cloth (using olive oil), and then apply a little solution of carbolic acid (made by adding a half teaspoonful of carbolic acid to a pint of hot water). If this does not allay the itching, wipe it off thoroughly with the oiled cloth, and rub in the tar ointment made of equal parts of "pix liquida " and olive oil. After the itching ceases, treat as directed according to the variety existing. Itching often disappears after a good saline cathartic has acted-Rochelle salts, solution of magnesia citrate, or phosphate of soda. Scratching must be avoided. In the case of children it is prevented by putting mittens of muslin on the hands.

The best cathartic for young children is a teaspoonful of castor oil. Carbolic-acid solution must not be used on them. The folds and creases of their skin must be kept dry and powdered with borated talcum. A great point in the treatment of all eczema is to avoid the use of water, and to substitute oiling with olive oil and wiping off for the usual washing of the affected

area.

BALDNESS AND DANDRUFF.- Baldness is commonly caused by seborrhea of the scalp, an affection probably due to a microbe, and consisting of an inflammation of the skin, with great increase of dandruff of a thick, greasy variety. Sometimes it appears as a thick film, not only covering the scalp, but also the forehead and back of the neck. The greasy substance should be removed with olive oil or vaseline, and the scalp treated with ointment of ammoniated

mercury, four per cent strength. Shampoos with tarsoap suds should be given once in four or five weeks, and the hair should not be wet with water between the shampoos. The hair must be arranged by combing, the brush being used to smooth the surface of the hair only. Deep and repeated brushing does great damage, which is equalled only by the frequent washing some illadvised sufferers employ. Massage of the scalp is useless to control seborrheic eczema, which is practically always present in these cases.

Tight hats are sometimes a cause of baldness. The lead used in the preparation of the "sweat leather " of hats is said to be a cause of loss of hair over the temples. When once killed, hair can rarely be made to grow again. Early treatment of seborrhea is the best preventive of baldness.

The baldness occurring during an attack of syphilis, when the hair falls out in round patches, is treated and often relieved by antisyphilitic remedies (see p. 224).

CHAPTER III

Rheumatism and Kindred Diseases

Causes of Rheumatic Fever-Relief of Pain in the Joints-Lumbago-Stiff Neck-Gout-Symptoms and Cure of Scurvy.

RHEUMATIC FEVER; INFLAMMATORY RHEUMATISM; ACUTE RHEUMATISM.-This variety of rheumatism is quite distinct from the other forms, being in all probability due to some special germ. It occurs in temperate climates during the fall, winter, and spring-less often in summer. Persons more frequently suffer between the ages of ten and forty years. It is rare in infants; their pain and swelling of the limbs can be attributed more often to scurvy (p. 194), or to surgical disease with abscess of joint or bone. Exposure to cold and damp, in persons insufficiently fed, fatigued, or overworked, is the most common exciting cause.

Symptoms.-Rheumatic fever may begin with tonsilitis, or other sore throat, with fever and pains in the joints. The joints rapidly become very painful, hot, red, swollen, and tender, the larger joints, as the knees, wrists, ankles, and elbows, being attacked in turn, the inflammation skipping from one joint to another. The muscles near the joints may be also somewhat swollen and tender. With the fever, which may be

high (the temperature ranging from 102° to 104° F.), there are rapid pulse, copious sweating, and often the development of various rashes and minute blisters on the skin. There is also loss of appetite, and the bowels are constipated. The urine is usually very darkcolored. Altogether, victims of the disease are truly pitiable, for they suffer agony, and are unable to move without increasing it. The weakness and prostration are marked. Small, hard lumps, from the size of a shot to that of a pea, sometimes appear on the skin of the fingers, hands, wrists, knees, and elbows. These are not tender; they last for weeks and months. They are seen more often in children, and are most characteristic of rheumatic fever, but do not show themselves till late in the disease.

Complications of rheumatic fever are many. In about half the cases the heart becomes involved, and more or less permanent crippling of the heart persists in after life. Unconsciousness and convulsions may develop more often when the fever runs high.

Lung trouble and pleurisy are not infrequent. Chorea or St. Vitus's dance follows inflammatory rheumatism, in children, in some instances. Repeated attacks at intervals, varying from one to four or five years, are rather the rule-more particularly in young persons. Acute rheumatism frequently takes a milder form, with slight fever (the temperature running not over 100° or 101° F.) and slight pain, and swelling of the joints. In children this is

a common occurrence, but heart disease is just as apt to follow, and, therefore, such cases should receive a physician's attention at the earliest moment. Recovery from rheumatic fever is the usual result, but with an increased tendency to future attacks, and with the possibility of more or less permanent weakness of the heart, for acute rheumatism is the most common origin of chronic heart troubles. The milder form often follows the more severe, and may persist for a long time. The duration of rheumatic fever is variable; in severe cases the patient is bedridden for six weeks or so.

Rheumatism may be named through a mistake in diagnosis. There are numerous other febrile disorders in which inflammation of the joints may occur. Among these are gonorrhea, pneumonia, scarlet fever, blood poisoning, diphtheria, etc. The joint trouble in these cases is caused by the toxins accompanying the special germ which occasions the original disease, and the joint inflammation is not in any way connected with rheumatism. The constant attention of a physician is emphatically demanded in every case of rheumatic fever, since the complications are so numerous, and since permanent damage of the heart may be prevented by proper care. Only frequent examinations of the heart by the medical man will reveal the presence or absence of heart complications.

Treatment. It appears extremely doubtful whether rheumatic fever can be cut short by any form of treat