VOL II. No. 7.

School Surgery.

BY ALFRED CARPENTER, M.D. (LOND.), C.S.S. (CAMB.), Vice-President of the British Medical Association.

THE

VII.

DISEASES OF THE SKIN.

HE Squamous, or Scaly Diseases. This class is made up of two or three very distinctive forms, which in their typical state are easily recognisable. They are not inconsistent with apparent good health. Children are frequently sent to school suffering under one of the forms belonging to this class, viz., Psoriasis; it is perfectly free from danger of infection. It affords a curious comment upon names, for we find that originally it was applied to the Eastern disease 'Leprosy,' and was synonymous with the term venomous, or malignant. It is now appropriated to a condition of skin which is only an increased secretion of scales. This arises from an inflammatory state of cutis; there is exudation nto, and thickening of, that structure. These actions are local, and are not attended with any evident constitutional disturbance. The surface of the skin is dry, there are neither vesicles, pustules, or any ulceration. The affection may exist in the form of simple spots, when it is called 'Psoriasis punctata,' each restricted to a single hair follicle. Sometimes these spots slowly increase in size, and each occupies an area the sixth to the third of an inch in diameter, when it is styled 'Psoriasis guttata.' These patches are sometimes almost white, and are frequently called Lepra, or the disease may occupy larger patches of skin from the first, it is then called Psoriasis circumscripta,' or 'diffusa.' Patches may become inflamed, and give rise to an exzematous rash, and it is even difficult for the expert to determine at first sight whether the disease belongs to the scaly or the vesicular class. As it subsides the scales fall off, and leave roundish red spots, which may be dull or copper coloured; at length they die away, and the skin is left without any mark or discolouration, to show the former position of the eruption. This may be somewhat changed by the excessive scratching to which the spots may be subjected by the patient.

Sometimes the disease affects the nails, they become brittle and split, or it is limited to the palms of the

VOL. II.

hands, and soles of the feet. These cases are probably connected with an hereditary blood depreciation, consequent upon Syphilis in a former generation. Sometimes the disease is excessively obstinate, the skin cracks and serous discharges ooze from it. It is then called 'Psoriasis inveterata.'

If children can be kept clean, there is nothing in these cases to prevent them from mixing with their fellows. It is a chronic disease, especially liable to relapse. It would be wrong to exclude the subjects of it from going to school on account of its nature. Probably half the cases which actually arise do occur in children. It is not uncommon, and it is well that managers should be able to recognise it, and act accordingly. Occupation, and regular habits by promoting good health, may help to cure it; whilst foul air, bad habits, and improper food, will tend to make it 'inveterate;' excess in eating and drinking fatigue or excitement of any unnatural kind, will render it more intractable. It requires medical treatment for its cure, which will be generally found in the internal administration of minute doses of arsenic or iodide of iron, and the local application of some of the creosote, or tar preparations which are now frequently to be met with. The diet should be simple: Salt meats, pork, spices, and stimulants should be altogether prohibited. Coffee, by drying the skin, is also injurious. Fresh fruits, vegetables, and milk foods, are more advantageous than meat. If there is a syphilitic taint, it will

continue to teaze the constitution until some other and more serious malady takes its place.

Pityriasis is another scaly disease. The name is derived from a Greek word signifying bran, and a branny kind of scale is its distinctive feature. It is requisite to avoid mistake, and not to confound it with the desquamation, which arises after measles or scarlatina. It would be difficult for the non-medical mind to distinguish the one from the other, if it were not for the general illness which had preceded the one, but not the other. It is sometimes mistaken, and much unnecessary alarm excited when the skin disease is thought to be the sign of the eruptive complaint. Another mistake is often made regarding the form which is known as ' Dandriff,'' Pityriasis capitis.' This is due to an excessive secretion from the sebaceous glands in the scalp, and may be mistaken for infectious disease, whilst it is really harmless; but it is indicative.

X

of a want of cleanliness, and the collection of scales in the hair may be a nidus for infectious disease, if such children come in contact with the germ which produces ringworn or favus. A form of chronic erythema is sometimes called Pityriasis improperly; it is seen at the corners of the mouth, on the lips and cheeks of delicate children. It may be induced by the use of soaps which are too alkaline, or by any means which will take off the epidermis in too rapid a manner, by which the tender cuticle is too much exposed. Pityriasis simplex' occurs in the form of small white round patches in the hairy parts of the body, which become covered with branny scales, and may give rise to patches of baldness. The baldness will not arise if the patch is cured quickly. This may be rapidly effected by using a solution of borax in rose water (cne dram of salt to the ounce), and afterwards applying a solution of bichloride of mercury, such as was prescribed for the cure of Acne. Frequent bathing in soft water, and an unction with pure salad oil, will help to get rid of the tendency.

There is a form of disease called 'Pityriasis versicolor,' which is due to a parasite, and which can only be cured by destroying the fungus which produces it.

Ichthyosis, or the Fish skin disease, need only be mentioned. It is sometimes seen in a very slight form, in which the skin is mapped out in a quadrangular or irregular-shaped segments, covered with slabs of cuticle, adherent in the centre but loose at the sides. Sometimes the whole body seems covered with laminæ of cuticle loosely adherent to the cutis; it is smooth and shining. It is not of such a character as need excite the attention of the master, except to see to the scrupulous cleanliness of the child, and that the diet be always wholesome.

The Vesicles consists of several forms of malady under the names (1) Sudamina, (2) Miliaria, (3) Eczema, (4) Herpes or Tetter, and a class which go by the name of (5) Blebs, or Pemphigus and Rupia.

Varicella and Vaccina are sometimes called Vesicular, but it is more convenient to class them with the Exanthemata.

'Sudamina' are simple transparent vesicles, which are often met with upon the bodies of rickety or tubercular children, who sweat much. They are hemispherical and smooth. They are not uncommon in the course of continued and other fevers. Miliaria are similar; they are not hemispherical, but acuminated and surrounded by a zone of redness. They are met with in cases of fever, and only call for mention.

Eczema is one of the commonest of skin diseases. It arises in the form of minute vesicles, containing serum. The fluid evaporates or absorbs, and their flakes or crusts are left. There is an erythematous condition, with heat and tingling. The skin is red. and raw looking. As soon as the flakes are removed, or even before the removal, there is a fresh crop of vesicles. The parts burn, or tingle and itch most abominably. It is closely allied to the papular and scaly forms of disease, and, when inveterate, renders life a positive burthen to the sufferer. It may be set up by the use of irritant applications in constitutions prone to it. It often accompanies scabies, that is the disease which the itch insect produces. I have often seen it rendered extremely difficult to cure by the action of the little microscopic red insect called the harvest bug, which frequents the thickets and hedgerows on the chalk hills of Surrey. It burrows into the legs and arms of boys who hunt them for birds' eggs and black

berries, and if the cause is not recognised cure will not follow upon the treatment adopted. The distinctive characteristic of Eczema is the fibrinous exudation which stiffens and stains the linen garments of the wearer. The discharge, which comes from a simple chafe caused by friction (Erythema intertrigo' is its scientific name), is not abundant, and does not stiffen the linen, so need not be mistaken for that disease. Eczema is common in children, and when it affects the head is called 'Eczema capitis.' The discharge is yellow, from mixture with sebaceous secretion. There is excessive production of epidermis; the fluid becomes purulent, and the hair mats together, forming a disgusting mass. This form differs from the infectious form called 'Tinea Tonsurans,' or Favus, inasmuch as that the hairs are intact, not broken off, twisted, and sheathed with a fine white deposit, as is the case in favus. There is also no moist discharge. The disease sometimes affects the ears, especially the grove behind the pinna. It sometimes affects the hands in those who handle sugar, soda, dyes, and other irrirating merchandise. 'Grocers' itch,' 'washerwoman's itch,' and 'bakers' itch' are all varieties of Eczema.

The treatment of this form of complaint is mixed up with constitutional remedies, and cannot be got rid of by local measures. Diet should be moderate, stimulants altogether avoided, and the immediate exciting cause be removed. The tendencies of the child must be considered as to whether there is any syphilitic, rheumatic, gouty, or scrofulous tendency, or whether it has had its origin in outside causes. The local crust should be removed by bread-and-water poultices, the hair must be cut to expedite the removal of the crusts, and the part affected kept scrupulously clean. A more decided course of treatment must be prescribed by the medical attendant, which will be according to the tendencies above referred to, for each requires a different class of medicine.

Herpes or Tetler, as it is commonly called, is a noncontagious and vesicular disease taking on several forms. The most common is 'Herpes liabialis,' a breaking out in the lips, which indicates cold, and may disappear after a few days; or it may be the accompaniment of a much more serious complaint, and is often one of the signs of inflammation of the lungs. It begins by redness and heat in a small patch. The vesicles scab over in two or three days, and if left alone fall off without leaving any permanent scar. When they form in the throat they give rise to considerable constitutional disturbance.

'HERPES ZOSTER,' or shingles, is another form of the disease. This form is limited to one side of the body. It is occasionally preceded by very great pain, and has been mistaken for Pleurisy, as its usual seat is on the ribs, although it may appear on any part of the body. The crop of vesicles is connected with some nerve disturbance, the nature of which is not yet fully understood. It commences with a hard inflamed base; the vesicle contains clear fluid at first. This changes in a few days to opaque lymph, which dries up and leaves a black scab. It is attended with

burning, pricking heat, and itches a great deal as it dies away. Old people often have a deal of neuralgic pain in the seat of the eruption, which may continue after all sign of the eruption has ceased, but this is quite unusual in children. Local treatment is best let alone. The vesicles should be covered up with

cotton wadding, so as to avoid friction, and not interfered with; whilst if the appetite is indifferent and the tongue foul, a little senna tea, followed by a dose or two of Gregory's powder, will be all the treatment that will be required. If the scabs are inclined to cause any breach of surface, they may be dressed with zinc ointment night and morning until they are entirely separated, and the surface of the skin has healed. Herpes cicinatus,' or Iris, is a form improperly named Herpes, and in which the disease is caused by a parasite. It is infectious.

The Bulla or Blebs are serious forms of disease, which are not likely to be met with in children at school. They are connected with a blood disease, and always require skilful medical treatment to effect a cure. In Pemphigus there are large blebs filled with an albuminous alkaline fluid, with an ulcerated under surface. In Rupia the bleb dries up and forms a crust, which becomes thicker as it rises above the level of the skin, and when it drops off leaves a deep ulcer in the skin, which heals after a time, leaving a distinct and specific mark behind it.

The Pustules. The last class to be considered are the Pustules, excluding Farcy and Small Pox. They are limited to two forms, Ecthyma' and 'Impetigo.' They are not common diseases. The former are round isolated pustules, with hard inflamed bases, which form brown adherent scabs, and when they drop off they leave a violet stain in the skin, but this fades away in time. Tartar Emetic ointment is sometimes used to bring out an eruption of this kind for purposes of counter irritation. The disease may be either acute or chronic. The latter assimilates very much to a crop of boils, but runs a slower course, is more painful, and has a core which does not form in a case of Ecthyma.

'Impetigo' is more common; it may be caused by local irritation, such as Pediculi in the heads of children, or by improper food or a poor kind of diet. The pustules occur in groups, which come to maturity in forty-eight hours, and rapidly discharge a thick purulent matter, giving rise to a brownish-yellow irregular-shaped crust. These crusts are slow in separating, and are sometimes mistaken for a more infectious form. The character of the pustule in Impetigo Capitis should at once distinguish it from Tinea or Favus. When it attacks the face of children it is called 'Crusta lactea.' Impetigo is sometimes contagious, and seems to spread from child to child, so that care is required to distinguish it. It seems as if the secretion in the heads of some children render them excessively prone to grow crops of pediculi. The ova of these parasites, popularly known as 'nits,' will be seen attached to the hair. They may be detached by washing the hair with vinegar and water, and then dressing the roots with white precipitate ointment or decoction of staves acre. This latter is the basis of the Persian insect powder, which is used for the same purpose. The presence of nits either favours the production of Impetigo, or the latter encourages the breed of the former, as they are very often in company. Cleanliness and the use of sulphur ointment occasionally if the presence of the nit is suspected will be the best plan to adopt.

From preceding observations it will be understood that diseases of the skin arise from several causes: they may be constitutional and inherited; they may arise from infection or local irritation. Each cause requires

a different kind of treatment, but all require the most scrupulous cleanliness and attention to diet. It is requisite to distinguish the constitutional tendency, be cause it is of more consequence than the name of the skin disease. First determine the point as to its contagious or non-contagious character, then the constitutional tendency, and thirdly, attend to the diet of the child. This should be vegetable, fruits, fish, and milk foods, whilst stimulants, meats, and indigestible things should be studiously avoided.

(To be continued.)

0

Anecdotal Natural History.

BY REV. J. G. WOOD, M. A., F.L.S.,

Author of Homes without Hands,' 'Nature's Teachings, etc.
AND THEODORE WOOD, M.E.S.,

Joint Author of The Field Naturalist's Handbook.'
No. XIX. THE BEAR TRIBE.
PART II.

THE animals belonging to the curious group of

Sun-bears derive their name from their habit of basking in the rays of the hottest sunshine, instead of retiring to their dens during the heat of the day, after the manner of bears in general. The generic title of Helarctos refers to this habit, being a compound of two Greek words, the one signifying the sun and the other a bear.

As a representative of the genus, several species of which are known to exist, we will take the Malayan Sun-bear, or Bruang (Helarctos Malayanus), a native, as its name implies, of certain parts of the Malay Archipelago.

This is by no means a large animal, seldom measuring more than four feet six inches in length when fully adult. The muscular powers, however, are very great, far more so than might be imagined when the small size of the bear is taken into consideration.

The lip and tongue are very flexible, and the latter organ is capable of considerable elongation. It is thought that this structure is intended to assist the animal in robbing the nests of the wild bee, by inserting its long and lithe tongue into the apertures, and licking out the contained treasures.

The colour of the fur is a deep, glossy black, with the exception of a crescent-shaped white mark upon the breast and a yellowish-white patch upon the snout and upper jaw. The hair is rather short, but is of a very fine and delicate quality, which renders the skin of some little value as an article of commerce.

The bruang seems to be almost exclusively a vegetable feeder, giving the preference to fruit of various kinds, and more especially to the young shoots of the cocoa-nut palm. So fond is the animal of this latter diet that in some parts of Sumatra, where the villages have been deserted hy their human inhabitants, the cocoanut plantations have been completely destroyed by his constant degradations.

Being a singularly even-tempered animal, the bruang is easily tamed, and speedily adapts himself to the conditions of his new mode of life. One of these bears, which was in the possession of Sir Stamford Raffles, was of so quiet and peaceable a disposition that he was

even allowed to remain unchained in the nursery tenanted by his master's children, and was also allowed to sit at table together with the family.

Here he became so fastidious in his diet that he would refuse any fruit except mangosteens, and any wine except champagne, for which beverage he developed a great fondness. His master used to say that he never knew his pet to lose his temper except when his favourite liquid was withheld.

Included in the same group of the ursine family, although not belonging to the same genus as the bruang, the Aswail, or Sloth Bear (Melursus Lybius), next claims our attention. This strange-looking creature is a native of the mountainous parts of India, where it is an object of great admiration, mingled with considerable dread, to the native population. It is by no means a fierce animal, however, and even if attacked and slightly wounded will, as a rule, seek safety in flight rather than attempt to revenge itself upon its pursuer. But if driven to bay, or enraged by a severe wound, it becomes a very dangerous enemy, and will fight with furious energy until it either destroys its foe, or is itself slain.

The peculiar aspect of the aswail is chiefly owing to the length of the hair, which falls in thick clusters over almost the entire body. The colour is a jetty black, with the exception of a forked patch of whitish hairs upon the breast.

The aswail is not in the habit of basking in the sunshine, like the animal about which we have just been reading, but retires to its den during the greater part of the day. This habit is probably owing to the structure of the feet, the soles of which are remarkably tender. So much is this the case, indeed, that in several instances, when the bear has been driven from its hiding-place, and pursued by hunters during the heat of the day, the soles of the feet have been found to be terribly scorched and blistered with the heated stones and rocks over which the animal has passed.

Owing partly to the nocturnal habits of the as wail, and partly to the dread with which it is regarded by the natives of the country it inhabits, we know comparatively little of its mode of life when in a state of freedom. It seems to exist upon an almost purely vegetable diet, varied only, except upon very rare occasions, by such small creatures as slugs, ants, bees and their honey, and so on.

THE last of the true bears which can be described in these pages is the well-known Polar Bear (Thalarctos maritimus), the Nennook of the Esquimaux.

All the bears are good swimmers, and are able to cross rivers, etc., with perfect ease, should occasion arise for so doing. The nennook, however, far surpasses its congeners in the matter of aquatic locomotion, being able to pursue and capture the very fish themselves in their native element, and almost to rival the seals in the ease and agility of their movements.

Being intended by nature to lead in great measure an aquatic existence, we may expect to find that in the polar bear some points of structure are modified to suit the requirements of its mode of life. And such is indeed the case, for the form of the body is such as to enable the animal to cleave through the water without any great exertion, while the huge and hair-clad paws afford excellent paddles for the supply of the necessary propelling power. Then, the senses, more especially that of scent, are exceptionally keen, as is proved by

the fact that the animal will discover, by the exercise of its olfactory powers alone, the tiny breathing-holes which the seals have made through the ice, even though those breathing-holes are covered with a thick layer of snow.

In the capture of its prey, which chiefly consists of seals and fish, the polar bear is remarkably adroit, having been repeatedly seen to dive into the water after a salmon, and re-appear almost immediately with the captured fish in its mouth. With regard to the seals, however, which are fully its equals in the natatory art, and possess, moreover, the power of remaining below the surface of the water for a considerable period of time, the bear adopts very different tactics.

Let us suppose that it has caught sight of a seal resting near the edge of a floating piece of ice at some little distance. Plunging noiselessly into the water, the bear at once dives, and proceeds as far as possible in the required direction before seeking a fresh supply of air. When this becomes necessary, the animal merely pokes its nostrils above the water for a few seconds, without exposing to view any other part of its body. As soon as the act of respiration is completed, it again dives, and so on until it has passed over the distance which separated it from the object of its attack. The last dive is always timed so that the bear makes its appearance within a few feet of its anticipated victim, which has now no chance of escape. If it attemp's to take to the water it is immediately seized by its expectant enemy, while if it should take to flight across the ice it is quickly overtaken by the more active bear.

The nennook owes its peculiar activity upon the frozen surface to the thick hair with which the soles of the feet are covered, and which enable it to pass along almost as readily as upon dry land. It also serves a second and equally important purpose, protecting the foot from the extreme cold of the substance with which it is so constantly in contact.

The size of the paws is wonderfully large, their length being fully one-sixth of the entire length of the body. The claws with which they are armed are not as long as in some of the preceding animals of the group, and are but slightly curved. Nevertheless, they form very terrible weapons, by the aid of which the bear can slay the huge walrus itself, beating in its skull by repeated blows of its mighty paw, as was mertioned in a prior article of this series.

The head is rather small when compared with the size of the body, and this circumstance, together with the length of the neck, gives a very snake-like appearance to the fore-parts of the animal's person. The fur is of a silvery-white hue, tinged with cream-colour, which varies in intensity in different individuals. The claws are black, forming a great contrast to the whiteness of the fur.

For many years great uncertainty prevailed as to whether the polar bear passed the winter months, or any part of them, in a state of hibernation, some ob servers telling us that the animal invariably retired to some sheltered retreat during the winter, while others asserted that nennooks might be seen at large through out the whole of the year. Neither of these reports was altogether correct, nor yet entirely wrong, for has lately been ascertained that the female bear alone hibernates, while the male continues to roam about in search of prey just as at any other season.

Neither does the female hibernate unless she

about to become a mother, in which case she selects some sheltered spot for her habitation, generally choosing the cleft of a rock, or some such situation, where she may be, at all events, partially protected from the inclemencies of the weather. Before she has been a tenant of her new home for very long she is completely covered by the snow-drifts, being thus effectually screened from the observation of enemies.

The young of the polar bear are generally two in number, and are born about two months before their mother makes her reappearance in the world. By the time that this event takes place they attain to a considerable size, being then about as large as an ordinary shepherd's dog.

Although to a great extent aquatic in its habits, the polar bear is often found at a considerable distance from the sea-coast, specimens having sometimes been met with more than thirty miles inland. These excursions are generally brought about by hunger, either from the failure of the food-supply, or, as frequently happens, from the fact that the bear has been carried to a considerable distance from its usual haunts by the separation from the main body of the piece of ice upon which it is resting. Sometimes quite a small colony of bears are carried off in this manner, causing terrible

havoc amongst the herds of the country in which they may happen to land.

Besides being endowed with great strength, the nennook is also possessed of considerable powers of endurance, as may be imagined from the fact that upon one occasion one of these bears was seen steadily swimming across a channel more than forty miles in width. Indeed, as far as the natatory art is concerned, it is but little inferior to the seal, and its proficiency in this respect, together with its great muscular power, and the terrible weapons with which it is provided by nature, renders it the acknowledged monarch of the polar seas.

Even the enormous and powerful walrus falls a

victim to the polar bear, and the strength of the bear can be best appreciated by comparing it with the animal which it kills. A fine male walrus measures some fifteen feet in length, so that if it had legs fit for walking, it would surpass in size the generality of elephants.

In order to understand the real size of the walrus, let the reader measure a line of fifteen feet in length upon the wall of a room, then let him sketch in imagination the form of the animal as shown in any illustration, and he will see what an enormous creature

resist even the white bear's paw.

.

as long as they are ashore, but if the walrus can once reach the water, it is safe. The water prevents the bear from delivering its terrible blows, and as the bear knows instinctively that the walrus can remain under water for a very long time, it relinquishes its prey.

Many an old walrus is killed which has its head, neck, and shoulders all seamed and scarred by the talons of the bear.

The thick fur of this bear, like that of the seal and the feathers of the duck, repels the water, so that the skin remains perfectly dry. The fur, however, must be in good condition, or it loses this protective power.