TINEA, OR RINGWORM.
Linea Circinala is the name applied to ringworm of the glabrous skin of the body. Whether due to the small or large spored trickophyton this type of the disease is easily and speedily cured by almost any anti parasitic application. The best routine application in mild cases is a mixture of equal parts of the Strong and Weak Tinctures of Iodine brushed over the diseased area. When the affection is due to the large-spored fungus received directly from the skin of cows, as is often observed amongst rural inhabitants and those in suburban districts who are employed in byres, the parasite is more resistant and tends to spread over large areas of the skin. Such cases require more active treatment, and the writer has found that the best application is the late L.P. Ungt. Suiph. lod. This ointment should, however, be very carefully triturated; when applied after being freshly made it is liable to produce considerable irritation, whilst if it is kept for some time after preparation, the particles of iodide of sulphur are partially dissolved in the fatty base, and though less irritating to the skin the preparation is more destructive to the spores.
The thick skin of the agricultural labourer, exposed to the various vicissitudes of an outdoor life, will bear an ointment of s in 8, but the city clerk or school-girl may suffer from the application of even quarter this strength.
The Ointments of Iodine, Hydrarg. Nit., White Precipitate, Phenol, Creosote, Chrysarobin and Salicylic Acid are all efficacious when rubbed into the affected patches. When for any reason a greasy application is objectionable, and when the soluble Iodine application already mentioned is unsightly for exposed patches, a solution consisting of Corrosive Sublimate i, Salicylic Acid so, Carbolic Acid so, with Glycerin 8o, may be painted over the rings. These agents, it must be remembered, are all capable of producing eczema or dermatitis, which will persist as long as the applications are continued, and the irritation which they cause must not he mistaken for the specific inflammation caused by the parasite. Dr. J. H. Clark successfully treats all cases, including T. Sycosis, by applying Sodium Carb. crystals liquefied over a spirit-lamp and covering the part with lint.
Tinea Tonsurans, or Ringworm of the Scalp.—The treatment of this hitherto often intractable disease has been reduced almost to the simplicity of that of ringworm of the body, since the introduction of the X rays. The main difficulty existed in epilation, because antiparasitic remedies are useless till they are introduced into the hair follicles. Formerly epilation by means of forceps was employed, each hair being pulled out separately, but as the diseased hairs are rendered brittle epilation by mechanical means failed on account of the stumps being often left behind.
By exposing the scalp to the X rays after the hair has been cropped with scissors, the entire area can be safely and effectually epilated after half a dozen exposures. Adamson's plan of dividing the scalp into five areas, by marking these with an aniline pencil, insures that no portion is over-acted upon, and the entire scalp can he treated in about s hours, allowing an exposure of 20 minutes to each area. By the use of the pastille of platinocyanide of barium, which changes by the action of the rays from a bright green to an orange colour, the proper dose of the agent can be gauged without the necessity of protecting any part of the surface with lead foil. When the rays are applied through a special tube designed for this purpose, the trained expert can effect complete epilation of the entire scalp within 21 days without any danger whatever to the brain. The overlying tissues, fibrous and osseous, effectively prevent the penetration of the agent when the fontanelles have closed; subsequent baldness is not to be feared. Where only one or two isolated patches exist in the earlier stages of the disease, it will be quite sufficient to limit the applica tion of the rays to the vicinity of the diseased area for about zo minutes. After the hairs drop out, the old treatment by the thorough application of antiseptic agents should be commenced, since it must he distinctly under stood that the X rays exert no lethal action on the fungus, but the orifices of the follicles, being freed from diseased stumps, are left patent for the introduction of the remedy, wlcich must be well rubbed in by the fingers.