RINGWORM IN GENERAL SURVEY IN LITERATURE
In daily life we find ringworm a difficult disorder to cure: a few cases yield to almost any sensible treatment, but the bulk of them offer a stubborn resistance. And yet we often find the therapeutics of ringworm in the text-books confined to a very few lines. One author of no mean standing tells us that the soft- soap treatment generally suffices! However, some authors do not hesitate to speak out plainly on the subject. And I notice that the more the authors know of ringworm, the more they have studied it, the less therapeutically positive do they become. Willan (1817) confessed that it is “hard to cure.”
Gruby (1844) made the discovery that a fungus was present in the broken-off hairs and in their root sheaths. This parasite was fully described by Malmsten, in Stockholm, in 1845, and it was named by him the Trichophyton tonsurans. Cazenave’s name, Herpes tonsurans, is most commonly met with in many works. Its other names are legion.
Alder Smith, M.B. Lond., F.R.C.S. (“Ringworm: Its Diagnosis and Treatment,” London 1885), has very usefully spent many years in studying ringworm, and in the work just named shows himself a thorough master of the subject, has position as Resident Medical Officer at Christ’s Hospital, London, affording him incomparable opportunities for such studies. I shall take this author as the representative of the latest views of science on the subject of ringworm.
Alder Smith thus defines ringworm:-
“Ringworm is a disease of the skin caused by a microscopic vegetable parasite; and the characteristic lesions are due to this minute fungus invading the epithelial layers of the skin, the hair follicles, and the hairs. The growth which causes this very troublesome affection belongs to the lowest order of plant life, the fungi or moulds; the same fungus is found both in ringworm of the head and the body, and the two affections are essentially one. This disease, which is a very common one, is liable to attack all classes-the rich as well as the poor-and is highly contagious, but it is almost entirely confined to children.” And then says:-
“The history of ringworm is complicated, as certain varieties of form of the disease have received a number of designations from the older authors.” *”Viz.- Porrigo scutullata, Willan; herpes tonsurans, herpes squamosus, Cazenave; herpes circinatus, Bateman; porrigo ton soria, dartre furfuracee arrondie, Alibert; tinea tondens, squarus tondens, Mahon; phyto- alopecia, Malmstem; rhizophyto-alopecia, trichophytie, Gruby; dermatomycosis tonsurans, Kobner; tinea trichophytina, tinea circinata, Anderson; trichonosis furfuracea; porrigo furfurans; lichen herpetiformis, Devergie; lichen circumscriptus, figuratus, gyratus, impetigo figerata, etc.; Germ., scherende flechte; Fr., herpes tonsurant; teigne tondante; teigne tonsurante.”
As to the life-history of the fungus I will refer my readers to Alder Smith’s work, which is beyond compare the best epitome of the subject with which I am acquainted, almost all the other works on ringworm are antiquated and only of historic value. But I must quote what Alder Smith says of the host of the Trichophyton tonsurans.
“All children are not equally susceptible to ringworm. A certain unknown condition of the skin is necessary for the growth of the fungus, as some children never take ringworm though constantly liable to become infected For it is evident that when one child in a family has ringworm, and is not under any treatment, the others must be exposed to the action of the fungus; yet, at times, the disease does not spread.
“This fact is often used as an argument by parents, to prove that their children are not suffering from any contagious form of disease, and that they are in a fit condition to enter a school.
“On some the fungus takes but slight hold, and is easily destroyed. Others are extremely susceptible; the disease quickly attacks the follicles and the hairs, and spreads with great rapidity although under treatment. Sometimes treatment even accelerates the already rapid spread of the disease, by producing impetiginous eczema with crusts; and, by means of the pus, the fungus is carried to more distant and healthy parts. This variety is most difficult to manage. “The difference in these cases must depend on some peculiar nutritive condition of the soil or material in which the fungus develops, or upon some special state of the general health or constitution. In fact the state of the soil is a most important condition; and the rapidity with which a small spot of ringworm will spread before it comes under efficient treatment depends chiefly upon this peculiar condition of the soil or nidus. We generally find that ringworm specially occurs, and spreads most rapidly among poorly nourished children of a strumous or lymphatic diathesis. *”Mr. M. Morris states- and I fully agree with him- ‘that children with very light brown, golden, or colourless hair, with light grey or blue eyes, and with fine skin with thin epidermis, take ringworm easily and usually have it severely. The Lancet, Jan. 29th, 1881. And it is often observed that all the children in a family of this description, if they become infected, will suffer severely; evidently showing that there is some general condition present favouring the parasitic growth.
“Ringworm is also commonly seen amongst those who, while they are not decidedly strumous, are yet thin and pallid.
“Most children with chronic ringworm dislike fat; this avoidance of fat in the diet-according to Dr. Fox-‘has a most potent influence in leading to the development of a condition of nutrition which is favourable to the occurrence of obstinate ringworm.’
“But, on the other hand, we constantly see both recent and chronic ringworm in those who are neither strumous nor ill- nourished,-in fact upon decidedly healthy and robust children. This leads me still to hold the opinion, that the peculiar condition which is favourable to the development of the ringworm fungus is unknown.
“Ringworm does not exercise any noticeable influence on the general organism or constitution, or on the general nutrition of the body.”
I cannot agree with Dr. Fox’s view, just quoted, in regard to the avoidance of fat as a food; what I would say is this: These children dislike fat because they are in an ill condition; the ill condition pre-exists the avoidance of fat, and is not produced by want of it, other than secondarily. Alder Smith, as we see, holds the opinion that “we constantly see both recent and chronic ringworm in those who are neither strumous nor ill- nourished-in fact, upon decidedly healthy and robust children.”
This I deny; the ringworm mould cannot grow on really healthy children any more than fish can live out of water. They may look healthy, even very healthy; they may appear to be robust, jolly, rosy, fat, but they are not truly healthy, or their skin-surface would not get mouldy in ringwormy patches. Of course, my opportunities for observing ringworm are not by any means to be compared to those of Alder Smith’s, but I have examined a goodly number to test the point, and have never yet found a truly healthy child the subject of ringworm: they all have more or less indurated glands somewhere. From the curative results following the exhibition of Bacillinum I am led to believe that the mould of ringworm can only grow on those who are more or less strumous or tubercular, and that the degree of the disease gauges the degree of the constitutional morbidity.
Now Alder Smith is a reliable observer, a man of science and fact, and there is strong inherent evidence in his work on ringworm that he puts his facts fairly and squarely before his readers. This being so, it must follow that his facts should prove the constitutional nature of ringworm if such be the case.
Let us see.
ALDER SMITH’S FACTS VERSUS
ALDER SMITH’S VIEW THAT
“DECIDEDLY HEALTHY CHILDREN”
MAY BE SUBJECT TO
In the following quotations from Alder Smith’s work most of the italics are mine.
He says (pp. 29 et seq.):-
“Diagnosis of Ringworm which has Existed Some Time.
“Chronic Squamous Ringworm. “In the first place, I cannot help observing that very few medical men, either in consultation or private practice, are aware how extremely difficult some cases of ringworm are to cure; and the majority consider a case well, even when it has assumed a decidedly chronic state. I constantly have boys brought to me on their return to private schools, and very many also on their presentation for admission to Christ’s Hospital, who, while bringing certificates from medical men of the highest professional standing that they are cured of ringworm, and quite fit to mix with other children, are still suffering from a severe, contagious, and chronic form of the disease; and I have often found on inquiry, l that an opinion has been formed, and a certificate given without any special examination of the scalp, and certainly without the help of the lens or microscope. Many practitioners imagine that ringworm is cured when some of the hair is again growing freely and firmly on the part affected. This is a great mistake, as some of the most chronic and intractable cases are those in which the hair has partially grown again on the scurfy patches; but, on close inspection with a lens, some short broken-off hair or stumps may be seen scattered among the healthy hairs.