In infants and young children it will be usually sufficient to wash the head thoroughly with soap and hot water every night, and after careful drying to paint the patch with tincture of iodine. After a few clays the application can be changed to the unguentum ammonio-chloricli (P. B.) diluted with an equal proportion of lard ; or equal parts of this salve and the unguentum sulplauris may be made use of. Either of these must be well rubbed into the affected parts of the scalp. Another useful application is the glycerine of carbolic acid diluted with a third part of glycerine. This may be painted on the patch with a stiff brush, or rubbed in with a piece of sponge tied to the end of a pencil.
In older children the treatment varies to the acuteness or chronicity of the disease. In either case it is important to keep the hair cut closely to the scalp in the neighbourhood of the patches. The disease is most infectious in its earlier stages, and becomes much less liable to be communicated when undergoing treatment. Of course care will be taken that towels, pillows, etc., used for the patient are not shared by the other children. As an additional precaution Dr. R. Liveing recommends that the carbolised glycerine, pure or diluted with an equal proportion of gly cerine, should be well rubbed into the scalp every morning.
In a recent case, if the diseased patch be of small extent, it should be blistered by the liq. epispasticus. Afterwards, when the sore has healed, the oleate of mercury ointment (five per cent) should be well rubbed into the patch every night. It is useful to vary the application every week or ten clays. Therefore, in addition to the preceding, a salve com posed of sulphur ointment (half an ounce) with white precipitate (twenty grains) may be used, or the ointment 1 recommended by Mr. Alder Smith, made by adding one part each of pure carbolic acid and unguentum hydrar gyri nitratis to four parts of the unguentum sulphuris, may be employed. A favourite remedy iu recent cases is the preparation known as " Coster's paste," made by adding two drachms of iodine to one ounce of the colour less oil of tar. Mr. Morant Baker prefers to substitute creasote for the oil of tar. The application is to be painted thickly on the patch with a camel's-hair brush.
If under treatment the patches become very sore, so that the rubbing in of the ointments causes too great pain, Mr. Alder Smith recommends
simply smearing the surface of the patch with the carbolic ointment dur ing the day and poulticing with bread-and-water every night. These measures are often followed by a rapid cure. The penetration of the remedy into the hair-follicles is aided by previous removal of the hair stumps. This epilation is done with a forceps made for the purpose. Care must, however, be taken in extracting the hair, as on account of its brittleness it is very apt to break off, leaving the bulb still in the follicle. It is also important to pick or wash off the fine crusts of scurf which, as long as they remain, are greatly in the way of efficient treatment. If the scab is difficult to remove it should be well greased with cold cream or saturated with olive-oil, and poulticed. It then becomes quite soft and can be easily picked off.
In old-standing cases the above remedies are still of service, and careful epilation should be practised. Sometimes the long duration of the dis order seems to be due to ignorance or neglect ; the remedies not having been applied effectually, or care not having been taken to remove the scurf before applying the salve. The energetic use of oleate of mercury oint ment (five per cent.) is recommended by Mr. Alder Smith as a useful remedy even in chronic cases. After careful washing of the head the oleate, freshly made, is well rubbed into the whole scalp with a sponge mop. In the use of this application it is well to refrain from charging the mop too liberally with the remedy, lest the ointment run down the face and neck. At night, too, a linen cap should be worn on the head ; and a thin towel is often necessary, applied as a turban, to prevent irritation of the face by the oleate. Any smearing of the skin elsewhere than on the scalp with the salve will produce a copious eruption of small pustules and much swelling. Every night the general application is to be repeated ; in the morning the is to be limited to the diseased patches. While this plan of treatment is being carried out the head must be washed only once a fortnight ; but scabs or yellowish incrustations must be fre quently removed by the forceps. If the oleate set up inflammation in the patch a speedy cure is usually effected.