“Nothing is easier to cure than a patch of ringworm situated on the body, but it is a very different matter when it exists on the hairy scalp. Then the treatment is, as a rule, most disappointing. Quick cures are very rare, and sure results are only to be obtained by thorough and long-continued employment of active remedies.
“It is necessary to keep in mind the important facts, that the fungus is the essential cause of the mischief; that it soon extends to the bottom of the hair-follicles; that its destruction is indispensable in order to cure the disease; that the great difficulty in curing ringworm is not to find parasiticides, but to get them to penetrate deeply into the hair-follicles, and thus come into contact with the fungus.
“Remedies act in two ways: first, by destroying the fungus- parasiticides, such as boracic acid, sulphurous acid, and the oleates of copper and mercury; others act by setting up inflammation, and even exudation about the follicles, and by this means cure the disease-as croton oil; but by far the majority combine both these properties, as acetic and carbolic acids, Goa powder, chrysarobin, nitrate of mercury, etc.
“It is very unwise to make a large sore place on the scalp, especially in recent ringworm, as the pustular variety may thus be set up; and strong preparations should never be used to young children.
“Selection of a Treatment.
“There are hundreds of different ways of treating ringworm of the head, and many ‘never-failing’ nostrums, which are warranted to cure the disease in a few days or weeks.
“The reason why so many things are said to cure ringworm is due to two causes: firstly, many cases are only ringworm of the body; secondly, numberless children are said to be well, when they still have ringworm in the most chronic form, and thus remedies are said to cure cases that have never been influenced for good by them. I have so often drawn attention to this fact that this may appear mere repetition, but considering the number of children constantly sent to me already certified as ‘cured, who have ringworm in a contagious form, it would appear that all that has been written on this subject has made but little impression on some medical men.
“The plain truth is that there is not a single plan (except the use of strong caustics which will form scars) which can be relied on with absolute certainty to cure ringworm of the head. The rapidity with which different cases, of apparently equal severity, yield to similar treatment varies greatly. Some go on unchecked for months, or even years, and may even spread under good treatment-while others rapidly get well.”
The next hundred pages of Alder Smith’s work are devoted to parasiticides and their modes of application to kill the fungi, and all this is by, perhaps, the greatest living authority on ringworm-always, bien entendu, from the outside surgeon’s standpoint. The treatment of ringworm by orthodoxy thus requires horse-clipper, scrubbing-brush, and ointment-pot, and, to identify the sinful fungi, a microscope.
Finally, in the light of the foregoing facts, it must be manifest to any thoughtful practitioner that annular scalp mould or ringworm is to be regarded as a constitutional affair, and the treatment should be addressed to the host and not to the parasite. We have seen that the germs of ringworm are almost universally present, and a that at all times. The treatment by parasiticides is difficult, tedious, and, for the most part, entirely unsatisfactory, for the vast majority of cases medically certified as cured are really not cured at all.
The nephew of one of the best-known dermatologists of this country was lately brought by his mother to me to be treated for an ill-defined pining condition and a trifling cough. “He has never been well since he had the ringworm,” exclaimed his mother. An examination of the boy’s scalp showed that we had to do with pretty severe scalp eczema, or Alder Smith’s Diffuse Chronic Ringworm. There was anorexia, and restless nights had brought down patient’s state of nutrition. His cervical glands were hard and visible: two months of Bacill. and The boy was discharged well, or rather the mother did not bring him again, as he was in her judgment “perfectly well.”