The Home Medical Library Volume II Part 9

_Threadlike Warts._--These are seen along the edge of the nails, on the face, neck, eyelids, and ears. They are formed by the great prolongation and growth of the projections, or _papillae_ of the middle layer of the skin just described.

_Flat Warts_, raised but slightly above the surface are more common in old people.

_Moist Warts_ occur where they are softened by secretions of the body, as about the s.e.xual organs (in connection with diseases of the same), and about the a.n.u.s (or opening of the bowel). They are of a white, pink, or red color, and consist of numerous, little, fleshy projections, usually covered with a foul-smelling secretion.

Warts most commonly appear on the hands of children, but may appear on any part of the body and at all ages. They may disappear quickly or remain indefinitely. They are not communicable from one person to another.

=Treatment.=--Warts may be removed by painting them frequently with the fresh juice of the milkweed, or with acetic acid or tincture of iodine. These remedies are all harmless, but somewhat slow and not always effective. Application, morning and evening, of a saturated solution of "washing soda" (impure bicarbonate of potash) will often remove a wart.

=CORNS.=--Corns are local, cone-shaped thickenings of the outer layer of the skin of the feet, due to pressure and friction of the shoes, or opposed surfaces of skin between the toes. They are not in themselves sensitive, but pain follows pressure upon them, as they act as foreign bodies in bearing down upon the sensitive lower layers of the skin. Continued irritation often leads to inflammation of the skin around and beneath the corn with the formation of pus. Ordinarily, corns are tough, yellowish, h.o.r.n.y ma.s.ses, but, when moistened by sweat between the toes, they are white, and are called "soft corns."

=Treatment.=--Comfortable shoes are the first requisite; well-fitting and neither tight nor loose. Pressure may be taken off the corns by surrounding them with felt rings or corn plaster. To remove the corn the foot should be soaked for a long time in warm water, in which is dissolved washing soda, and then the surface of the corn is gently sc.r.a.ped off with a clean, sharp knife. Another useful method consists in painting the corn, night and morning for five days, with the following formula, when both the coating and corn will come off on soaking the same for some time in warm water:

Salicylic acid 30 grains Tincture of iodine 10 drops Extract of Cannabis Indica 10 grains Collodion 4 drams

Mix.

When the tissues about the corn become inflamed the patient must rest with the foot elevated and wrapped in a thick layer of absorbent cotton saturated with a hot solution of corrosive sublimate (one tablet to the pint of water) and covered with oil silk or rubber cloth. Pus must be let out with a knife which has been laid in boiling water.

If corns are removed by the knife the foot should be previously made absolutely clean, the knife boiled, and the paring not carried to the extent of drawing blood. The too-close removal of a corn may lead to infection of the wounded tissues with germs, and in old people, and those with feeble circulation, gangrene or erysipelas may result. Soft corns are treated by removal of the surface layer, by soaking in washing soda and hot water and sc.r.a.ping as above stated, and then the corn should be dusted with a mixture of boric acid and zinc oxide, equal parts, and the toes kept apart by pads of absorbent cotton.

=CALLUS AND CRACKS OF THE SKIN.=--Callus consists of round or irregular, flattened, yellowish thickenings of the upper or h.o.r.n.y layer of the skin. The skin becomes hypertrophied and resembles a thick, h.o.r.n.y layer, caused by intermittent pressure of tools, shoes, etc. The whole palm of the hand or soles of the feet may be the seats of a continuous callus. Callus is not harmful, except in leading to cracks of the skin near the bend of joints, and, rarely, in causing irritation, heat, pain, and even the formation of pus in the skin beneath. Callus usually disappears when the exciting cause or pressure is removed.

=Treatment.=--The hands and feet should be soaked continuously in hot baths containing washing soda, and then should be covered with diachylon (or other) ointment. This may be done each night; or collodion (one ounce containing thirty grains of salicylic acid) may be painted, night and morning for several days, on the callus, and then, after soaking for some time in hot water, the surface should be sc.r.a.ped off with a dull knife and the process repeated as often as necessary to effect a cure. Fissure or cracks of the skin caused by callus are treated in the same manner: by prolonged soaking in hot water, paring away the edges, and applying diachylon ointment or cold cream to the part. Inflammation about callus must be cared for as recommended above for inflamed corns.

=BOILS.=--A boil is a circ.u.mscribed inflammatory process, caused by the entrance of pus-producing germs into the skin either through the pores (the mouths of the sweat glands) or along the shafts of the hair, and in this way invading the glands which secrete a greasy material (sebaceous glands). In either case the pus germs set up an inflammation of the sweat or sebaceous glands, and the surrounding structures of the skin, and a small, red, itching pimple results.

Rarely, after a few days, the redness and swelling disappear, and the pus, if any, dries and the whole process subsides. This is called a "blind boil." But usually the boil increases in size for several days, until it may be as large as a pigeon's egg. It a.s.sumes a bright-red sharply defined, rounded shape, with a conical point, and is at first hard and then softens as pus or "matter" forms. There is severe pain of a throbbing, boring character, which is worse at night, and destroys the patient's sleep and appet.i.te. There may be some fever.

The glands in the neighborhood may be enlarged and tender, owing to some of the pus germs' escaping from the boil and lodging in the glands.

If the boil is not lanced, it reaches its full development in seven to ten days with the formation of a central "core" of dead tissue and some pus, which gives to the center of the boil a whitish or yellowish-brown appearance. The boil then breaks down spontaneously in one or more places (usually only one) and discharges some pus, and, with a little pressure, also the white, central core of dead tissue.

The remaining wound closes in and heals in a week or two. Boils occur singly or in numbers, and sometimes in successive crops. When this happens it is because the pus germs from the previous boils have invaded fresh areas of skin.

=Causes.=--Boils are thus contagious, the pus germs being communicated to new points on the patient's skin, or to that of another person.

Local irritation of the skin, from whatever cause, enables the germs to grow more readily. The existence of skin diseases, as eczema ("salt rheum"), p.r.i.c.kly heat, and other sources of itching and scratching, is conducive to boils, as the pus germs contained in ordinary dirt are rubbed into the irritated skin. Whenever the skin is chafed by rough clothing, as about the wrists and neck by frayed collars and sweaters, etc., boils are likely to occur. Also when the face and neck are handled by barbers with dirty hands or instruments, a fruitful field is provided for their invasion. While boils are always the result of pus germs gaining entrance to the skin glands, and, therefore, strictly due to local causes, yet they are more p.r.o.ne to occur when the body is weakened and unable to cope with germs which might do no harm under other circ.u.mstances.

The conditions favoring the occurrence of boils are: an impoverished state of the blood, errors of diet and indigestion, overwork, dissipation, and certain diseases, as typhoid fever, diabetes, and smallpox. Boils are thought to occur more frequently in persons with rough skin and with a vigorous growth of dark hair. They may be situated on any part of the body, but certain localities are more commonly attacked, as the scalp, the eyelids, cheeks, neck, armpits, back, and b.u.t.tocks. Boys and young men are generally the sufferers.

=Treatment.=--The importance of cleanliness cannot be overestimated in the care of boils if we keep their cause in mind. Dirty underclothes or fingers used in squeezing or otherwise handling the boil, may carry the trouble to fresh parts. Any sort of local irritation should be removed; also all articles of clothing which have come in contact with the boils should not be worn until they have been washed in boiling water. There is no single remedy of much value for the cure of boils, although pills of calcium sulphide (each one-tenth grain) are commonly prescribed by physicians, every three hours.

The most rational measure consists in removing the general causes, as noted above, if this is possible. When the patient is thin and poorly nourished, give food and cod-liver oil; and if the lips and skin are pale, iron a.r.s.enate pills (one-sixteenth grain each) are to be taken three times daily for several weeks. A boil may sometimes be arrested by painting it with tincture of iodine until the boil is almost black, or with a very heavy coating of collodion. If a boil continues to develop, notwithstanding this treatment, one should either use an ointment of vaseline containing ten per cent of boric acid spread on soft cotton over the boil, or, if the latter is very painful, resort to the frequent application of hot flaxseed poultices.

When the boil has burst, and pus is flowing out on the surrounding skin, it should be kept very clean by frequent washing with hot water and soap and the application of a solution of corrosive sublimate (one part to 1,000) made by dissolving one of the tablets, sold everywhere for surgical purposes, in a pint of warm water. This will prevent the lodgment of the pus germs in the skin and the formation of more boils.

Poultices mixed with bichloride (corrosive sublimate) solution are less likely to encourage inoculation of neighboring areas.

The poultices should be stopped as soon as the pain ceases, and the boil dressed as recommended above, dusted with pure boric acid and covered with clean absorbent cotton and bandage. After pus has begun to form in a boil recovery will be materially hastened by the use of a knife, although this is not essential. The boil should be thoroughly cleaned, and a sharp knife, which has been boiled in water for five minutes, is inserted, point first, into the center of the boil, far enough to liberate the pus and dead tissue. By this means healing is much more rapid than by nature's una.s.sisted methods. Pure carbolic acid, applied on the tip of a toothpick, thrust into the head of a boil, is generally curative. When many boils occur, consult a physician.

=CARBUNCLE.=--A carbuncle is similar to a boil in its causation and structure, but is usually a much more serious matter having a tendency to spread laterally and involve the deeper layers of the skin. It is commonly a disease of old persons, those prematurely old or debilitated, and occurs most frequently on the neck, back, or b.u.t.tocks. It is particularly dangerous when attacking the back of the neck, upper lip, or abdomen.

Carbuncle often begins, with a chill and fever, as a pimple, and rapidly increases in size forming a hot, dusky red, rounded lump which may grow until it is from three to six inches in diameter.

Occasionally it runs a mild course, remains small, and begins to discharge pus and dead tissue at the end of a week and heals rapidly.

More commonly the pain soon becomes intense, of a burning, throbbing character, and the carbuncle continues to enlarge for a week or ten days, when it softens and breaks open at various points discharging shreds of dead tissue and pus. The skin over the whole top of the carbuncle dies and sloughs away, leaving an angry-looking excavation or crater-like ulcer. This slowly heals from the edges and bottom, so that the whole period of healing occupies from a week to two, or even six months. The danger depends largely upon blood poisoning, and also upon pain, continuous fever, and exhaustion which follow it. Sweating and fever, higher at night, are the more prominent signs of blood poisoning.

Carbuncles differ from boils in being much larger, in having rounded or flat tops instead of the conical shape of boils, in having numerous, sievelike openings, in the occurrence of death of the skin over the top of the carbuncle, and in being accompanied by intense pain and high fever.

=Treatment.=--Carbuncle demands the earliest incision by a skilled surgeon, as it is only by cutting it freely open, or even removing the whole carbuncle as if it were a tumor, that the best results are accomplished. However, when a surgeon cannot be obtained, the patient's strength should be sustained by feeding every two hours with beef tea, milk and raw eggs, and with wine or alcoholic liquors. Three two-grain quinine pills and ten drops of the tincture of the chloride of iron in water should be given three times daily.

The local treatment consists in applying large, hot, fresh flaxseed poultices frequently, with the removal of all dead tissue with scissors, which have been boiled in water for ten minutes. When the pain is not unbearable, dressings made by soaking thick sheets of absorbent cotton in hot solution of corrosive sublimate (1 to 1,000 as directed under Boils, p. 161) should be applied and covered by oil silk or rubber cloth and bandage. They are preferable to poultices as being better germ destroyers, but are not so comfortable. When the dead tissue comes away and the carbuncle presents a red, raw surface, it should be washed twice a day in the 1 to 1,000 corrosive-sublimate solution, dusted with pure boric acid, and covered with clean, dry absorbent cotton and bandage.

=ECZEMA; SALT RHEUM; TETTER.=--Eczema is really a catarrhal inflammation of the skin, with the exudate (fluid that escapes) concealed beneath the surface, or appearing on the surface after irritation has occurred. The many varieties are best cla.s.sified as follows:

(1) Eczema of internal origin, including cases due to morbid agencies produced within the body, cases due to drugs, and possibly reflex cases.

(2) Eczema of external origin, including cases caused by occupation, by climate, or by seborrhea.

Eczema of internal origin almost invariably appears on both sides of the body at once, as on both cheeks, or both arms, or both thighs. Its border shades into the surrounding skin, it is dotted with papules (or heads) filled with fluid, and its surface is clean and not greasy.

As it spreads, the symmetry of distribution is lost. Among the morbid agencies producing this variety of eczema are the products of indigestion. Among the drugs producing it is cod-liver oil.

Occupation eczema occurs first on exposed parts, as the hands, arms, face, and neck, in those who handle irritant dyes, sugar, formalin, etc.

Climatic eczema includes the "winter itch," common in this lat.i.tude, appearing on wrists and ankles in the form of clean, scaly patches, often ringed.

The seborrheic variety spreads from the scalp to the folds of the skin. Its borders are sharply defined, and its crusts and scales yellowish and greasy. It spreads from a center in all directions at once.

=Treatment.=--The treatment of eczema puzzles a physician, and only specialists in skin diseases are able easily to diagnose the subacute or chronic forms. It may appear different, and need different treatment almost from day to day, and consequently only general suggestions can be made for home management of a case of this disease.

The outlook is always good; and even in the case of weak and debilitated patients, there is excellent chance of cure.

The diet must be regulated at once. Meat should be eaten in small quant.i.ties once a day only, and none but very digestible meats should be eaten, as fowl, beef, and lamb. Sugar and sweet food need be cut down only when there is indigestion with a production of gas. Fresh air and exercise are imperative. Five grains of calomel, at night, followed by one heaped tablespoonful of Roch.e.l.le salts dissolved in a full tumbler of water the next morning before breakfast, should be repeated twice a week till marked improvement is seen. Meanwhile, external treatment must be pushed.

Generally speaking, ointments must not be used on weeping or exuding surfaces; all scales and crusts must be removed from the surface; and acute patches must be soothed, chronic patches stimulated. Water is harmful and increases the trouble; but it is necessary to use it once, in cleansing the affected area, in the form of soap and water. If there are thick, adherent crusts, a poultice of boiled starch, covered with a muslin cloth, will loosen them in a night. Thickened or h.o.r.n.y layers on the palms and soles may be covered with salicylic plaster (ten per cent strength), which is removed after two days, and the whole part soaked in warm water, when the h.o.r.n.y layer is to be peeled off. Thickened surfaces are best treated with wood tar, in the form of oil of cade ointment, or the "pix liquida" of the drug shops mixed with twice its amount of olive oil. This should be well rubbed into the affected part.

Seborrheic eczema of the scalp and neighboring areas is best treated with a four per cent ointment of ammoniated mercury, rubbed in once a day for five days, followed by the application of a solution of resorcin in water, four grains to the ounce. Weeping and exuding patches should be treated with powdered stearate of zinc, or oleate of bis.m.u.th, or aristol, either one dusted on till the area is fairly covered. When the surface begins to dry up, the following paste may be applied:

Salicylic acid 5 to 15 grains Zinc oxide 2 drams Powdered starch 2 drams Vaseline 1 ounce

If weeping returns, stop the ointment and resume the powder treatment, or use the following lotion:

Zinc oleate 1 dram Magnesium carbonate 1 dram Ichthyol 1/2 ounce Lime water 4 ounces

When the skin after scaling off becomes thin, all swelling having disappeared, lead plaster is of service, or diachylon ointment twenty-five per cent, made with olive oil.

An eczema of moderate extent should recover after four to six weeks'

treatment, unless the soles or palms be attacked, when six or more months of treatment may be necessary.