One of the earliest skin troubles that the average normal child suffers from is prickly heat—a tiny, red-pointed rash always accompanied by sweating and usually resulting from over-dressing, stuffy rooms, and other conditions that make the child too warm. Prickly heat produces more or less discomfort but usually little or no itching. Ordinarily, a sponge bath followed by the application of talcum powder is sufficient to give relief in mild cases; but severe or neglected cases should be treated by means of bran baths, a cupful of bran being tied up in a gauze bag and suspended in water until the water assumes a milky color. Soda baths, two tablespoons to a gallon of water, are also very soothing. A baby should never receive any friction with a towel after such baths, but should be rolled up in a clean linen towel and simply patted dry.

CHAFING

Great care should be exercised in the choice of baby's soaps. Among a number of soaps that might be mentioned castile soap is, perhaps, as good as any. Frequent sponging is required to wash off the irritating perspiration; cool clothing, plenty of talcum powder, a dose of calcined magnesia, and a regulated diet are necessary to clear up the trouble.

Chafed skin, particularly between the buttocks or in other folds and creases, should be kept free from soap. Either the starch or bran bath may be tried, while olive oil should be frequently and lightly rubbed over the chafed part. A bit of sterile cotton placed between the folds to prevent friction is often all that is necessary to correct the difficulty.

Dandruff or milk crust which is often seen on young babies' scalps has been described in detail elsewhere. It should early receive the vaseline rub at night which will often loosen up the hardened crusts. It may be gently removed in the morning with soap and water unless the case has gone on to great severity. In such neglected cases the mother should not undertake to correct the difficulty alone. Taken early, when the scalp is covered with tiny flakes known as milk crust, it can be quickly relieved.

VULVOVAGINITIS

Vulvovaginitis is a very contagious disease, and before the days of hospital asepsis, which is so perfectly maintained today in our large institutions, this disease used to go right through a children's ward because of carelessness in the handling of soiled diapers, etc. The sign of this disease is a yellow-white vaginal discharge, while the surrounding skin covering the inside of the thighs and buttocks may be very much reddened. The baby should be taken at once to the physician at the first appearance of these symptoms. Only rigid isolation can possibly prevent other children from getting it—essentials are separate towels, wash towels, soap (in the case of the older children), and, in the case of the baby, separate diapers and rigid scrubbing of the attendant's hands—in this way only can this infection be held in check. The infected child should sleep by herself, and utmost care must be exercised in preventing her fingers from first touching the itching vulva and then placing them to the eyes or to the mother's eyes. A vulva pad must be worn as long as the disease lasts. The physician will give you the proper medicines to be used in these cases, and if no physician is within reach, you are perfectly safe in dropping into the spread apart vulva a few drops of twenty-per-cent argyrol and then applying the vulva pad. After each treatment the hands of the mother or nurse must be most rigidly cleansed.

ECZEMA

Eczema is a very troublesome disease, particularly in infants; there are so many forms of it that there is neither time nor space in this volume to describe them individually. This disease may be produced in children by either internal or external causes—from friction on the skin, from coarse, rough woolen clothes, or from starched garments, or from lace or starched bonnet strings which rub into the folds of the skin. Irritating soap, the contact of soiled diapers, cheap toilet powders, and discharges from the nose and ears may also be responsible for the disease. The particular internal causes are over-feeding, digestive disturbances, the too early use of starches which create fermentation in the intestinal tract. In the most frequent form of eczema the skin becomes red and then there appear tiny vesicles (water blisters) which soon rupture and "weep." This fluid which oozes from these tiny, ruptured vesicles, in connection with the perspiration and exfoliation of old skin, forms heavy crusts upon the face which are both unsightly and annoying.

Another form of eczema is simply a very badly chafed condition accompanied by intense itching, and commonly known as "dry eczema." A very disagreeable form is the pustular variety. One poor little sufferer that was once brought to us had so many pustules on his head that one could not put a ten cent piece on his scalp without touching a pustule. The treatment of these cases, in order to be effective and leave the child's head in normal condition, must be administered with the utmost patience every day for weeks. A doctor's help is always required in combating this sort of skin trouble. If the cause is external, then the clothes should be changed. All irritation should be removed—the clothing must not be allowed to scratch the skin. The child must not scratch himself. If necessary, little splints may be placed on the inside of his arms to prevent his bending the elbows if the eczema is on the face, while the little sleeves may be pinned to the side of the dress to resist the movement of the arms.

ECZEMA TREATMENT

The diet should be most carefully looked into. The nursing mother will earnestly look into every article of food she herself is eating, and carefully avoid all foods that produce fermentation or decomposition. The mother's urine should be examined and its acidity noted; if it is above normal she should take some alkalines such as ordinary baking soda or calcined magnesia. If it is a bottle-fed baby, any form of flour should be removed from the food and the quantity of the milk reduced. All this, of course, is done under the direction of the physician. Repeated doses of castor oil may be given.

The name of the medicinal agents that have been used in the treatment of eczema, is legion. Perhaps one of the most widely used is the early varnishing of the affected skin with ichthyol (one part ichthyol, one part distilled water), which is swabbed on after the skin has been cleansed with olive oil. Allow this to almost dry, and then sprinkle on talcum powder which smooths over the dry varnish of ichthyol. This is worn every night and during the day, in bad cases, even when the eczema is on the face. It is renewed each day, and is preceded by the olive-oil bath. No water or soap is ever used in eczema. Fortunately, the Eskimo has taught us that the skin really can be cleansed with oil as well as with water. In the appendix will be found two prescriptions, number one and number two, that have proved very beneficial in some of the most severe forms of eczema.

HIVES AND FRECKLES

Hives, a crop of little raised red papules closely resembling lesions caused by the sting of a mosquito, may make their appearance upon the skin of the child, remain a few hours, and then disappear. Hives are usually due to digestive disturbances and may be caused by such foods as strawberries, nuts, pastries, pineapple, certain sea foods, mushrooms, etc. A good cathartic, the taking of alkalines, such as baking soda or calcined magnesia, with a bran or starch bath, or possibly a soda bath, will usually correct the difficulty. The same treatment may be used in nettle rash or prickly heat.

Freckles seem to run in families. Broad-brimmed hats or sunbonnets may be worn, but under no circumstance should a little girl be bidden to remain in the house and shun the beautiful, sunshiny outdoors just because she freckles easily. Do not apply any lotions to the freckled face without medical advice, for great harm may be done the tender skin of the child.

RINGWORM

Often upon the scalps of young children may be seen circles—rather, patches—which are slightly rough to the touch, and which cause the hair to fall out and the spots to remain bald. They are known as ringworms of the scalp. The affection may likewise appear on the body or the face, presenting a ring of reddened skin with a scaly border. Ringworm on the scalp is hard to treat and medical help should be secured, for, in spite of all that can be done, the disease often runs its course, leaving round bald spots over the head. Ringworm of the face, taken early, is helped by carefully painting with tincture of iodine. The mother should constantly bear in mind that ringworm is a "catching" disease, so that all handkerchiefs, towels, and clothes are to be kept separate. The disease known as mange which so often attacks dogs, is nothing more than ringworm, and children often contract the disease from dogs. Ringworm, whether it be on children or dogs, may be greatly helped by the use of tincture of iodine and other appropriate remedies.

BOILS

The much poulticing of boils has done an untold amount of mischief. Many children and adults are in their graves today because of improper treatment of boils. Blood poisoning which so often follows the careless poulticing, as well as the uncleanly opening of boils, can all be avoided. Before touching a boil, the surrounding skin should be thoroughly washed with sterile cotton and laundry soap and then disinfected with alcohol. Then, with a scalpel or a surgeon's knife which has been either boiled for twenty minutes or allowed to remain in pure carbolic acid two minutes and then in alcohol two minutes, it should be thoroughly opened down to the core so that the pus may come out. It is very much better for the trained hands of a physician to do this than for any member of the family to undertake such an operation—where the danger of blood poisoning is always present. The only treatment of skin eruptions containing pus which is justifiable for the home folks to undertake is to simply paint them with iodine. Under no circumstance should poultices be used.

FEVER BLISTERS

It is not at all uncommon for small children to develop a group of fever blisters on the lips when suffering with any disease, or experiencing a high fever. Even a simple cold or a spell of indigestion may be accompanied by fever blisters. They appear not only on the lips but also on the edges of the nose and may even be seen on the chin.

Early in their first appearance they may be treated with spirits of camphor or plain alcohol, which sometimes tends to abort them; but they usually run their course, and when they are fully developed they may be treated with zinc oxide, simple borated vaseline, or ichthyol.

WARTS

Very often children's hands are disfigured by warts. They appear suddenly, develop rapidly, and many times disappear just about as suddenly as they appeared. Every child suffering from warts usually passes through the stage of charms and lingoes which are popularly used to remove these disagreeable growths. We hardly see any efficacy in "bean-ie, bean-ie take this wart away," or any particular virtue in stealing mother's dishcloth, cutting it up into as many pieces as there are warts on the hand and rubbing each wart with a separate piece of the cloth; but you will find people in every town or village who will assure you that their warts were driven away by one of these charms or lingoes. Warts are either better left alone or removed by a physician with the high-frequency spark or some other reliable method.

BIRTHMARKS

A red or purplish patch on the skin is the result, as mentioned in an earlier chapter, of an embryological accident in which one or more embryonic cells slipped out of place in the early days of skin formation. These accidental markings may occur on the face, the scalp, or on any other portion of the body, and they should be let alone, unless they show a tendency to grow, when it may prove best to give them proper surgical attention.

A mole is also a birthmark, and if found upon the neck or shoulders where it is likely to disfigure, it may be removed by the high-frequency spark, or by surgery, in the same way as warts. Never tamper with moles. Leave them alone or turn them over to the surgeon.

ERYSIPELAS

Erysipelas is a much-dreaded disease which is the result of infection with the blood-poisoning germ—streptococcus. It usually occurs about a wound, and is due to infection by this microbe. If it follows circumcision, it is due, of course, to infection, and may be very serious, even causing death. It attacks persons of any age and is oftenest seen on the face. In appearance, the skin is a bright and shiny red, with a definite line of demarcation slightly raised at the edges because of the swollen tissues underneath. On pressure, the redness disappears but reappears immediately upon relieving the pressure. The inflammation, pain, and fever often continues a number of days, during which the child should be isolated from all other members of the family. The bowels should be freely opened, and the diet should be liquid and soft; while local treatment is cared for by the physician who should always be called. Should erysipelas develop on a very young baby it is very important that he should be removed at once from the mother. As stated before, the disease is produced by the blood-poisoning germ which is very much to be avoided in any and all stages of obstetrics. One attack in no way renders the patients immune. They may have repeated attacks of erysipelas. The treatments should be started early and kept up most rigidly.

SCABIES AND LICE

In thickly settled districts among the poor and uneducated, where filth and untidiness reign, the "itch" is a very prominent disease. It is caused by the itch mite, a parasite which burrows underneath the skin leaving behind its eggs in little irregularly shaped, bluish tinted ridges. Such a profound itching is set up by this burrowing and depositing of eggs that the child cannot resist scratching, and all taken together produces the typical itch-rash. The common site for this rash is on the sides and between the fingers and toes; on arm pits and buttocks of the child, as well as at the waistline. The treatment is usually beyond home remedies. A physician should have charge of the case who will conduct a line of treatment which, if diligently followed, will rid the body of this scourge within a week or ten days.

Along with the itch are often found parasites of the head, or lice (pediculi). It is not at all infrequent to find them in the heads of uncared for children; but if a much-cared-for child is brought in contact with an infected head he will probably "catch" the infection. A most intense and disagreeable itching is set up at once. The treatment consists in getting the head clean by the use of a very fine comb, thus endeavoring to remove the adult parasites as well as the eggs or "nits." However, great care should be taken to avoid injuring the scalp. Perhaps the simplest and most effective treatment known is the kerosene bath which should be applied at night, the hair being done up in a bandage until morning, when the kerosene is washed off with soap and water and then the hair given a vigorous vinegar shampoo in order to destroy the "nits." Tincture of larkspur, or an ointment made from the seeds, may also be used. It is applied several days in succession and then washed out.