is to be peeled off. Thickened surfaces are best treated with wood tar, in the form of oil of cade ointment, or the "pix liquida" of the drug shops mixed with twice its amount of olive oil. This should be well rubbed into the affected part.
Seborrheic eczema of the scalp and neighboring areas is best treated with a four per cent ointment of ammoniated mercury, rubbed in once a day for five days, followed by the application of a solution of resor[Pg 166]cin in water, four grains to the ounce. Weeping and exuding patches should be treated with powdered stearate of zinc, or oleate of bismuth, or aristol, either one dusted on till the area is fairly covered. When the surface begins to dry up, the following paste may be applied:
| Salicylic acid | 5 to 15 grains |
| Zinc oxide | 2 drams |
| Powdered starch | 2 drams |
| Vaseline | 1 ounce |
If weeping returns, stop the ointment and resume the powder treatment, or use the following lotion:
| Zinc oleate | 1 dram |
| Magnesium carbonate | 1 dram |
| Ichthyol | 1/2 ounce |
| Lime water | 4 ounces |
When the skin after scaling off becomes thin, all swelling having disappeared, lead plaster is of service, or diachylon ointment twenty-five per cent, made with olive oil.
An eczema of moderate extent should recover after four to six weeks' treatment, unless the soles or palms be attacked, when six or more months of treatment may be necessary.
If itching is pronounced, remove crusts and scabs after soaking with olive oil, dust borax, finely powdered on the surface. If the itching is not controlled in twenty minutes, wipe off the borax with a very oily[Pg 167] cloth (using olive oil), and then apply a little solution of carbolic acid (made by adding a half teaspoonful of carbolic acid to a pint of hot water). If this does not allay the itching, wipe it off thoroughly with the oiled cloth, and rub in the tar ointment made of equal parts of "pix liquida" and olive oil. After the itching ceases, treat as directed according to the variety existing. Itching often disappears after a good saline cathartic has acted—Rochelle salts, solution of magnesia citrate, or phosphate of soda. Scratching must be avoided. In the case of children it is prevented by putting mittens of muslin on the hands.
The best cathartic for young children is a teaspoonful of castor oil. Carbolic-acid solution must not be used on them. The folds and creases of their skin must be kept dry and powdered with borated talcum. A great point in the treatment of all eczema is to avoid the use of water, and to substitute oiling with olive oil and wiping off for the usual washing of the affected area.
BALDNESS AND DANDRUFF.—Baldness is commonly caused by seborrhea of the scalp, an affection probably due to a microbe, and consisting of an inflammation of the skin, with great increase of dandruff of a thick, greasy variety. Sometimes it appears as a thick film, not only covering the scalp, but also the forehead and back of the neck. The greasy substance should be removed with olive oil or vaseline, and the scalp treated with ointment of ammoniated mercury, four per cent strength. Shampoos with tar-soap suds should be given once in four or five weeks, and the hair should not be wet with water between the shampoos. The hair must be arranged by combing, the brush being used to smooth the surface of the hair only. Deep and repeated brushing does great damage, which is equalled only by the frequent washing some ill-advised sufferers employ. Massage of the scalp is useless to control seborrheic eczema, which is practically always present in these cases.
Tight hats are sometimes a cause of baldness. The lead used in the preparation of the "sweat leather" of hats is said to be a cause of loss of hair over the temples. When once killed, hair can rarely be made to grow again. Early treatment of seborrhea is the best preventive of baldness.
The baldness occurring during an attack of syphilis, when the hair falls out in round patches, is treated and often relieved by antisyphilitic remedies
