The treatment of venereal disease and scabies in the army : report.

  • Great Britain. Army Medical Department. Advisory Board for Army Medical Services.
Date:
1904
Catalogue details

Licence: In copyright

Credit: The treatment of venereal disease and scabies in the army : report. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    Question X. | What are the most satisfactory methods of treating scabies ? 1 Bt whom, 1 Report of Evidence. T)r. T. CoLCOTT Fox. There ought to be no diflSculty in framing a plan to deal with it satisfactorily, for it is the most easilj- managed thing in the world, if the conditions of the problem be clearly understood. We have to deal with a superficial inflam- matory affection of the skin caused by an animal parasite, which burrows in the epidermis of certain regions. We can easily kill the pai-asite by a number of remedies, and we have to do this efficiently without causing any further irritation. Directly the parasite is killed, and we can guarantee that by a proper method, all that remains to do is to heal the existing inflammation. The method in use at the St. Louis Hospital in Paris is a striking example of a rapid and rather energetic treatment. It is most efficacious, but it is all done in under two hours. They call it “ la frotte.” Patients are taken and first of all rubbed ’20 minutes with soft soap. This is not carried out in exceptionally inflamed cases, in which there is a good deal of eczema. In the ordinary run of cases the patient is soaked in a hot bath, during which time he goes on scrubbing himself, especially about the hands, and soon. Then when he comes out of the bath he is rubbed all over with a modification of Helmerich’s sulphur ointment. Then th^y get the patient to go home and persuade him to leave it on till next morning. But sometimes they wash it off there and then; and it is said only about 6 per cent, of the patients come back with any trace of the disease after that two hours’ treatment. They get such cases in hundreds there. My experience of Vlemingck’s fluid is that it is a very strong remed>. It is used by some country practitioners, and as matter of routine in some Belgian hospitals. In my opinion, it cannot compare with the ordinary sulphur ointment. The mildest and most effective and agreeable remedy of all no doubt is Professor Kaposi’s naphthol ointment. There is a good deal of soft soap in that, which is apt to be irritating sometimes ; and if that is taken out in very inflammatory cases it is most agreeable. My routine treatment at the hospital, where there are no special baths available, is as follows, and I find it most effective. I order a warm bath to be taken for 20—00 minutes in order to macerate the skin. Then I direct the patient to scrub the softened skin thoroughly with soap in order to cleanse away all crusts and scales and acari, to break vesicles and pustules, and devoting special attention to the hands to clear away the roofs of the burrows. I order cieosote soap, but any soap from soft soap to a toilet soap can be used according to the delicacy and state of the skin. Then the skin being dried a weak sulphur and mercury ointment is care- fully smeared over the w'hole surface, except the face as a rule, paying special attention to the hands. The ointment is left on and re-applied every night and morning for three days and three nights, the patient wearing the same under- clothes throughout and gloves. The acari are then effectively killed. A bath is taken and any inflamiuation of the skin is healed up, and any itching left soothed. With regard to the treatment, my brother’s favourite maxim was “ not too long and not too strong.” It is impossible in out-patient practice to have the bedclothes, &c., disinfected. I use styrax ointment for babies who g('t very' eczematous. 1 think balsam of Peru is pi-obably the most effective killer of the parasite of all. It is fragrant, but it is smelly, and I do not use it very much in private practice, because of the scent. I have no other objection to the treatment; you can paint the patient all over with it, and then again next day, and they are well the next. It is the most effective treatment. Mr. Charles Gibbs, F.E.C.S. I know nothing about the treatment of scabies. Mr. Arthur Ward, F.R.C.S. I have nothing very definite to say about that. Dr.. W. Allan Jamieson. There are three methods that I employ in the treatment of scabies. If in hospital a case comes up we treat him in this way : The patient has a warm bath, with plenty of black soap, and this is rubbed in thoroughly. Immediately after- wards, before a warm fire, he rubs in some ordinary unguenmm snlphuris of the Pharmacopoeia, and he does that for three nights without a second bath. That is, he takes his single bath, and for three nights rubs in the ointment. He has another bath, and then we give him a mild ointment, composed of ammoniated mercury, 5 grains to the oz., which he rubs in for the purpose of getting rid, if they are present, of any pustular lesions by destroying the activity of the staphylococcus. That we find to be the best treatment, as a rule. In private work it is sometimes not advisable, and sometimes even in hospital practice, to use sulphur. Some of the patients’ skins are irritated considerably, and then I substitute j3-naphthol, which is of course more expensive ; and I give it in the proportion of 1 in 10 in Lassar's paste, omitting the salicylic acid. When I use this instead of the sulphur the patient does rather differently. He washes first of all with soap and warm water, in the same way as I have mentioned, so as to open the pores and interstices of the skin. Then he rubs the naphthol paste in for four nights. Then he takes a bath again. As a rule it is quite cured by that time. The third method which is sometimes used is to employ Vlemingck’s solution (quick-lime one part, precipitated sulphur two parts, water twenty parts. The lime and the water are first to be well mixed, then the sulphur is added, and the fluid boiled slowly down to twelve