CHILBLAIN.
Prevention consists, as in the case of chapped hands. in the avoidance of frequent washing with very hot or very cold water and exposing the imperfectly dried hands to the heat of the fire, and of exposure to cold winds, followed by injurious warming methods. Vigorous open-air exer cise, even in coldest weather, during which the hands should be protected by loosely fitting thin woollen gloves. is imperative. When the feet are attacked, woollen stockings and roomy hoots with cork insoles should be worn; night-socks may be used in bed after vigorous towelling. but hot-water bottles must be condemned.
Internal remedies (Iron and Quinine, &c.) are usually necessary, especi ally when anemia is present, and in many chronically susceptible patients there appears to be a well-defined diathesis, as pointed out by Wright, in which constant headaches, chilblains, an ervthematous state of the general cutaneous surface and slight (edema of the legs are present. This condi tion can only be relieved by increasing the coagulable power of the blood by administering Chloride of Calcium (r5-gr. doses) for short courses. a practice which the writer has many times found to give most unmistakably good results. Ichthyol internally has many advocates.
If the lesion has already appeared, local treatment in the early erythe matous stage may effectually prevent ulceration, by restoring the tone of the vessels through vigorous friction and the use of any stimulating appli cation as the following:— R. Tr. Capsici 5j.
Tr. Cannab. Ind. 5j.
Olei Cajouti 3j.
Spirit. Camphore ad 3ij. 3/isce.
Fiat Linimenturn.
Lin. Camph. Co. is a good application, as is also the following:—Lin. Saponis, Chloroformi, 5j.; Lin. Belladonnte, 3iv.; mince.
Mansel Symp on recommends bathing of the affected parts in ro vol. Peroxide of Hydrogen Solution diluted with an equal quantity of hot water for 15 to 20 minutes twice daily.
Tr. Iodi Fort. freely painted over the parts often acts well, and when severe pain and tingling are complained of Belladonna Liniment, Menthol, Oil of Peppermint, or of Eucalyptus, may be employed, but these agents should not be applied when the skin is broken.
Electricity in every form has its advocates; the X rays and also high frequency currents have proved a valuable means of improving the tone of the cutaneous vessels. Flexile Collodion painted over the erythematous skin often acts well, and a 20 per cent. Fornialin Ointment applied at night acts as a local tonic.
When ulceration has occurred the sore must be treated upon general surgical principles, the main fact being kept in mind that as the local vascular condition has its tone reduced stimulating ointments are indi cated. One of the best routine applications is the following: It. Tr. Benzoin. Co. 3ij.
Lanolin. 5iv.
Ungt. Zinei Ox. Tsj. Misce.
Friar's Balsam may be replaced by Balsam of Peru in the above: Ichthyol 1 part and Lanolin 4 parts make an excellent ointment. For very sluggish sores there is nothing better than Basilicon (Ungt. Resina;), to which a few grains of Compile) to each oz. may he added. ShoUld healing still remain slow, 5 grs. per oz. solution of Chloral Hydrate should be tried. Caustics are to be avoided, especially Argent. Nit., which is very painful, but occasionally flabby granulations may be lightly touched with a smooth L:rystal of Copper Sulphate. The ointments used in the ulcerating stage should be of firm consistence, and should be applied thickly spread upon lint and blebs snipped as they form, so as to bring the unguent into direct :.ontact with the ulcerated surface.