The general health of children affected with ringworm is often unsatis factory ; and the complaint seems to attack, by preference, weakly and scrofulous subjects. The latter, especially, have seemed to me to be pecu liarly prone to the disorder.
Diagnosis.—In cases of ringworm of the scalp the chief diagnostic point is the appearance of little rounded, scaly patches, on the surface of which the hairs are thick, dull in colour, and broken short off just above the follicles. If one of these short hairs be removed with a pair of fine forceps, and placed with a drop of liq. potassee under the microscope, the characteristic masses of spores and mycelium filaments will be readily distinguished. If the hair-stump be allowed to soak in the drop of potash solution for an hour or two before inspection, the parasitic fungus will be more readily detected.
At an earlier period than this the complaint is less easy to recognise. It is, however, of great importance to detect the affection in its early stage. It often happens that when one child of a family suffers from tinea rans one of his brothers or sisters is brought for examination, because he has been to have some irritation of the scalp. If, in such a case, ringworm be present, we shall find one or two small rounded patches, roughened with fine scales ; and shall notice that although no stumpy hairs are to be seen, and the hairs have a natural appearance, they are yet unusually brittle, so that they break off when an attempt is made to pull them out with the forceps. From the first, therefore, in ringworm the hairs are brittle ; and at an early period of the disease the circular shape of the patch on the scalp, and the brittleness of the hairs growing upon it, are the two points of chief diagnostic value.
An important question, and one upon which our opinion is often re quired, is that of whether in a given case the child is well. To settle this point correctly requires a very careful examination of the scalp. If any diseased stumps of hairs remain the complaint is not entirely eradicated. The child is therefore still a source of infection to others, and is him self liable to a relapse. Even a bald patch from which the hairs have been
carefully extracted is not to be considered well. Often after an interval the stumps will shoot up again, the diseased bulb of the hair having been left in the follicle. It is not until the part lately the seat of the ringworm is seen to be covered with a fine downy growth, in which no single stump of the old crop can be detected, that it can be said, confidently, to be free from disease.
In some cases a difficulty is occasioned by the presence of eczema which has invaded the scalp towards the end of an attack of ringworm. When this happens the evidences of ringworm may be quite concealed by the complication. We must therefore withhold a positive opinion until the eczema has been cared.
Tinea circinata is distinguished by its annular shape, and in cases of doubt by examination under the microscope of a scraping from the skin of the patch. The spot selected for this purpose should be a part of the ring towards the inner margin. This should be gently scraped, and the scaly matter removed is to be placed under the microscope, with a drop of liq. potassm. The jointed mycelium will then be recognised, and a few spores will usually be seen.
T•eatment.—In cases of ringworm of the scalp, the measures to be adopted, and the probable efficacy of the treatment, vary considerably, ac cording as the disease is of recent or remote origin. Recent cases can usually be quickly cured, but chronic cases resist treatment with singular obstinacy.
Treatment will also vary according to the age of the patient. Ring worm can only be cured by local applications, and the measures to be adopted consist of the use of two classes of remedies, viz., those which irri tate the skin and destroy the fungus, by exciting inflammation in the fol licle, and those which kill the parasite without producing inflammation. Of these two classes the first is not suitable to very young patients. Blis ters and violent caustics are dangerous remedies in the case of infants ; and on account of the pain they excite are not to be used carelessly even on older subjects.