Symptoms Of Diseases Of The Skin
( Originally Published 1927 )
For the recognition of the various skin diseases, two groups of symptoms are to be considered. These are termed the subjective and the objective. The subjective symptoms include itching, burning, stinging, feeling of heat and pain. The latter is rather uncommon in skin disorders, being, as a rule, met only in such conditions as boils, carbuncles, etc.
The objective symptoms are those visible to the eye and result from such changes in the skin structure not seen in health. These abnormal changes are termed lesions and they may be flat or elevated, solid or filled with fluid. Their color may be a bright red or a dark red, bluish or violaceous; they may also vary in size and depth.
MEASURES FOR THE PRESERVATION OF THE HEALTH OF THE SKIN HYGIENE
Under the term "hygiene," we include the proper uses of soap and water and various other measures beneficial to the skin.
Soap and Water.—Normally, the skin will remain healthy by keeping it clean. Soap and water are usually the agents best suited for this purpose. The almost universal use of these substances among civilized people makes it essential for the laity to have an intimate knowledge of their composition, mode of action, etc.
Water is classified as hard and soft. By hard water is meant water that contains various mineral substances in solution, especially calcium carbonate (a form of lime). These mineral matters not only make the water more irritating, but pro-duce a white, ugly deposit, when brought in con-tact with soap. Soft water is free of these mineral substances and, therefore, less irritating. Both soft and hard water may be used for bathing, al-though soft water is preferable. Hard water may be converted into the soft variety by boiling. Rain water is soft. The water of lakes, rivers and free running streams is soft (without chemicals), while that of springs and wells is classified as hard water.
Effects of Water upon the Skin.—The Warm Bath. —A warm bath is much more cleansing than a cold one. Warm water, when used with the mildest soap, not only removes the dirt, fat and other materials adhering to the skin surface of the body, but also the tough, horny scales which are constantly being shed. A warm bath is soothing and slightly depressing. This soothing effect is accomplished by the increased amount of blood brought to the skin surface. The temporary diminution in the blood supply of the brain accounts for the depressed feeling. It is unwise to take a warm bath for at least two hours after a hearty meal, as the warm bath reduces the amount of blood needed by the digestive organs for the maintenance of their activity at a high level.
The following simple rules governing warm baths will be found useful:
1. The normal skin should be bathed daily with soap and warm water.
2. A five- or ten-minute stay in the tub is sufficient.
3. The skin should be rubbed gently.
4. The body surface should be dried, with moderate friction, beginning from the head and going downward.
5. The skin should be perfectly dry before dressing.
6. The most suitable time for taking a warm bath is before retiring.
Certain individuals may experience some form of skin irritation, such as itching, after the daily warm bath. This discomfort, while not serious, is rather annoying and is most apt to occur during cold weather. When this occurs, relief may be obtained by anointing the body with olive oil after the bath, or by dusting the skin with some bland powder, e.g., equal parts of boric acid and talcum.
The Cold Bath.—While the warm bath cleanses, the cold bath tones up the body. Cold water, applied externally, contracts the blood vessels of the skin, and at the same time causes a strong nervous shock which acts as a stimulant. As the nervous stimulation is the more powerful, it soon over-comes the cold shiver, resulting from contact with the cold water. Therefore, while at first the body feels cold, as soon as reaction due to the nervous shock sets in, the person experiences a glow of warmth which is most stimulating. This healthy effect of the cold bath depends upon the promptness of reaction from the shock and is aided by the vigorous rubbing with dry towels. The cold bath also invigorates the skin and makes it firm and tense. Those suffering from a dry skin may experience itching after such a bath. The best time for taking a cold bath is in the morning.
Bathing an Infant.—The bathing of the newly born infant must be carried out with a great deal of care. The water should first be boiled and then cooled to a temperature of not less than 100 degrees Fahrenheit. The hands and face should first be bathed with a sponge and the body washed in fresh water with a different sponge. Only the purest and mildest soap obtainable should be employed. Following the bath the skin is massaged with cocoa butter or olive oil.
Soap.—Soap is a very valuable substance. A well-known author has tersely summed up the attributes of soap in the following sentence: "Soap is a tonic to the skin and very wholesome; it re moves the old face of the skin and the varnish of dirt which is apt to form upon it."
Composition.—All soap is made by the addition of an alkali to an animal or vegetable fat. There are many different kinds of soaps, depending upon the type and quantity of alkali used. Those containing the alkali sodium are less irritating than those containing potassium.
Varieties.—The soap to be selected depends upon the purpose for which it is to be used. A cleansing soap should contain a large excess of alkali and should lather plentifully. To this class belongs the so-called "soft soaps." These cleanse the skin by removing the uppermost part of its horny layer and are useful for the removal of crusts and scales. An example of such a soap is "green soap"; it is often employed in the form of a tincture.
Toilet soaps contain a slight excess of alkali. These do not lather very much and are, therefore, not too cleansing. A commonly used toilet soap is Castile soap (genuine Castile soap), made with the alkali sodium and a special brand of olive oil.
There are many forms and varieties of fancy soaps, usually manufactured because of some alleged special virtue. Such are the floating soaps, made by mixing air with the soap, while it is in a fluid state. Saponified rosin is not a true soap. It is sticky, probably harmful and its cleansing properties are poor. Transparent soaps, brilliant looking soaps, are made by adding to the soap alcohol, glycerin, or sugar, in a special manner. The alleged virtues of these soaps are unfounded.
Action of Soap.—The alkali content is very important in the cleansing effect of a soap but is not the sole factor. The entire make-up of the soap as well as its power to hold very small particles in suspension are valuable factors in the beneficial cleansing effect of soap.
HEALTH MEASURES FOR THE SCALP AND HAIR
The proper care of the scalp is important, not only for those who inherit a tendency to baldness, but also for all who wish to preserve the hair and keep it in good condition.
Attention to the hair should begin shortly after birth, with the proper removal of the fatty matter which covers the scalp of the newborn. This is begun by first anointing the scalp with sweet almond oil, olive oil, or vaseline. Then after bathing the rest of the body, the head is washed with plenty of warm water and soap, such as pure Castile or glycerin soap. This should be done very gently. If this fatty material does not come off easily, the process should be repeated. Under no circumstances is a fine-toothed comb to be used for this purpose. For some weeks, the infant's scalp should be slightly oiled, so as to protect it until the hair grows and to avoid the accumulation of greasy material. It should be washed, daily, to prevent the oil from decomposing. When the hair has grown, the scalp should be washed and oiled, once or twice weekly.
Shampoo.—Ordinarily, the scalp of the child or adult can be kept clean by shampooing every second or fourth week. The proper method of shampooing the head consists in thoroughly wetting the hair with water, making a thick lather on the hands with soap, and then rubbing it vigorously into the scalp. The lather is then removed by rinsing with an abundance of warm water. This procedure should be repeated until the scalp is thoroughly cleansed, and is followed by a rinsing with cold water. The hair is next rubbed dry with a warm bath towel. Women can dry their hair by sitting before an open fire or in the sunlight, or by the aid of an electric fan. The hot-air blast from an electric drier is not healthy for the hair or the scalp.
When the hair is dry, rub a small quantity of sweet oil or vaseline into the scalp, being careful not to get it on the hair. This oiling is best accomplished by parting the hair and rubbing the oil along the part, and reparting the hair until the whole scalp has been gone over. Should an excess of oil be found on the hair, it can be removed by pulling the hair between the folds of a towel, moistened with cologne water.
The practice of wetting the hair daily is to be condemned. This is not because the water itself is harmful but because the scalp is not thoroughly dried and since usually no oil is applied to the scalp to replace that removed by the water, the hair soon becomes dry and brittle.
Soap.—For the ordinary scalp, use any good soap. When the scalp is very oily, tincture of green soap should be employed. When it is very tender, however, soap may cause harm and either a solution of borax in water, or a mixture of the yolks of three eggs to a pint of lime water, are recommended as beneficial and harmless substitutes.
Brush and Comb.—Brushing of the hair is quite important. The brush for the scalp of an infant should have long, soft bristles for smoothing and polishing the hair. For young children a stiffer brush is necessary. For adults two brushes should be used. A stiff brush should be applied, once daily, over the entire scalp with sufficient vigor to cause a feeling of warmth. Ten to fifteen strokes to each part of the scalp are usually sufficient. The correct brush should have moderately stiff bristles, placed in bunches but not too close together, the higher bristles in the center and the lower ones at the edges. The use of a soft brush is also recommended as an aid in the arrangement of the hair and to give it gloss and softness.
Brushes should be washed and disinfected at least once a week. This may be done by cleansing the brush thoroughly with a disinfectant soap and water containing some ammonia, or with ordinary soap, followed either by a five-minute soaking in alcohol, in a strong solution of borax, or in a solution of formalin (one teaspoonful to a pint of water). The disinfectant should be thoroughly washed out with warm water, and the brush rinsed with cold water and placed on end to drain and dry.
Combs should be used only to remove tangles and in parting the hair, never to remove any crusts sticking to the scalp. No comb should ever be used on the scalp of an infant. The fine-toothed comb has no place as an article of toilet. Combs should be cleansed every few days with pure alcohol or a solution of Lysol.
Air and Sunlight.—Air and sunlight are necessary for the health and growth of the hair. This does not mean that the head is to be exposed to the direct rays of the sun. The constant wearing of a hat, especially of the stiff type, is undoubtedly injurious to the hair. If, because of one's occupation, a hat must be worn constantly, it should be well ventilated. The wearing of wigs, false hair, and braids is to be discouraged.
Singeing of the hair, shingling and curling between irons, may increase the dryness of the hair and cause it to break and split, thus favoring baldness. For these reasons these procedures should be avoided.
CARE OF THE SKIN AND SCALP IN DISEASE
Care of the Skin.—The most perfect method of applying water, especially when treating severe and extensive burns, is the continuous warm water bath. The patient may be placed in such a bath for a few hours at a time.
In acute inflammations of the skin, the use of the purest water even at the proper temperature is harmful, and soap and water bathing is still more injurious. Under such circumstances, water medicated by starch, bicarbonate of soda, borax or bran usually proves agreeable and nonirritating.
Starch may be used in the proportion of one-half pound to two-thirds of a bathtubful of lukewarm water. Bicarbonate of soda or borax is used in the amount of twelve ounces of either substance, to every thirty gallons of water. Bran is to be employed in the amount of one-half gallon to thirty gallons of water. The bran added to the water should be allowed to soak for five minutes before one takes a bath. A convenient plan is to put the bran in a gauze bag and suspend it in the water. For washing the face, a handful of bran to a bowl of water is sufficient.
When a small area of the skin is affected by inflammation, such surface may be cleansed with olive oil, sweet oil, or vaseline.
Ordinary salt and sea-salt baths, although invigorating to the entire body, often do damage to the inflamed skin surface. The usual strength of the sea-salt bath is one quarter of a pound to the gallon, but as much as ten pounds of salt may be added to twenty-five gallons of water. There is no advantage of sea salt over table salt as to effect. Invalids who need the invigoration of salt baths may obtain this result by having the skin surface thoroughly rubbed with the finest table salt well warmed in the oven, after which a tepid or warm bath may be used to cleanse the surface.
Vapor, steam, Russian and Turkish baths have no great value in curing diseases of the skin.
An antiseptic bath is prepared by dissolving sixty grains of bichloride of mercury in thirty gallons of water.
Sulphur baths, tar baths, and other medicated baths are found useful in treatment of but few skin diseases. Baths of this kind may be obtained at various resorts having natural springs or may be artificially prepared at home.
Care of the Scalp.—The great frequency of dandruff of the scalp demands the laying down of a few important principles relative to it. In those instances where the hair and scalp are excessively dry and scaling is present, frequent washing of the hair is unwise. When washing is necessary only the mildest soaps, or the combinations advised for tender scalps, are to be employed, and alcoholic tonics only upon the advice of a physician. Fatty substances, such as the oil of sweet almonds, olive oil, or vaseline, in moderate quantities, should be frequently rubbed in with the fingers or a soft brush. Severe cases of dandruff require medical care, for often, dandruff proves stubborn, because of the improper state of the general health, which includes poor blood (anaemia), bad digestion, nervousness, etc.
In place of excessive dryness, the scalp and the hair may be very oily and greasy. In this type, frequent washings with ordinary soap and water, with a decoction of tincture of soap bark, or with tincture of green soap, become imperative. In some individuals weekly washings suffice, while in others, a daily shampoo must be taken. Alcoholic tonics are often beneficial in this variety.
Dandruff of the scalp must not be neglected, for in its mildest (early) forms, it is usually easily controlled and little or no damage to the hair results. When treatment is begun after considerable hair loss has occurred, the condition requires more attention, the results are slower, restoration of the hair may be impossible, and considerable difficulty may be experienced in completely controlling the further hair loss.
The employment of hair tonics is not without some danger. Various hair tonics may affect the color of the hair. Those containing oily sub-stances tend to darken the hair, while those containing ammonia and resorcin, discolor and slightly redden it.