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Ringworm.The disease consists essentially in the growth upon and in the skin of a microscopic plant, technically known as the tricJwpJiyton tonsiirans. The growth of this plant in the skin causes irritation and inflammation, so that a certain amount of redness and even a slight swelling may occur. A symptom which is rarely absent is an intense itchiness. If the course of the affection be closely observed, it will be seen that the beginning of the disease is a small grayish speck, which rapidly spreads in all directions from the common center. It is peculiar that, as the disease spreads on the outside it heals on the inside of the ring, so that in a few days there will be a ring of perhaps an inch in diameter, composed of this minute plant, and surrounding a circle of perfectly healthy looking skin, although this circle was two or three days before quite covered with the plant. A number of these rings may be formed near each other on the skin. These are apt to run together and make a large spot, which is bounded by an irregular, scalloped line. The disease is highly contagious. Its occurrence in one member of a family is usually followed in a few days by its appearance on the skin of other members. Yet it is limited almost exclusively to children. The affection does not attack adults, even though the plants be intentionally rubbed upon the skin. It is a curious fact that this disease attacks several of the lower animals, especially horses and dogs, and that it maybe transmitted from them to man. It is probable that many cases originate in this way, although opportunities enough are afforded for the communication of the disease in the intimate contact of children at play. There is also a form of ringworm in which there can be seen upon close inspection numerous little vesicles or blisters at the edge of the diseased patch. This does not differ in any essentials from the common form of ringworm, and yields to the same treatment. The development of ringworm is favored by warmth and moisture and by the accumulation of scales upon the skin. Hence the occurrence of the disease is favored by lack of cleanliness and by the long-continued use of the same garments without washing. It is especially often found in those who inhabit damp dwellings, and in those who habitually use flannel underclothing. Ringworm of the scalp is essentially the same disease as ringworm on other parts of the skin ; it consists in the growth of a microscopic vegetable, which causes a light inflammation and irritation of the surrounding skin. In consequence of the presence of the hairs, however, ringworm of the scalp is a far more obstinate affection than ringworm on parts of the body not covered with a thick growth of hair, for these miscroscopic plants grow down into the little sacs or follicles which surround the roots of the hairs ; hence it is far more difficult to destroy and eradicate the parasites when they acquire a foothold on the scalp than it is when they grow upon the surface of the skin elsewhere. The fact that these plants grow into and fill up the hair follicles explains another and characteristic feature of the disease, namely: that the hairs become brittle and lose their natural luster ; in a short time most of these hairs become broken off close to the scalp. In course of time it may even happen that a considerable patch of the scalp becomes quite bald. The hairs are not, however, permanently destroyed, that is, so soon as the parasite is removed the hairs grow again as before. Ringworm of the scalp often exists for some time before it is discovered ; because the little elevation caused by the growth of the plant is concealed by the rest of the hair. It may thus happen that the diseased patch has attained a diameter of an inch or more before being detected ; and in this case there are usually other patches in different parts of the scalp, of greater or less size. Ringworm of the scalp usually causes considerable itching and scratching, as a result of which salt rheum or eczema is apt to follow. The eczema causes the discharge of watery fluid, and this dries so as to mat the hairs together, hence there may result from a simple ringworm of the scalp an extensive sore on the head, which discharges profusely and causes the patient great annoyance. This condition is popularly known as " scald head." When ringworm affects the beard, it runs essentially the same course as on the scalp ; in this situation it is known as " barbers' itch. " There are several affections of the hairs of the beard, which are also designated by this term ; the others are not contagious, but ringworm of the beard is. This form of barbers' itch causes the appearance of pimples in and around the roots of the beard ; these often result in the formation of pustules in and around the hair follicles. Sometimes these pustules occur close together, and coalesce, so as to form blisters of considerable size ; when these break, and the matter in them dries, a crust is made by which the hairs are matted together. In some cases of disease it will be impossible to recognize exactly the nature of the disease w'ithout a microscopic examination of the scales and crusts. In case of ringworm, whether of the scalp or of other parts of the skin, there will be found upon microscopic examination, numerous round or oval bodies, which are often arranged in chains; and it is sometimes possible to distinguish in the short, broken hairs, long chains composed of the parasite which causes the disease. Treatment.- Ringworm on parts of the skin which are not covered with hair is usually cured very easily. The principle of treatment consists simply in the application of some material which destroys the vegetable parasite ; so soon as the plant is killed the irritation subsides, the crust is thrown off, the skin resumes its natural condition. A considerable number of agents have been used for this purpose ; among household remedies may be mentioned kerosene oil and a solution of borax, as follows : Borax, - Half an ounce. Water, - Half a pint. Some of the borax remains undissolved at the bottom of the vessel, but this is useful in order to keep the solution at full strength. While these remedies are usually effectual, yet many people object to the application of kerosene, which is moreover irritating as well as unpleasant, and is apt to cause some swelling and pain of the skin around the diseased spot. For these reasons various other remedies are to be preferred in the treatment of ringworm. Among those most employed by physicians are the following : Hyposulphite of soda, - - - One ounce. Dilute sulphurous acid, - Two drachms. Glycerine, - One ounce. Water, ------ Four ounces. This should be applied to the diseased patches by means of a stiff brush or a coarse cloth, which is to be dipped in the lotion. Saturated solution of sulphurous acid, - One ounce. Water, ------ Three ounces. The removal of the parasites is hastened by the use of a remedy in solid form, which can, therefore, be kept in contact with the skin constantly, and not simply applied at intervals, as is necessary when liquids are used. If the disease be located on the face, an ointment can be applied at night and allowed to remain till morning ; for this purpose any one of several ointments may be used, as follows : Ammoniated mercury, - - Twenty grains. Red oxide of mercury, powdered, - Twenty grains. Simple ointment, - One ounce. Mix thoroughly and apply directly to the skin, rubbing the salve vigorously into the pores of the skin. The simple ointment of mercury will also be found efficient. In most cases, too, the ordinary sulphur ointment can be successfully used for destroying the parasite. This affection is entirely a local disease of the skin, and requires no internal treatment. Ringworm of the scalp is a far more toublesome and obstinate affection to cure, not because the parasite is any more difficult to destioy, but because it is extremely difficult to introduce the remedy into the follicles of the hair, which are a continual breeding place for these organisms. It will often happen that by a few applications of one of the remedies above given the disease will entirely disappear from the scalp, and the patient will consider himself cured ; but in a few days or weeks it becomes evident that the ringworm has started again in the same place. It is, therefore, necessary to take especial pains to introduce the various agents used for killing the parasites into the hair follicles. For this purpose the first requisite is to shave the head closely, so as to remove all the hairs from the diseased patch and from its immediate vicinity. After this has been done there may be rubbed into the scalp daily one of the following ointments : Hyposulphite of sodium, - - - One drachm. Vaseline, * One ounce. Or, Salicylic acid, - - - Twenty grains. Vaseline, ------ One ounce. In some cases good results may be obtained by brushing the surface thoroughly with strong tincture of iodine. Yet in many instances the most careful treatment in this way will prove ineffectual ; the disease will seem to have disappeared, treatment will be discontinued, but in a few days the parasitic growth reappears. In such cases it becomes necessary to pull out the hairs over the diseased patch. This is a most tedious and laborious procedure, and quite painful to the patient. Much trouble will often be experienced with children in persuading them to submit to it. But there is no other means which can be relied on to secure recovery, since the hair follicles are full of the parasites, which can be reached only after the hair has been removed. This process does not, of course, destroy the hairs, which grow again in due time ; in fact, it often saves the hairs, since the disease would otherwise result in the destruction of the roots of the hair and permanent baldness in consequence. There are cases in which even the pulling out of the hair does not suffice ; in these instances it becomes necessary to apply a light blister - plaster of cantharides - until the skin is quite red, after which the usual lotions may be used. As to the remedies themselves nothing further need be said ; any of the prescriptions above given are quite efficient in destroying the parasites. The difference in treatment required by ringworm of the scalp consists merely in the care necessary to bring the lotion into the hair follicles. In that form of " barber's itch" which is really ringworm of the beard, the same general treatment is necessary The face must be kept closely shaven, and the lotions applied as already directed in the treatment of ringworm affecting the scalp. In some cases it will be found necessary to pull out the hairs of the beard also, and to apply one of the salves or lotions mentioned after the hair follicles have been thus exposed. In all cases of ringworm affecting a hairy part of the skin, patient and physician alike must be prepared for a long and tedious course of treatment; yet the patient should, for his own sake, never despair nor give up treatment, for he may be sure that the disease can be completely and finally eradicated, even though it require months to accomplish. On the other hand he may be sure that if allowed to proceed the disease will ultimately cause baldness of the affected spots. 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