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.