RL 
 780 
 
 UC-NRLF 
 
 172 
 
 BY 
 
 JOHN P. TURNER.M.D. 
 
RINGWORM 
 
 AND ITS 
 
 SUCCESSFUL TREATMENT 
 
 BY 
 
 JOHN P. TURNER, M.D. 
 
 MEDICAL INSPECTOR OF PUBLIC SCHOOLS, PHILADELPHIA, PA. 
 
 ILLUSTRATED BY EIGHT HALF-TONE 
 ENGRAVINGS 
 
 PHILADELPHIA 
 
 F. A. DAVIS COMPANY, PUBLISHERS 
 1921 
 
BIOLOGY 
 
 COPYRIGHT, NOVEMBER, 1921 
 
 BY 
 F. A. DAVIS COMPANY 
 
 Copyright, Great Britain. All Rights Reserved 
 
 PRESS OF 
 
 F. A. DAVIS COMPANY 
 PHILADELPHIA. U.S.A. 
 
IN MEMORY OF MY FATHER 
 JESSE E. TURNER 
 
 500626 
 
INTRODUCTION. 
 
 IT gives me pleasure to state that the 
 treatment of ringworm of the scalp devised 
 by Dr. John P. Turner has proven remark- 
 ably efficacious in his hands. In the year 1913 
 the Reynolds Public School, Philadelphia, 
 with a population of six hundred children was 
 badly infested with ringworm. About eighty 
 cases were discovered, of which at least one- 
 half were ringworm of the scalp. In view of 
 the obstinate nature of the latter affection, 
 the proper conduct of the school was a serious 
 problem. Dr. Turner consented to undertake 
 the treatment of these cases in connection 
 with his work as school medical inspector 
 and effected a complete cure a remarkable 
 achievement deserving of medical notice. 
 
 WALTER S. CORNELL, M.D. 
 
 Director Medical Inspection of Public Schools of 
 Philadelphia, Penna. 
 
 (5) 
 
FOREWORD. 
 
 THE author offers this treatise be- 
 cause of the prevalence of ringworm, 
 and because of the success obtained with 
 thousands of cases that have come un- 
 der his care. For over one hundred years 
 this disease has been studied and various 
 treatments advocated. Wherever num- 
 bers of school children are found, ring- 
 worm is most apt to be present. A neg- 
 lected case in a classroom is liable to 
 spread until many cases are found in the 
 school building. The personal appear- 
 ance of the child is interfered with by 
 the presence of this malady, and in ad- 
 dition there is the discomfort it causes 
 by itching and scaling. The treatment 
 
 (7) 
 
Foreword. 
 
 used by the writer is simple, easy of ap- 
 plication and inexpensive. Any parent 
 or guardian can apply it. Many cases 
 of ringworm, especially of the scalp, 
 are obstinate to most treatments. Usu- 
 ally ringworm is neglected. In order 
 to obtain results, daily treatments must 
 be systematically given. Many children 
 have ringworm of the scalp, and the 
 parents are unaware of its presence until 
 it has developed sufficiently to be very 
 obstinate to ordinary treatment. As soon 
 as the smallest patch or ring is noticed, 
 if instructions given in the Chapter on 
 Treatment are followed, a speedy cure 
 may be expected. In chronic and severe 
 cases, the rapidity with which results 
 are obtained is most remarkable. 
 
 The treatment to be described has 
 been used by the author for nearly ten 
 
Foreword. 
 
 years. When originated, he had under 
 his care the pupils of a school where 
 existed eighty severe cases of ringworm 
 of the scalp and face. In order to check 
 the rapidly spreading disease, immediate 
 and drastic steps had to be taken. The 
 result was the working out of what is 
 to be given in the Chapter on Treatment. 
 Before describing the remedies used, 
 we shall discuss the history of ring- 
 worm, its diagnosis, differential diagno- 
 sis, and pathology. 
 
 J. P. T. 
 
CONTENTS. 
 
 I. THE HISTORY OF RINGWORM 15 
 
 II. THE PATHOLOGY OF RINGWORM 18 
 
 III. THE DIAGNOSIS OF RINGWORM 24 
 
 IV. THE DIFFERENTIAL DIAGNOSIS OF 
 
 RINGWORM 40 
 
 V. How RINGWORM is SPREAD 52 
 
 VI. THE TREATMENT OF RINGWORM 54 
 
 VII. WHEN is RINGWORM CURED? . . 58 
 
ILLUSTRATIONS. 
 
 1. How a ringworm grows 21 
 
 2. Ringworm of scalp 25 
 
 3. Ringworm 1 of scalp 29 
 
 4. Ringworm of the face 33 
 
 5. Ringworm of the hand 37 
 
 6. Ringworm of scalp 41 
 
 7. Ringworm of scalp. Diffuse case 45 
 
 8. Ringworm of scalp 49 
 
 (13) 
 
CHAPTER I. 
 THE HISTORY OF RINGWORM. 
 
 THIS affection was first described by 
 Willan, in 1817, and Plumbe, in 1821. 
 At that time, however, it was not under- 
 stood. It was confounded with alopecia, 
 eczema, and seborrhea. Credit is given 
 to Gruby, of Paris, in 1843, f r discovery 
 of a fungus in the broken off hairs of 
 ringworm areas. To this fungus he gave 
 the name of Microsporon aitdouini. Un- 
 fortunately he called the disease "Porrigo 
 Decalvans." This term had already been 
 used by Bateman in describing alopecia 
 areata. As a result, for a long time there 
 was a confusion between these two con- 
 ditions. Later on Sabouraud (1894), 
 
 (15) ' 
 
1.6 
 
 History of Ringworm. 
 
 through his discoveries, cleared up these 
 misunderstandings. The fungus of ring- 
 worm was named Trichophyton tonsurans 
 by Malmsten in Stockholm, in 1845. F r ~ 
 merly it was believed all varieties of ring- 
 worm were due to this one distinct species 
 of fungus. Now it is known there are 
 various fungi causing the different forms 
 of the disease. 
 
 In 1894 Sabouraud published a work 
 on the nature of the Tinea, in which he 
 divided the Tinea tonsurans into two 
 distinct groups : 
 
 (A) Tinea with small pores (which is 
 due to the fungus called Micro- 
 sporon audouini). 
 
 (B) Tinea with large spores (due to 
 various forms of the Tricho- 
 megalosporon). 
 
History of Ringworm. 17 
 
 The small spore Tinea is the common 
 form of ringworm, the large spore the 
 rarer form. 
 
 Fifty years ago ringworm was very 
 prevalent in England. School children in 
 large numbers w r ere sufferers. 
 
CHAPTER II. 
 THE PATHOLOGY OF RINGWORM. 
 
 THE pathology of ringworm is that 
 of a specific inflammation. The skin is 
 altered in color, due to congestion, al- 
 tered in sensation, due to the effect of 
 the foreign substance produced by the 
 fungus, anxl altered in the size of the 
 part affected, due to enlargement of the 
 blood-vessels. There is present a des- 
 quamation of the skin, and sometimes 
 there is a serous or purulent discharge 
 with crust and scab formation. The 
 eruption caused by the fungus is super- 
 ficial, leaving no permanent destruction 
 of the upper or deeper layers of the 
 skin. 
 
 (18) 
 
Pathology of Ringworm. 19 
 
 THE FUNGUS. 
 
 The fungus consists of branching 
 hollow tubes called mycelium, and of 
 spores. These spores may grow into 
 mycelium tubes. The transition is 
 formed by a protrusion in the cell wall 
 and then by an increase in this projec- 
 tion. In ringworm of the body, the my- 
 celium is large and abundant. 
 
 INVASION OF THE HAIRS. 
 
 The view confirmed by Balzer in 1883, 
 and substantiated by many since, is that 
 the mycelium enters the orifice of the hair 
 follicle, insinuates itself between the hair 
 shaft and inner root sheath, and passing 
 down till it reaches the softer cells of the 
 bulb, enters the hair. It then multiplies 
 and ramifies between the fibres of the 
 hair. However, it is possibly best that 
 
20 Pathology of Ringworm. 
 
 no given rule be laid down as to where 
 the fungus first attacks the hair. It is 
 always in the follicular portion and often 
 toward the root end, but sometimes in 
 one place and sometimes in another. The 
 fungus rapidly grows in and on the 
 hairs, rendering them lustreless, opaque 
 and brittle. They therefore easily break 
 off near the surface of the scalp forming 
 the so-called "stumps." The fungus does 
 not flourish in living tissue. It is not 
 found beyond the epidermic strata. 
 
 ACTION OF THE FUNGUS. 
 
 When brought into contact with the 
 skin it passes between the superficial 
 cells of the epidermis and finds its way 
 into the deeper layers. Here it develops 
 and causes an inflammation, forming first 
 a ring of small papules, followed by ves- 
 
Fig. 1. How a ringworm grows. Highly magnified. 
 
 (21) 
 
Pathology of Ringworm. 23 
 
 icles and possibly crusts. As the ring 
 spreads, the hyperemia in the center dis- 
 appears and desquamation follows (Fig. 
 i). If the scalp is involved and the 
 fungus is the one that causes Tinea ton- 
 surans, the hairs are quickly involved, 
 causing the characteristic scaling patches 
 with the broken off stumps of hairs 
 showing in the affected area. 
 
CHAPTER III. 
 THE DIAGNOSIS OF RINGWORM. 
 
 As it relates to school children, there 
 are two varieties of ringworm. Ring- 
 worm of the scalp (Tinea tonsurans) 
 (Fig. 2) and ringworm of the body 
 (Tinea circinata) (Fig. 4). Ringworm 
 of the inner thighs and perineum (Tinea 
 cruris) need not be considered in the 
 case of children. 
 
 RINGWORM OF THE SCALP. 
 
 This form of the disease attacks chil- 
 dren almost exclusively, being hardly 
 ever seen in an adult. It is first noticed 
 as a pea-sized scaly patch. It may en- 
 large to the size of a silver dollar 'or 
 even larger. There may be one or more 
 (24) 
 
Fig. 2. Ringworm of scalp. Tinea tonsurans. 
 After Schamberg. 
 
 (25) 
 
Diagnosis of Ringworm. 27 
 
 of these patches, or the entire scalp 
 may be involved. When fully developed 
 the patches are usually circular in out- 
 line, slightly elevated above the normal 
 surface, covered with scales, and some- 
 times have a number of little follicular 
 elevations. Over the diseased area are 
 found ends of broken off hairs. The 
 color of the patches varies according to 
 the complexion of the patient. In darker 
 skins they are grayish or slate color, 
 while on white children they are inclined 
 to be more of a pinkish hue. The diag- 
 nosis of ringworm of the scalp is not 
 difficult, although there are a few con- 
 ditions that are at times confused with 
 it. The most important point to remem- 
 ber is the existence of scaling patches 
 with broken off hairs projecting here and 
 there (Fig. 3). A magnifying glass will 
 
28 Diagnosis of Ringworm. 
 
 readily reveal this condition in case it is 
 not possible to see it with the naked eye. 
 If there is any doubt, the use of the 
 microscope will settle the matter. The 
 presence of the fungus will clinch the 
 diagnosis of ringworm. 
 
 KERION. 
 
 (Pustular Ringworm of Scalp.) 
 
 This form of ringworm arises when 
 deep folliculitis occurs. The patch swells 
 up and appears as a subcutaneous ab- 
 scess. The disease embodies one or 
 more patches which are red, tender, 
 semi-fluctuant, soft and swollen. Many 
 of the hairs come out while a few may 
 remain for a time. These are easily 
 pulled out without the usual breaking 
 off. They are loosened by the exudate 
 formation. 
 
Fig. 3. Ringworm of scalp. Tinea tonsurans. 
 
 (29) 
 
Diagnosis of Ringworm. 31 
 
 While Kerion presents a worse pic- 
 ture, it will cure itself quicker than ordi- 
 nary Tinea tonsurans. The reason is, 
 that after a time the hairs over the 
 patch all come out, the inflammation 
 subsides and new hairs grow. We are 
 not troubled with the stumps. 
 
 STUMPS. 
 
 A distinction must be made between 
 healthy short hairs and stumps. The 
 term "stumps" should be restricted to 
 diseased short hairs about an eighth or 
 a quarter of an inch long, broken off 
 near the surface of the skin. They are 
 swollen, lustreless and usually break off 
 when the attempt is made to pull them 
 out. The reason they are so fragile is 
 because they are impregnated with fungi. 
 In chronic cases, stumps are sometimes 
 
32 Diagnosis of Ringworm. 
 
 difficult to find. They may be hidden 
 among the long hairs, .on a patch, or 
 under a scab. At other times the stumps 
 may be found lying close on the surface 
 of the skin, sometimes glued to the scalp 
 with a sticky sebaceous matter. 
 
 HOW TO PREPARE THE SLIDE. 
 
 Pull out two or three of the broken 
 off hairs and place on a slide with a drop 
 of liquor potassae (a forty per cent, solu- 
 tion of caustic potash). Permit this to 
 stand for fifteen minutes, then under a 
 power of two hundred and fifty diam- 
 eters the fungus and the lesion of the 
 hair will be visible. 
 
 RINGWORM OF THE BODY. 
 
 This form of ringworm is most often 
 found on the face (Fig. 4). It is char- 
 
Fig. 4. Ringworm of the face. Tinea circlnata. 
 After Schamberg. 
 
 (33) 
 
Diagnosis of Ringworm. 35 
 
 acterized by the presence of rounded 
 sharply circumscribed, pinkish or gray- 
 ish scaly patches. These areas often 
 clear up in the center causing a ring- 
 like formation. The affected part is 
 raised above the surrounding skin. It 
 sometimes itches. The presence of the 
 fungus determines the diagnosis. The 
 examination of a specimen under the 
 microscope is made as follows : Scrape a 
 few of the scales with a knife blade and 
 place upon a slide, containing a drop of 
 liquor potassae. Over this place a thin 
 glass cover. Press the cover down and 
 permit the specimen to remain for a few 
 minutes. The fungus will be detected 
 here and there. 
 
 Sometimes brothers and sisters in a 
 family with one obstinate case of ring- 
 worm remain free from the complaint. 
 
36 Diagnosis of Ringworm. 
 
 In some children the fungus takes but 
 slight hold and is easily destroyed. In 
 others the disease takes rapid hold and 
 3preads quickly. The state of the soil 
 (skin) has much to do with the growth 
 of the fungus. Many writers contend 
 there must be present some constitu- 
 tional ailment, lowering the natural re- 
 sistance, in order for the fungus of ring- 
 worm to gain lodgement and grow. It 
 has been observed by some that children 
 of pallid, sickly natures are the most sus- 
 ceptible victims. Malcolm Morris wrote 
 in 1 88 1 that children with golden or 
 colorless hair, with gray or blue eyes, 
 and with a very fine skin, were the most 
 often affected. In the experience of the 
 writer, this is not true. In this country, 
 among Caucasians, the more swarthily 
 complexioned seem to be the greater 
 
Fig. 5. Ringworm of the hand. Tinea circinata. 
 After Schamberg. 
 
 (37) 
 
Diagnosis of Ringworm. 39 
 
 sufferers; while Negro children furnish 
 the richest soil for the development and 
 growth of ringworm. Three-fourths of 
 the number of cases of this disease re- 
 ported to the Bureau of Health in Phil- 
 adelphia during the past year, were from 
 Negro children. It is also the experience 
 of the writer that robust, and to all ap- 
 pearances healthy children, have ring- 
 worm as violently as the ill nourished. 
 There seems to be a certain condition 
 present in the skin, the nature of which 
 is obscure, which invites the growth of 
 the germ. 
 
CHAPTER IV. 
 
 THE DIFFERENTIAL DIAGNOSIS OF 
 RINGWORM. 
 
 IN order to be able to discriminate 
 between this affection and those condi- 
 tions that might be confused with it, we 
 shall discuss briefly a few of them. 
 
 SIMPLE ECZEMA OF THE SCALP. 
 
 This disease is attended with consid- 
 erably more itching. It is usually spread 
 over a larger area, and not limited to 
 well defined patches. The broken off 
 hairs, which are characteristic of ring- 
 worm, are not present. The hairs of 
 ringworm are easily pulled out while in 
 eczema they are as a rule firmly im- 
 bedded. 
 (40) 
 
Fig. 6. Ringworm of scalp. Tinea tonsurans. 
 
 (41) 
 
Differential Diagnosis of Ringworm. 43 
 
 PEDICULOSIS CAPITIS. 
 (Head Lice.) 
 
 Itching is one of the chief symptoms. 
 It is found mainly on the back of the 
 head. Inflamed patches are present on 
 which are found signs of scratching. 
 The patches are small and the hairs are 
 matted and moist. There is an absence 
 of stumps of hairs. The presence of 
 pediculi confirm the diagnosis. 
 
 SEBORRHEA CAPITIS. 
 (Dandruff.) 
 
 Dandruff is a condition caused by an 
 excessive secretion of sebum. The hairs 
 are matted together. The scales are 
 smaller and much greater in number than 
 those found in ringworm. They stick to 
 the skin which is not inflamed. 
 
44 Differential Diagnosis of Ringworm. 
 PSORIASIS CAPITIS. 
 
 This disease occurs in small or large 
 patches. It runs a chronic course. The 
 scales on the patches are thicker than in 
 ringworm. Usually there is a history of 
 psoriasis on other parts of the body. 
 The hairs on the scalp are found to be 
 growing unbroken in the patch. 
 
 ALOPECIA AREATA. 
 
 (Baldness in Areas.) 
 
 This is the affection with which ring- 
 worm is most often confused. The diag- 
 nosis between the two is usually not diffi- 
 cult. In alopecia areata there is an ab- 
 sence of scales and stumps over the bald 
 spot. Around the margin of the bald- 
 ness we often find short stumps of hair. 
 These should not be confused with those 
 of ringworm, as they are all broken off 
 
Fig. 7. Ringworm of scalp. Tinea tonsurans. 
 Diffuse case. 
 
 (45) 
 
Differential Diagnosis of Ringworm. 47 
 
 on a level with the skin. The micro- 
 scope will settle the diagnosis if in 
 doubt. 
 
 IMPETIGO CONTAGIOSA. 
 
 This disease is characterized by the 
 formation of discrete flat vesicles which 
 turn rapidly to pustules and then form 
 crusts. It is highly contagious. The 
 vesicles range in size from a pin head to 
 a pea or even larger. There are present 
 no stumps of hairs as in ringworm. Im- 
 petigo appears on either the scalp or 
 body. Aldersmith writes concerning this 
 disease : "Impetigo is sometimes thought 
 to be ringworm. The rapidly spreading 
 form of pustular ringworm (Kerion) 
 closely simulates Impetigo contagiosa." 
 Impetigo is common in the occipital 
 region of the scalp. This is especially 
 true when complicated with pediculosis. 
 
48 Differential Diagnosis of Ringworm. 
 
 Some writers regard as the cause of im- 
 petigo a particular fungus, while others 
 contend micrococci are the root of the 
 trouble. A microscopical examination 
 will determine the presence or absence of 
 ringworm if in doubt. Impetigo does 
 not spread in schools as does ringworm. 
 It is found often in several members of 
 the same family. 
 
 SYPHILITIC ERUPTIONS. 
 
 Many of these may resemble Tinea 
 circinata. Itching is not present and as 
 a rule the eruption is more symmetrical. 
 The history will aid in diagnosis. 
 
 HERPES IRIS. 
 
 In this condition we find a number of 
 vesicles and papules. Often the vesicles 
 are arranged so as to form distinct 
 
Fig. 8. Ringworm of scalp. Tinea tonsurans. 
 
 (49) 
 
Differential Diagnosis of Ringworm. 51 
 
 rings. When one ring is fully formed, 
 another sometimes forms around it. If 
 in doubt, the microscope will determine. 
 
 ERYTHEMA CIRCINATUM. 
 
 This and other varieties of erythema 
 are often mistaken for Tinea circinata. 
 Erythematous patches are often symmet- 
 rical. They have well defined edges, 
 which are raised and thickened. 
 
CHAPTER V. 
 How RINGWORM is SPREAD. 
 
 RINGWORM is spread through simple 
 contact. Hairdresser's and barber's tools 
 are not infrequent conveyers. The 
 fungus may be carried from one child 
 to another by towels, brushes and other 
 utensils used in common;. Often ring- 
 worm exists in a child's head unknown 
 to its parents. Such a child is a source 
 of contagion to its playmates. Children 
 in play often pass their hands through 
 each others' hair, put on each others' 
 hats or rub their heads together. Adults 
 not infrequently contract ringworm of 
 the body by handling and treating ring- 
 (52) 
 
How Ringworm is Spread. 53 
 
 worm of the scalp. It is quite possible 
 the disease is spread by the promiscuous 
 piling together of wraps and hats in a 
 school closet. 
 
CHAPTER VI. 
 
 THE TREATMENT OF RINGWORM OF THE 
 SCALP AND BODY. 
 
 THE SCALP. 
 
 IN severe cases, have all the hair cut 
 close. If there is only one isolated patch, 
 cut the hair close, the radius of an inch 
 all around the area involved. The treat- 
 ment consists of four stages each occupy- 
 ing a few days, then a repetition if neces- 
 sary. 
 
 First Stage: 
 
 (Daily for four days.) 
 
 Scrub the scalp or patch with castile 
 soap and warm water. 
 
 Then apply with a cotton probe, 
 tincture of iodine. 
 (54) 
 
Treatment of Ringworm. 55 
 
 Second Stage: 
 
 (Daily for three days.) 
 Following the scrubbing, rub into 
 the parts thoroughly oil of cade. 
 
 Third Stage: 
 
 (Daily for three days.) 
 
 Following the scrubbing apply, by 
 rubbing into the parts, ammoniated mer- 
 cury ointment 20 per cent, strength. 
 
 Fourth Stage: 
 
 (Daily for three days.) 
 
 Following the scrubbing, rub into 
 the parts resorcin ointment 20 per cent, 
 strength. 
 
 Continue the treatment if necessary 
 by beginning all over and going through 
 the same routine until cured. Mild cases 
 will yield readily, and the most obstinate 
 
56 Treatment of Ringworm. 
 
 will soon show signs of improvement. 
 From one to fifteen courses of treatment 
 will be necessary. Few cases fail to 
 yield to four courses of treatment. 
 
 THE BODY. 
 
 There are two stages: 
 First Stage: 
 
 (Daily for three days.) 
 
 After thoroughly scrubbing the af- 
 fected area with castile soap and warm 
 water, paint over the part with tincture 
 of iodine. In case the ringworm is on 
 the face it is well to use colorless iodine. 
 
 Second Stage: 
 
 After cleansing with castile soap and 
 warm water, rub into the parts ammoni- 
 ated mercury ointment 20 per cent, 
 strength. 
 
Treatment of Ringworm. 57 
 
 Continue the treatment until the ring- 
 worm disappears. This will require 
 from one to four courses of treatment. 
 
 
 
 
CHAPTER VII. 
 WHEN is RINGWORM CURED? 
 
 THIS question is often asked, particu- 
 larly in reference to the return to school 
 of children who have been suffering with 
 the disease. 
 
 THE SCALP. 
 
 Ringworm of the scalp cannot be said 
 to be cured until the entire scalp is care- 
 fully examined with a magnifying glass 
 to ascertain if there are any stumps of 
 hair present. Absence of the fungus 
 upon microscopic examination is an im- 
 portant determining factor. 
 
 Hair may be growing over the form- 
 erly bald spot, but if the broken off hairs 
 are found, the case is not cured. 
 (58) 
 
When is Ringworm Cured? 59 
 
 THE BODY. 
 
 A patient with Tinea circinata cannot 
 be pronounced cured until the margins of 
 the patch are free from all papules and 
 desquamation. The area should no longer 
 be raised above the surrounding surface. 
 If there is doubt, the skin just inside the 
 margin of the patch should be scraped and 
 examined under the microscope for the 
 presence of the fungus. If found the .case 
 is not cured. Sometimes we are unable 
 to find any fungi in the specimen, yet 
 the disease is still present. Stop all 
 treatment and watch for a recurrence of 
 papules and scales. 
 
 DOES ONE ATTACK RENDER IMMUNITY 
 AGAINST ANOTHER? 
 
 Many people are under the false im- 
 pression that one attack of ringworm 
 
60- When is Ringworm Cured? 
 
 gives the child an immunity against fur- 
 ther attacks. Even after new healthy 
 hair has grown on a previous patch, the 
 disease has been known to commence 
 again on the old spot. In most of such 
 cases, the old attack was never properly 
 cured; the next infection starting from 
 the stumps that had been quiescent. 
 
 SOME CHARACTERISTICS OF 
 RINGWORM. 
 
 It is contagious. 
 
 It is more prevalent among boys than 
 girls. 
 
 Found more frequently among Negro 
 children than among white. 
 
 Its presence gives an objectionable 
 appearance whether on the face or scalp. 
 
 Ringworm of the scalp if neglected 
 
When is Ringworm Cured? 61 
 
 will form layers of scales, which peel 
 off. 
 
 If through neglect or otherwise, ring- 
 worm persists through childhood, it dis- 
 appears when the child reaches the age 
 of fifteen or sixteen. There appears to 
 be some unexplained change in the skin, 
 as a soil for the growth of the germ at 
 that period of life. 
 
 SOME DON'TS IN THE CARE OF RING- 
 WORM CASES. 
 
 Don't neglect a case no matter how 
 trivial in appearance. 
 
 Don't place on the head the hat or 
 cap of another suffering with ringworm. 
 
 Don't allow the use of a towel or 
 other article that has been in contact 
 with ringworm. 
 
62 When is Ringworm Cured? 
 
 Don't fail to wear a skull cap if a 
 scaling ringworm of the scalp exists. 
 
 Don't apply vaseline or grease to ring- 
 worm patches for the sake of hiding 
 them. These applications have no cura- 
 tive effect. 
 
 Don't permit the hair to grow long 
 if ringworm is present. Keep it short. 
 
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