School Surgery.

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

VI.

CHILBLAINS AND CHAPS.

CLOSELY allied to boils in appearance, but not

in cause are the swellings which are produced by frost and cold. Chapped hands arise, in a great measure, from neglect in not sufficiently drying them after they have been washed. If they are exposed to the cold air in a damp state, the effect of evaporation is to chill the cuticle. When there is a low state of vitality in the system the consequence is soon manifest. The cuticle is destroyed, and is thrown off before its natural exfoliation is complete. The result is a rapid rise of a so-called inflammatory action. Heat, redness, a swelling with some amount of tenderness, supervene in the swollen part. Some children are much more susceptible to a chapped state of skin than others, from constitutional weakness. When the chilled condition has extended to the cutis vera, or true skin, a chilblain is produced. These effects are very prone to form in those who have a weak circulation; who are the children of persons who have been addicted to high living; who have trusted to meat and stimulants as the staple articles of food, rather than to more simple diet, and who have not had a proper supply of milk and vegetables. The fingers and toes, the tips of the ears and nose, sometimes parts of the skin on the arms and legs are affected. In the case of chaps, the mischief is limited to the cuticle. Every one who does not dry the skin thoroughly is liable in cold weather to have this condition produced. The greatest care should be taken to remove all moisture from the skin, especially in cold and frosty weather. It is beneficial to smear the hands with a minute quantity of honey, after washing and before drying, when the weather is really cold. The application of honey makes the drying a more tedious process, but it is capable of being more thoroughly performed than when honey is not used. If the chaps have been actually produced, and the skin is cracked, it requires the application of something more stimulating than honey.

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generally use an ointment such as the following:One part of camphor, six parts of spermaceti ointment, and one part of citron or golden ointment. These should be thoroughly well mixed, and the cracks smeared with the mixture at bedtime, after the hands have been well washed and properly dried. Two or three applications will be sufficient to effect a cure. The parts smeared with the ointment should be covered up by berlin or silk gloves. The lips are sometimes chapped; they should be painted with a little solution of the tannate of glycerine, and the application allowed to remain upon it for a few minutes before it is wiped off. The cracks should then be touched by a little strong camphorated oil--four parts of salad oil, and one of camphor, being rubbed together so as to make an application; the thinnest possible coating should be applied by the aid of a camel's-hair brush; or a camphor ball, such as all druggists supply, may be used. If the chill has extended to the cellular tissue, there is active inflammation. The vitality of some of the minute capillaries has been interfered with, and the blood has stagnated in them. As a consequence, there is obstructed circulation, and a local dropsy results. Children who have been accustomed in cold weather to wash in hot water are more liable to chilblains than others, especially if they have been improperly fed. Any sudden change of temperature, ranging below 40° may produce chilblains, though they are much more decided when the temperature is absolutely below the freezing-point. Those adults who are accustomed to wash their hands in hot water in frosty weather are very liable to them. Children whose feet are kept too hot, or who are badly shod, and who get their feet damp in severe weather, suffer much from the effects. There is impeded circulation, then an intolerable itching, and scratching only adds to the pain and the inflammation. If the malady be properly treated, it remains a simple chilblain, and is soon removed, but if the process of exposure be continued, if it be scratched excessively, the skin breaks, and the cellular tissue beneath is exposed, and then a painful sore results. The best kind of treatment is a gentle friction with a warm hand. If the skin is not broken, the part affected may be covered up, and supported by chamois leather spread with lead plaster; but if the skin be broken, a stimulating ointment may be applied. The best kind

is, one part of turpentine rubbed up with seven parts of yellow basilicon, and applied on lint twice or three times a day, taking care to keep the affected part perfectly dry. Persons who are very sensitive to cold, and upon whom chilblains easily appear, should take a dessert spoonful of cod-liver oil every night on going to bed, when the thermometer shows a temperature constantly below freezing point. Stimulants, such as wine and beer, will not assist to remove the cause which allows of the production of chilblains, although they are remedies which are much vaunted by some authorities.

I can scarcely pass over the subject of frost-bite, though it rarely happens in this country, but now and then a child does inadvertently get frost-bitten in very severe weather. A condition, which corresponds to that producing chilblains, extends in the tissues beneath the skin until the vitality of the organ may be entirely destroyed. There is numbness at first; an attempt is made to restore the circulation, there is intense pain; the mischief is done before the latter arises at all; when children's fingers are frost-bitten, as will happen sometimes when they are intent upon snow-hut building, or even snow-balling, it is very imprudent to warm them by exposure to a fire, or by plunging them into hot water; the chilled part should be only rubbed with a warm hand, using at first a little snow-water, and then simply the heat of the hand itself, and very gently, too, until the deadly pallor in the part which announces the arrest of circulation gives way to a more florid aspect. This must be done carefully and slowly, otherwise mortification will be the natural result.

Powerful stimulants are to be utterly avoided; they are certain to produce mischief. Some other directions will be given upon this head when treating of the rescue of drowning persons.

DISEASES OF THE SKIN.

The transition from boils and chaps and chilblains to diseases of the skin appears to be a most natural one, but it is not strictly scientific. As, however, we are treating this subject from a popular point of view, we may consider this troublesome and disagreeable set of cases at this part of our subject. The skin is often much damaged by the continuous poulticing to which boils and blains are but too often subjected, and some of the most obstinate skin affections date their commencement from some application which has been used for some other object. I have already treated of the class of maladies which are styled eruptive fevers, or 'the Exanthemata,' as they are termed by medical men. They are attended by high fever, and are all infectious or contagious. They include Measles, Scarlet Fever, Small Pox, et id genus omne. Another class of infectious complaints, which are truly parasitic, affecting the hair and skin, have also been already dealt with. It remains now only to take account of those diseases of the skin which are called tetters, breakings out, scorbutic affections, etc. They are chronic in their course, and are not usually attended by feverish disturbances. Some of them are very difficult to cure, and leave lasting impressions behind them. There are several distinct classes, such as papules or pimply diseases; squamous or scaly affections; others are vesicular or pustular. These divisions are not natural, a papule may become a pustule, and a vesicular disease, such as eczema, may

lapse into a scaly kit Others are simply blisters, whilst the disease called Itch may take on almost every kind of form, viz., pustular, papular, or vesicular. There is no truly natural classification for skin diseases, but for convenience of description I will take them in the following order :

1, Papules. 2, Scales. 3, Vesicles. 4, Pustules. Papules. These are small elevations of the cuticle with hardish bases; they do not suppurate or form pus ; after a time (sometimes extended) the hardened base declines, a small scale forms, which is not exactly a scab; it rubs off, generally in consequence of some itching, or when it appears on the face by the act of rubbing; it may recur in the same place. There are several kinds of papule: (1) Acne, (2) Strophus, (3) Lichen, (4) Prurigo.

Acne. This affection is common upon the faces and necks of young people; it is caused by an inflammation of the sadiparous or oil glands, and the tissues immediately adjacent. The sebaceous matter is concreted into a solid form; it distends the excretory duct and even the hair follicle. It then comes into contact with the dirt contained in the air, and forms a black spot on the skin. These are sometimes squeezed out and a thin maggot-like body exudes. Children are

wont to describe the victims of this disease under various fanciful names. It is more frequently seen in young men and women just as they approach the age of puberty than in younger children, and usually disappears in the course of a few years. It is more usually met with in those parts of the body which are exposed to the influence of the atmosphere. There are several varieties, as the simple, the indurated, the punctuated, and the form called Acne Rosacea, in which the integument around assumes a livid hue. This last is not often seen in young people; it is more usual in those who, having transgressed the rules of propriety, have their errors discovered later on in life, and whilst the simple forms are easily removed, Acne Rosacea is most intractable.

Treatment. The simple form may usually be got rid of by a proper application of soap and water, with gentle or vigorous friction, according to the condition of the base of the papule. Friction with sulphurointment is useful at times, and in obstinate cases a lotion containing one grain of bichloride of mercury in an ounce of emulsion of bitter almonds will generally remove the complaint. The lotion should be applied at bedtime, a little being rubbed into the orifices of the glands which are faulty. The general health requires attention; fresh air, exercise, attention to diet, and some saline laxative may all be indicated according to the habits of the person affected.

Strophus or Red Gain, or tooth-rash, is a malady affecting infants, and need only be mentioned here; it is closely allied to Lichen; it requires attention to cleanliness, and the removal of causes of intestinal irritation which are common among infants.

Lichen is an eruption of minute papules, reddish in colour, conical in shape; they produce an intolerable itching, and terminate in a branny kind of scale, which causes a shower of debris when the under-garments are changed. There are several varieties, which have distinct names, derived from the shape of the patches, position of the papules, or colour of the neighbouring skin. Lichen tropicus is the prickly heat of the tropics. They all appear usually without any constitutional disorder. They are not common among children, are

THE HE BEARS (Ursida) are generally considered to form one of the families of the carnivora, although, in the strict sense of the word, they are not flesh-eating animals. In their wild state their diet appears to be of a mixed nature, consisting partly of snails and other small creatures, but chiefly of fruit, honey, and roots. They seem but seldom to attack the higher animals, unless when their ordinary food is not to be procured, and, as a general rule, are singularly harmless and inoffensive animals, unless attacked or otherwise annoyed.

In captivity it is found that bears thrive very well upon an exclusively vegetable diet, animal food being seldom or never given to them. The Polar bear, of course, forms an exception to this rule, its natural surroundings rendering it an almost entirely carnivorous animal.

All the bears are plantigrades, that is, the entire sole of the foot is placed upon the ground when the animals are standing or walking. Strange as it may appear, this structure renders them far more capable of assuming an erect position than is the case with any of the monkey family, although the hinder feet of the animals of this latter group approximate so much more closely to those of the human form. Indeed, a bear seems fully as much at ease when standing erect as when upon all fours, and usually assumes an upright position when attacking a foe.

The paws of the bear are armed with long and sharp talons, which, however, are not retractile like those of the animals of the cat tribe. These claws form most terrible weapons when urged by the powerful muscles of the fore-limbs, a bear having been known to scalp a man by a single blow of the paw.

The mode of attack seems invariably to be the same. Approaching to within a short distance of its enemy, the bear halts for a second, rears itself upon its hinder limbs, and delivers a series of terrific blows with the fore-paws, always directing them at the head of its adversary. Should these fail to take effect, it enters upon a different system of attack, and endeavours to seize its foe round the body, and crush him to death by the tremendous pressure of the fore-limbs.

Few animals are more formidable than an enraged bear, no matter of what species, and even an experienced hunter hesitates before encountering one of these animals, except under very favourable conditions. And the animal becomes a more terrible antagonist from its extreme tenacity of life, and from the concentrated energy and fury which it exhibits after receiving a fatal wound, during the last few moments of its existence. Nothing less than a ball through the heart or brain appears to cause instantaneous death, and any less immediately fatal wound appears only to stimulate the animal to fresh and more energetic exertions.

THE first bear upon our list is the Brown Bear (Ursus Arctos) of Europe and Asia, an animal with which most of us are more or less familiar. It is a large animal when fully grown, an adult specimen averaging about eight hundred pounds in weight when in good condition.

The fur of this animal is of a uniform brown tint, varying slightly in different individuals. When young a white band is sometimes found encircling the neck of the animal, which, however, almost invariably disappears in the course of two or three years.

The brown bear is tolerably plentiful in the mountainous forests of many parts of Europe and Asia, but in spite of its strength and powers of destruction, is by no means so great a foe to the farmers as might be imagined. Indeed, a cattle-eating bear appears to be the exception and not the rule, the animal generally contenting itself with a vegetable diet, and allowing the flocks to rest in peace.

If, however, the bear should once break through its usual habits, and make a meal upon some cow or sheep, it becomes a confirmed cattle-eater, visiting the folds night after night in order to appease its hunger with the flesh of one of the enclosed animals. In such a case, there is no rest for the farmer until his voracious foe is slain, and his flocks can once more repose in safety from its attacks.

Two very favourite articles of diet with the brown bear are to be found in the insect world, ants furnishing the one, bees the other. Of the former insects the bear is very fond, tearing the nests open with its paws, gathering the ants and their pupa into its mouth by means of its tongue. Beehives, too, frequently suffer from its attacks, both the insects and their sweet produce being speedily entombed in the body of their destroyer. The animal does not fear their stings, its thick long fur proving an effectual bee-dress. The brown bear affords us a very good instance of perfect hibernation, passing the entire winter in a state of torpor. Towards the autumn, the animal becomes extremely fat, and, about the end of October, sets to work and prepares a suitable chamber in which to pass the chilly months which must intervene before springtime again makes its appearance.

This hiding-place is usually situated among rocks, or beneath the roots of a tree, where the animal will not be exposed to the direct action of the elements. Should such a spot be unattainable, however, the bear constructs a kind of hillock of moss, in which it takes up its abode. In spite of their size, these hillocks are by no means conspicuous, for the deep snow usually conceals every trace of their presence.

Having once fairly entered upon the period of enforced repose, a singular phenomenon takes place in the system of the bear. The stomach and intestines, being

no longer supplied with food, contract very considerably, and the passage is, moreover, blocked by an ob struction, technically known as 'tappen,' so that nothing can possibly pass from the system. This 'tappen generally consists of pine-leaves, and various substances swallowed by the bear together with the ants of which it is so fond. In constructing its retreat, the bear is very careful of its personal comfort, and carefully lines the floor with a soft bed composed of dried leaves, moss, and other substances of a similar nature.

Secure in its winter retreat, the bear passes the cold months in a state of torpid inaction, subsisting, meanwhile, upon the fat which it has accumulated previous to entering upon its long repose. Yet, strange to say, very little difference is

manifested in its condition, for the hunters. tell us that if the hibernaculum of a bear be opened before the expiration of the winter, the animal is fully as fat and sleek as before it retired to its retreat. The period of inactivity lasts for about five months, the animal returning to the outer world towards the middle of April.

The young of the bear, from one to four in number, are brought forth while their parent is still in her winter retreat, this event usually taking place about the end of January. It is a curious fact that, although at the time of the birth of her cubs, the mother has been deprived of food for upwards of three months, she is yet able to nourish her offspring until the time comes round for her again to make her appearance in the world.

When taken young, the brown bear is easily tamed, and shortly be

comes perfectly domesticated, almost as much so, indeed, as a pet dog or cat. Being naturally of a mild and gentle disposition, tame bears of this species have often been allowed to roam about the house with perfect freedom, seldom or never abusing the confidence reposed in them.

This is the animal whose fat, popularly known as "bears' grease," is, or perhaps was, in such estimation as a means for increasing the growth of hair. The hunters who are necessarily practical naturalists, are aware that the bear, like the squirrel and other hibernating animals, is fattest towards the end of autumn, and consequently they choose that time of year for bear-killing.

I regret to say that the high repute of bears'-grease has been the cause of many frauds. Indeed, if every bear that was killed in any one year were composed

entirely of fat, the amount of bears'-grease would not equal the hundredth part of the annual quantity sold in the shops.

My lamented friend, the late Frank Buckland, tells an amusing story of bears'-grease.

Not many years ago, hair-dressers used to advertise the day on which they were going to kill a bear. Readers of Dickens will remember that one of his most humorous stories is founded on this custom. The romantic hair-dresser in question seems, however, to have really slaughtered real bears and sold the genuine fat; whereas, as a rule, no bear was killed, and hogs' lard took the place of bears'-grease.

The hair-dresser in Mr. F. Buckland's story was clever enough to kill the same bear three times weekly. He had one real live bear, which he kept in a cage visible to the public. He had also a skin (head included) of the same kind of bear. On killing days, the bear was withdrawn from the cage, and presently a terrific noise of angry growls, shouts of men, rattling of chains, and so forth, was sure to attract a

large crowd. After awhile the proprietor, all flushed and panting came into the shop, and hung up the (apparently) newly flayed skin of the slaughtered bear. Then his cart, with a large box in it, drove off to the docks to fetch another bear. Next morning a fresh bear was to be seen in the cage.

Unfortunately for the ingenious hair-dresser, the secret leaked out unexpectedly. The yells and growls of the wounded bear were produced by a costermonger popularly called 'Leather-mouthed Jemmy,' who was retained to enact the part at a fee of five shillings for each performance. On one occasion he was dissatisfied, quarrelled with his employer, and then the whole ingenious deception was exposed.

The hair-dresser was careful that the new bear should be never quite like its predecessor, and darkened or lightened the hue as required, by the means of blacking and flour. But the bear and the skin were carefully made to agree in hue, and then the latter was greased and streaked with blood before it was hung up. I have heard of another case where the hair-dresser used to allow his customers to rub their heads against the actual fat of the slain animal as it hung in his shop. The man had a real bear-skin, but used to insert within it the carcass of a large pig which he hired for the day.