Oleate of Mercury(Ointment 25 per cent.) causes little irritation of itself, and when in doubt whether the dermatitis is being produced by the parasite or the remedy it may safely be resorted to. Shoemaker, who employs this drug extensively,states that he has never known it to induce salivation when vigorously rubbed in for weeks as an ointment of 5 to 2.0 per cent.
All through the duration of the treatment the scalp should be periodi cally searched by a lens for broken or brittle stumps, and these should be dealt with by further exposure to the X rays or by forceps epilation when sparse in number. Any odd diseased hairs after being pulled out 61 may have their follicles disinfected by thrusting a blunt needle moistened with pure Carbolic Acid into the recess.
Kerion is a complication which is sometimes observed in ringworm of the scalp. It is the result of a pustular inflammation of the follicles of the diseased patches, whereby the areas become boggv and stand out above the level of the surrounding healthy scalp. The best way of dealing with this is to apply a series of hot Boric compresses under oiled silk, and after the evacuation of all pus and the removal of crusts a weak ointment of Oleate of Mercury (t in to) or Boroglyceride should be applied. When kerion results, the disease at the suppurating spot is already far on its way to final resolution.
l'aceine Trealinent.—Many attempts are being made to treat the different forms of ringworm by vaccines prepared from the secretions adherent to the hair bulbs. Various satisfactory reports arc forthcoming, hut, owing to the certainty of the newer antiparasitic remedies, it is very improbable that vaccine treatment, if of any use, will ever be used except as an adjuvans.
Prophylaxis.—This is of much importance in large families of young children and in schools, owing to the highly infective nature of the disease. The steps to be taken are obvious; the affected child should not be per mitted to sleep with others, and he should have the hair over the entire scalp clipped close even when the disease is very circumscribed, and he must be compelled to keep a loose silken or linen cap continually over the head. His soap, towels, combs and hair-brushes must be reserved entirely for his own use, and these should be kept in a state of the most absolute cleanliness. Children coming into close contact with affected ones should have the hair on the scalp cut short, and their heads washed regularly with Borax instead of soap, and they may use crude petroleum as a hair-oil or the prophylactic pomade of Harrison may be used— R. Ungl. Eucalypti Ungt. Acidi Borici Olei Nucis Cocoo vita 51).
Olei Caryophylli ill. xxx. 111isce.
Tinea Sycosis.—Ringworm of the beard or barber's itch is a most intractable affection if not dealt with promptly on its first appearance. The treatment must be carried out on the same principles as should be pursued in the case of ringworm of the scalp, though the parasite is usually the Trichophyton megalosporon eclothrix of animal origin, which is liable to cause suppuration of the follicles.
The entire beard must be clipped short and shaving prohibited, though Levin recommends shaving daily. Epilation is imperative; owing to the strength of the hair shafts these can be more effectually plucked out of the diseased follicles than in the case of the more brittle scalp hairs, but the process is painful and tedious. A score of affected hairs may,
however, he removed at a single sitting, and much more than this number can be readily extracted when loosened by suppuration.
The X rays should he resorted to when mechanical epilation is im practicable owing to the extensive surface invaded.
After the removal of all crusts and of hairs visibly altered by the fungus and of those with pus at their roots, any of the antiparasitic applications should be well rubbed in twice a day. A r in io Iodine Ointment and the Ungt Iod. Sulph. are excellent. but objectionable owing to the unsightly discoloration which they produce. The Ungt. Hyd. Nit. or the Ungt. Hyd. Ammon. may be selected, as their colour is scarcely noticeable; the same remark applies to Carbolic, Calomel, and Creosote ointments, but these are not reliable. Whichever antiseptic preparation is selected, it should be combined with a fatty basis, as aqueous or spirituous solutions cannot be got to reach the bottom of the deep follicles where the fungus is flourishing, and ointments to he of value must be firmly rubbed in, pressure being necessary to force the fat into the bottom of the recesses, and a considerable degree of dermatitis is usually desirable to get the best results. Some authorities recommend blistering with Liquor Epispasticus on the theory of the value of counter-irritation, but it must he remembered that cantharidin is itself a powerful germ-destroyer. Vaccine treatment with a preparation of the spores after the method of Strickler (Journal Cutaneous Disease, 1915) has been employed successfully.
Coccogenic Sycosis is a different affection, caused by Staphylococcus aureus and albus, and like true ringworm is a most intractable disease. It may be suspected when the hairs do not loosen and readily fall out. X rays are therefore clearly indicated for epilation, after which the Ungt. Hyd. Ammon. or Ungt. Hyd. Nit. must be persistently employed. Repeated poulticing with well-boiled Starch will be necessary for the removal of the crusts which continually form, and occasionally the puncturing of purulent points will be necessary, after which hot fomentations should be applied. Crocker's treatment consisted in shaving the part, using oil instead of soap, after which he rubbed in a 3 per cent. ointment of Iodoform, Europhen, Loretin or Oleate of Mercury.
The condition commonly occurs in weak debilitated subjects, and most authorities extol Cod-Liver Oil administration. In chronic cases a Vaccine should be prepared from the perifollicular pus and injected; this treat ment has given most satisfactory results, and should always be resorted to when the pus-forming cocci cannot be reached by antiseptics.
T inea U ngteium, or ringworm of the nails, known also as Onychomycosis, is caused by the large-spored fungus. The best treatment is to soft-n the nail by applying Boric solution on lint under oiled silk, or painting with equal parts of Liquor Potassx. and water, after which it should be well scraped and enveloped in a r in 200 solution of Perchloride of Mercury applied on lint and covered with a rubber finger-stall.