Prevention Of Athlete's Foot
( Originally Published 1936 )
The condition of the skin which has come to be known as "athlete's foot," while apparently mild and harmless in most cases, may become a serious health menace.
Indeed, in many school gymnasiums its prevalence interferes with much of the school athletics. In one junior high school 50 per cent of the students were excluded from the swimming pool, locker rooms and shower baths on account of the severity of the disease on their persons.
The disease is due to a minute fungus, one of the so-called ring-worm group. It burrows into the skin and sets up an inflammation which may be merely a mild desquamating itching affair or may break out repeatedly into blisters which easily become infected with pus organisms.
A far more potent cause of the spread of the disease is the fact that in an infected gymnasium or locker room nearly all the habitues become carriers. They have the ringworm on the skin of their feet and everywhere they walk they leave some on the wet floors to be picked up by others.
Ninety-seven per cent of the students in a certain high school in the United States were found to be carriers.
Prevention of the condition should begin with individual prophylaxis.
It is easy to see that if you have an infection of the foot in the form of athlete's foot, and if it itches and you scratch it, you will get the fungus, which is the cause of the eruption, underneath the finger-nails or on the fingernails. Then, if you rub other parts of the body with hands thus contaminated, the infection is spread to those parts. In this way, an infection on the foot may cause an eruption on the hands and under the armpits, and in nearly any part of the body.
The hands always should be carefully washed after they have touched such an eruption, and scrubbed with a scrub brush, which is then put for a moment or two in boiling water or allowed to soak in alcohol. Socks which have come in contact with ringworm eruption on the foot should be separated from other clothing and washed in a separate receptacle.
Soap is a good antiseptic for many things, but not for this particular fungus, and it often is advisable to dip the hands in alcohol or a 10 per cent formaldehyde solution after washing them.
The commonest method of spread of ringworm infection of the foot, or athlete's foot, is in the locker rooms of country clubs, golf courses, and especially in the shower baths near swimming pools. The fungus grows very well on moist surfaces, and one person with such an infection on the foot coming out, may spread it around the entire border of the pool.
In preventing such cross infection, it is necessary to insist that everyone entering the pool or shower bath shall first disinfect the feet. This is done by dipping them in a solution which destroys the fungus, or standing on a rubber mat saturated with such a solution, until the bottom of the feet and the spaces between the toes are moistened.
In selecting the solution, it is desirable to remember that swimming pools usually are disinfected with chlorine. An antiseptic formula used for disinfecting feet in locker rooms is sodium thiosulphate, but sodium thiosulphate is a reducing agent, and if a 10 per cent solution is carried on the feet into the swimming pool, it rapidly reduces the available chlorine content of the pool.
For this reason, the best substance to use is a hypochlorite solution, which will augment rather than reduce the chlorine content of the pool. A solution containing five thousand parts per million available chlorine as a foot bath, and a solution containing five hundred parts per million available chlorine for disinfecting mats, walks and other equipment, is available on the market in the form of a calcium hypochlorite solution, sold under the trade name of H. T. H.
One simple method of prevention which should be enforced in all locker rooms and shower baths of country clubs, golf clubs and swimming pools, is to require the athletes to wear paper slippers while walking around or to and from their lockers and showers. These paper slippers are on the market in extremely inexpensive form.
TREATMENT OF RINGWORM OF THE FOOT-ATHLETE'S FOOT
Those itchy, blistery eruptions on the feet and hands, which are so common in warm weather, are due to infection by a microscopic vegetable fungus which lives indefinitely on such apparently unfertile places as smooth stone floors, and hence is likely to be on the bathroom or swimming room floor, to be picked up by the unsuspecting feet, and start trouble.
Once you have it, what are you going to do about it? Fungi and yeasts are much more easily killed with antiseptic medicines than ordinary germs, so it would seem that we could stop an attack of this kind very promptly. So we can, most of them, if they are taken early. An ointment called "Whitfield's Ointment" can be obtained at any drug store, and smeared on the eruption and left on all night for one or two nights, will usually do the trick. Its active ingredient is salicylic acid (12 per cent).
But all the varieties of this fungus are not killed by salicylic acid and as, if it is applied too long or too often, salicylic acid will irritate the skin, much trouble has been caused by its too persistent use. If it does not improve the condition promptly, therefore, its use should be discontinued and one of the other fungicides applied. Of these, iodine is one of the most efficient. Dilute potassium permanganate solution, and the dye carbol-fuchsin, developed by the Italian student of these fungus infections, Castellanio.
Another method which has recently been reported is the use of a mercurial preparation known as "phenylmercuric nitrate," which is put up in an ointment in a concentration of 1 to 1500. The method of preparation is described in the Journal of the American Medical Association for Dec. 30, 1933.
Reports from its use are very encouraging. For instance, one case reported is that of a woman who had had for twelve years a weeping, itching eruption between the toes. Nearly every form of treatment had been tried on it until the phenylmercuric nitrate ointment was used, with the result that she was cured in two weeks, with no recurrence within three months.
Of 262 cases of yeast or mould infection, 205 responded favorably to the use of this preparation. It is somewhat irritating in greater strength than the proportions given above, and even sometimes in that strength. Should this occur, it can be weakened.
The treatment may need to be further changed by the complications which may occur. The most natural and almost inevitable one, since we are in the presence of an eruption which prompts incessant itching and, therefore, rupture of the skin by dirty fingernails, is pustular secondary infection. This should be treated with hot wet packs of boric acid or mercury solution. The wet packs alone—simply hot water—are very grateful in any stage of the disease.
For the stubborn chronic form, where there has occurred considerable thickening of the skin, nothing but the x-ray is calculated to bring about a cure.
These things are mentioned, not to encourage elaborate self-medication, but to point out that if simple early treatment is not successful there is a reason for it, and the complicated case should be put in professional hands. Self-medication of the early stages with Whitfield's ointment and other remedies is entirely justifiable and practiced by everyone, including the members of the medical profession themselves.
Prevention is most desirable, in view of the almost universal occurrence of the pest in our country. I have known the affliction to be kept alive in the person of an individual for months. The finger-nails which do the scratching become infected with the fungi and spread it all over the body. Therefore, the hands should be soaked in an antiseptic solution, such as alcohol. Nail brushes should be treated similarly or boiled after use, in the presence of an infection. The shoes may be depots of re-infection. Bathroom floors may have to be wiped with lysol solution. Dry the feet thoroughly after bathing, especially between the toes.