The feet and armpits are chiefly the scat of this affection, with its excessive perspiration accompanied by evil-smelling exhalations. The most scrupulous and frequent cleansing by antiseptic solutions must be rigidly enforced, and the general health carefully attended to. Internal remedies are of little use, though Belladonna or Atropine inter nally has some influence upon the secretion of the sweat, and may be com bined with Ergot; or io grs. of Boric Acid along with 3o grs. of Precipitated Sulphur morning and night may he tried.
The best local treatment is powdered Boric Acid rubbed into the skin and dusted freely between the toes, and generously strewn over the inside of the stockings and boots, and repeated twice a day or oftener with change of stockings after thorough washing in two or three waters containing Condy's fluid, Creolin or a small quantity of Chlorinated Lime. Cork inside soles should be worn and changed from time to time, or dipped into saturated Boracic Acid Solution and allowed to dry. Stockings may be treated in the same way with advantage. Old footwear should be dis carded and roomy shoes, or boots with cloth tops, are to be worn ; the feet should be kept as cool as possible, and the armpits well ventilated by apertures made in the undershirt. This treatment will, in the great majority of cases, effect a cure if persisted in. Strong Boric Ointment may be used instead by those who have long walks to accomplish. Smearing the feet or axilhe with Glycerin or sponging with strong Alcohol is often efficacious.
Bardet recommends Pulv. Talcis, 5x.; I3ismuthi Subnit., 3xi.; Potassii Permang., 5iij.; Sochi Salicyl., ass., sprinkled inside the stocking soles after washing the feet.
Pringle uses Sodii 15 grs.; Bismuth. Subnit., 3o grs.; Pot.
Perman., 8o grs.; with Creta Prep., 6 drs.
Liniment of Belladonna is useful when painted over the feet or armpits; and lIebra used the Diachylon Ointment (melted diachylon plaster, mixed with an equal weight of linseed oil), spread upon strips of linen and applied morning and night. In a few days the thick cuticle exfoliates, leaving a healthy skin below. After this has come away, astringent dusting
powders effect a cure in a few weeks.
Stillians recommends the painting on of a 25 per cent. Solution of Aluminium Chloride, which should he allowed to dry on the skin. Hydrg. Perchlor. Solution i in 2,5oo has been tried, and solution of Salicylate of Soda, Oxalic Aid, Naphthol and Boroglyceride have given good results. A strong spirituous solution of Quinine and a 6 per cent. aqueous solution of Zinc Chloride have given good results. Unna uses an ointment consist ing of equal parts of Zinc Ointment, Turpentine and Ichthyol, and dusts in a powder during the day composed of 15 grs.powdered Mustard and r oz. Talc. Kaposi applies a solution of 24 grs. Naphthol, 48 m. Glycerin, and i oz. Alcohol, twice a day, and afterwards dusts on iG grs. Naphthol, mixed with 3 oz. Starch Powder. Formalin painted over the sole of the foot in 5 per cent. Solution and a weaker strength (i per cent.) applied to the dorsum is also efficacious. Resorcin diluted with starch makes a good antiseptic powder.
Dry Boracic Acid will often effect a cure when ulcers and abrasions occur, but the use of a 5 to ro per cent. Solution of Chromic Acid as a preventive before ulcers break out was adopted in the German Army for tender feet. The writer has seen trouble follow the use of this solution in cases where blisters or ulcers had already formed, and several cases of serious poisoning from the absorption of the acid are reported. A 2 per cent. Ointment of Salicylic Acid is now used in army practice.
Neebe places the soles of the feet and heels in crude Nitric Acid for a few seconds or in Hydrochloric Acid for ten minutes, taking care not to let the acid come in contact with the dorsum of the foot. As soon as pain is excited the immersion is stopped. The skin, especially between the toes, is then carefully washed in soap and warm water. Applications of the hydrochloric acid are repeated twice weekly for five to eight weeks, when a permanent cure may be confidently expected after exfoliation has been completed. A To per cent. solution of Nitrate of Silver may be used in the same manner.