;. :•• ■ '■ ■1 . Class _Jl_Li_£ Book JA 3 OojpghtN i i COPYRIGHT DEPOSE ■J II THE SKIN Its Care and Treatment BY EMILY LLOYD TEACHING EVERY DETAIL OF THIS IMPORTANT WORK 1\ A SIMPLE, CONCISE AND PRACTICAL M \ N N E R FIFTH EDITION K E-W R ITT EN A N D m:\vly [LLUSTR VTED Mcintosh Battery & Optical Company CHICAGO Copyright 1914 McIntosh Battery & Optical Co, /< /<<■ JUL 24 1914 0CI.A374963 4t THE SKIN 17 members became so evident that now the club numbers 300 and is constantly growing. Any one may begin. Why not try it now? As one of the members said, "One feels so ridiculous at trying to give an angry or hasty answer after smiling at the person that usually there is a laugh instead. Then, too, when one smiles at people they smile back, and some way the whole day is made easier/' Any woman can belong to the Smile Club. Any wo- man can accomplish that which she wills, but she must will strong enough. Muscle is only developed by exercise, not by ease. So instead of complaining at the apparent hardships in the path she has chosen, the woman in business should rejoice at the opportunity for bringing about devel- opment of the mental muscles and the formation of new, better brain cells. The cheerful woman is always sure to win out, for she fails to notice the dark cloud ; she is too busy looking for the "silvery lining. ,, She has a number of other quali- ties, too, of which I am sure you will wish to learn. She is a restful kind of person — quiet in manner, se- rene of face, destitute of nerves and so filled with self- confidence that if she sweetly suggested the amputation of an arm the patient would at least be tempted to consider it. She is not talkative ; "restful" women seldom are ; and yet some way when you have left her she has managed to impress upon you a few very positive facts and you feel really inclined to do exactly as she suggested. She inspires you with confidence because she has no fear. She knows what she can do and you know that she knows it, and there your troubles end. Another excellent point about the ideal operator is the way she discourages you from talking while you are having 18 THE SKIN a treatment. She does not tell you her troubles. Conse- quently she won't let you talk about yours and get your muscles out of order while your face is being manipulated. If you ask too many questions, she will usually stop, look at you reproachfully and say: "Unless you relax I cannot do a thing for you; just try for a moment, close your eyes, and I am sure you won't feel like opening them again until the treatment is ended." Some way you feel like doing as you are told, and when the treatment is over you do both feel and look like a different person, thanks to the quiet as well as the work. You have not been regaled with the latest gossip, nor have you repeated any yourself. You have been having a thor- ough treatment, free from hurry, or worry, and if you are a wise woman you will appreciate it enough to go back again at the first opportunity. The very fact that you have not been compelled to learn "how hard the work is, and how poor the pay is, how- many symptoms of various troubles some one has, or how mean the Manager is," counts for a lot. You have secured a treatment without having to listen to a list of woes, and it is small wonder you like it. There are many other good points about this ideal operator that may perhaps be enumerated for the benefit of those who might wish to copy h?r example. She is always scrupulously neat, dressed in plain gowns on the street, and invariably enveloped in a clean white apron when at work. Not a sign of jewelry, such as bracelet or rings, will be in evidence, because anything of the kind would be out of place. She is low voiced and sympathetic, and is so interested in you and your various ailments and in the members of T H E S K I N 19 your family that you just know she is especially interested in your case. She is considerate, too, helps you off with your wraps and just as carefully helps you into them. She knows what you ought to do to keep your skin and scalp in good condition and tells you all about it, so you can accomplish things at home if you have the proper arti- cles to work with and know how to use them. As a conse- quence you get just exactly what you need, because there is such a satisfaction in having the right thing. When she places you in the massage chair she sees that you are perfectly comfortable before she begins work, then notes that the light does not shine in your eyes, has the head band arranged carefully and the towels tucked in securely so that the gown is protected. Everything is in readiness and all the necessary arti- cles in the booth before the treatment is commenced, so there is no mad rushing about for the electrode that should be there and the cotton and gauze that was not cut. Every detail has been looked after before your arrival. Then in the treatment she remembers you may be a bit particular about odors, so she does not eat disagreeable things for lunch, nor does she use strong perfume. She also avoids leaning over the chair so that you g^t her breath, as some operators carelessly do. Instead, whenever she is doing work where it is necessary to bend her head over she keeps her face slighly averted. She is always punctual for your appointment, never keeps you waiting even for a moment, unless the appoint- ment before was a little late, and in that manner she has been unavoidably delayed. Even then she does not seem hurried, but some way 20 THE SKIN gets through with the treatment and keeps you good-natured even though the time is a little less. She never says anything unkind to anybody. Mention a competitor. She may smile, but she won't say a word. You will notice that she does not discuss her other patrons with you, or tell you anything that they have said. Occasionally she does tell of a remarkable result ob- tained by the use of some treatment, but she never men- tions names, and you can't coax her to do so. Consequently you feel quite comfortable about your own case. She never feels that she knows everything, but is will- ing to learn. In fact, she is constantly searching for some- thing newer and better, and every time she takes a trip she bears you in mind and drops you a card so you will know of the new things, too. Another agreeable thing about this ideal operator is that she won't talk to other patients or go to the telephone or be disturbed in any way while she is waiting on you. She may have troubles, but you don't know about them, for she is a monopolist where sorrow is concerned and does not believe in forming a syndicate of patients to whom she can unfold each separate grief. In fact, she always seems content and happy and you feel it rests you to be near her. She never discusses prices with you or tells you how cheap some one else is doing the work, but just keeps at her own business and gets what she asks. The list of her virtues may seem inexhaustible, so after recounting those that are most prominent, we won't say a word more, but will hope fervently to see more people adopt some of her methods. A woman of this kind is bound to become known and certain to succeed. She is so lovable, so filled with opti- mism, so sincere in her feeling toward her own work that T H E S K I X 21 she invariably attracts towards herself the patrons who can best help her to make the kind of a reputation she desires. She is not to be envied, for none of these virtues are at all proprietary. The most sincere compliment you can show her will be to at least attempt to resemble her in some details. The more operators who are found like her, the sooner will all the work in the country be what it should be, honest, beneficial, and last, but not least important — decid- edly remunerative. CHAPTER II STERILIZATION No subject is of more importance to the operator than a knowledge of the proper care and sterilization of her instruments. Few subjects are less understood. Mention sterilization and in nearly every case the operator interviewed will ex- claim, " Sterilize, indeed we do; why, we put every comb and brush into gasoline every day." Attempt to explain that gasoline is not a disinfectant and that every comb and brush must be properly cleansed every time after being used and immediately a storm is produced. The lady usu- ally regards your desire to aid her as a reflection upon her personal cleanliness. You may perhaps meet another operator who looks fairly intelligent and gently commence the subject by re- marking that "few places are really sanitary." Before you have time to catch your breath she will indignantly retort, "You certainly cannot say that of our parlors, every comb and brush is washed with soap and water after each patient." Again you wearily attempt to explain that still a further process is necessary and once more you are assailed until finally, tired of trying to make people see things as they should be, you refrain from doing anything more in the argument line and just pray for an investigation by the board of health. The germs of diseases that we must constantly fight are present everywhere. Though we may not be afflicted by any trouble, ourselves, yet on our skins, in our hair, 22 THE SKIN 23 under our finger-nails, everywhere we find germs that lodge there harmlessly until there is an abrasion of the skin. Then, unless the tiny soldiers in the shape of the white cor- puscles are strong enough to throw off the poison and repel the invaders, we have an infection, which may be quite a serious affair if we happen to be in a rundown or debili- tated condition. It is for this reason that such care is taken in the use of antiseptic measures. The term "antiseptic" means against poison or sepsis. Any chemic agent that will cause the death or retard the growth of a germ is called an antiseptic, a germicide or a disinfectant. Articles that have been subjected to treat- ment by any of these solutions are called antiseptic. When heat has been used to destroy germ life as in boiling instruments or in the steaming process for gauze and bandages the articles are called "aseptic." In many of the parlors throughout the country not even the slightest precaution in the way of preventing in- fection by the use of antiseptics is even considered. Gasoline is used to cleanse brushes and perhaps a bot- tle of some mild antiseptic, such as boracic acid, may acci- dentally be found, but as to really knowing the principles of sterilization or practicing them the average woman will be found very lax. Fortunately for public safety, state laws are now be- coming strict and an investigation of the sanitary condi- tion of the various shops will soon be the universal prac- tice. In giving a list of antiseptics here, care has been taken to choose only those that are effective without being objec- tionable. Lysol, carbolic acid, and many others that might be used, leave an odor that makes a shop smell like a hos- 24 T H E S K I N pital. For this reason, and also because it has been chosen by the various Boards of Health in the greater number of countries, I have chosen formalin as the most practical disinfectant for the average shop. ANTISEPTICS THAT MAY BE USED Formaldehyde is a gas formed by the partial oxidation of wood alcohol. When combined with water in form of a liquid, it is called formol, formalin or formal. It is color- less, does not injure the finest materials, and may be used in a 5 per cent solution for instruments and brushes and i per cent for the face. In general this antiseptic will be found the most practical for use and should be kept on hand in quantities sufficient for every purpose. Corrosive sublimate cannot be employed in the sterili- zation of instruments because it corrodes and tarnishes them. Carbolic acid has too strong an odor and also dis- colors clothing and furniture when used in strong solution. Potassium permanganate also stains and causes pains and burns if used in strong solutions. Peroxide of hydrogen is a popular antiseptic, and is an excellent agent for the destruction of bacteria or pus, as in pimple treatment, but cannot be used successfully on instru- ments. When not in use, it should be kept tightly corked in a place away from the light. Boracic acid is a mild antiseptic and is non-irritating. It can be used on the skin in its full strength, but is not effective for instruments. Absolute alcohol is an antiseptic and disinfectant used for cleansing the skin, but not for instruments. Whenever practical, heat is always given first place for the work of sterilization, and after that the use of formalin T H E S K I N 25 will be found the most useful. In this connection the stu- dent should always remember that it is not alone enough to sterilize an instrument, but care must also be taken to pre- vent contamination with dust or foreign objects afterwards; thus the necessity for the sterilizers, in which instruments may remain until ready for use. The Way Every Conscientious Operator Will Do After washing combs and brushes in soap and water they should be plunged into a formalin solution and allowed to remain for at least twenty minutes. Then all superfluous water may be shaken out and they should be placed on one of the trays in the cabinet sterilizer where they may be 26 THE SKIN kept safe from dust and constantly exposed to the fumes of formalin that comes from the little dish kept in the bottom of the cabinet. Here they may stay ready for use. The effect is not only excellent from a sanitary standpoint, but also from the advertising view, for every caller who sees the care with which her own safety from infection is considered will lose no time in mentioning this fact to some one else. Comedone extractors, scissors, carbon electrodes, needles, and in fact everything that is used by the operator should be sterilized in this strong solution. In the cabinet sterilizer pure formalin is used. It is poured onto the blotting paper in the small dish fresh each morning. Each booth should be equipped with at least two steril- izers ; one of the cabinet variety and one of the old fish- kettle style, while in all facial booths extra porcelain dishes are also indicated for the weaker solutions. All bottles should be properly labeled and these labels renewed at frequent intervals. Jars should also have labels renewed frequently. Cotton and gauze should be cut in size convenient for use, and kept in large mouthed jars. In this way the opera- tor can take out only just what is needed for each case. Other antiseptics are frequently mentioned, and of these the operator should become informed. Common water kept at a high temperature is an excel- lent aid, but cannot be used on all instruments, because of the destructive power of great heat and also because it is not always possible to procure arrangements for boiling water. T H E S K I N 27 THE MOST PRACTICAL ANTISEPTIC As formalin has been adopted so universally not only as a powerful germicide but also as a deodorizing agent, and as it has the double advantage of not discoloring the clothing though really performing the necessary work, it will be found one of the most excellent agents for practical use. Over zealous persons have occasionally tried to use this solution at full strength, thinking if a "little was good, more would be better." The results are anything but pleasing, for formalin is a caustic fluid and used pure will certainly cause a decided irritation. In any strength it is slightly irritating to the eyes, and occasionally even the weak solution will have to be further diluted before using on the skin. All instruments made antiseptic by dipping in the stronger solution should be rinsed in alcohol or a weaker solution before using on the face. For combs, brushes and instruments the 4 per cent or strong solution is used. All these solutions keep indefinitely and should be kept on hand ready for use. Strong or 4 Per Cent Solution W^ter 64 oz. (two quarts) Formalin 2]/ 2 oz. The next solution of formalin is usually employed for washing off the tops of the tables, shampoo boards and enameled dishes, and is also excellent for cleaning the hands after treating any scalp or skin disease. 2y 2 Per Cent Solution Formalin Water 1 quart Formalin iy 2 tablespoonful This Table, Irrigator aod Sterilizer Combined is an attractive and practical piece of furniture. Basin may be swung under opaque top out of way. Railing prevents jars from being brushed off. Solid plate glass shelves. T H E S K I N 29 Last of all comes the I per cent solution of formalin. This is used for sponging off the face before using the comedone extractor. It is also excellent for destroying any bodily odor, such as that sometimes caused by undue perspiration. i Per Cent Formalin Solution Water i quart Formalin 3 teaspoonsful This solution should be poured into the small dishes and kept ready for use on manicure tables or near where the operator is working. Instruments not in use may then be placed back in the small dish for a moment or so until the operator is ready to use it again. This prevents placing them on the table where they would become freshly exposed to more germs. This table forms a very necessary part of the furnish- ing of the average office, as it affords a most convenient and sanitary resting place for bottles, glass jars, etc. In addition to the use of antiseptics, however, there are many other points to be considered. The operator should always be provided with fresh aprons and should endeavor to impress the patient with the idea that an effort is made to have everything as cleanly as possible. Fresh towels and head-bands should be provided for each patient. In- struments should be dipped into a sterilizing solution the moment after they have been used, and should in addition always be freshly cleansed and ready for each new patient. Powder should be kept in shakers, dusted on to cotton or gauze, and then after the application, the cotton con- signed to the metal waste basket. Creams should be kept tightly covered when not in use. When in use the ivory spatula or spoon should be employed 30 THE SKIN for removing the amount necessary so as to avoid having the operator place her fingers in the jar, then on the patient's face, and so on, from one to another,. Combs and brushes should have hair removed from them immediately after use. They should be first rinsed with hot water and then placed in sterilizing solution and allowed to remain for ten minutes, when they can be drained and placed in the cabinet sterilizer. It should be borne in mind that one of the most important points in regard to the matter of sterilization is to establish the habit. That is, one should never use the comb, brush or towel that has been used by any other person before sterilizing, any more than one would use another's tooth-brush. In shampooing, the board should be sterilized just as conscientiously after working on a friend as when caring for a comparative stranger who really has a scalp disease. Peculiar diseases of the face and scalp should not be treated by the average operator. Among those commonly found I mention sycosis, or barber's itch, ringworm, and any pustular disease. There is a double reason for refusing such cases ; first is that all conditions of this skin require the care and advice of a physician. The second, the danger of infection to the operator herself, to say nothing of the possibility of conveying the trouble to her other patients through the medium of her finger tips. In some establishments, where extremely sanitary con- ditions prevail, a special sterilizer is set apart for the care of hair. For instance, when all extra hair must be washed and sterilized while the patient is having a shampoo and scalp THE SKIN 31 treatment, the extra hair will be cleansed in gasoline to which formalin has been added. It may then be shaken dry, aired for a few moments and then placed in the sterilizer subjected to the fumes of formalin. As hair itself is always filled with germs, much care should be taken to see that it does not float about the room, but is immediately placed in a covered receptacle. Stray hairs should not be allowed to remain on the dressing tables, as they always convey the idea of careless habits. Manicure instruments, such as scissors, files, etc., should also be sterilized before and after the use and a small dish filled with a dilute solution of formalin should be placed on the table so that the instruments may be dipped into it. The cup of the electrolytic massage should be cleansed immediately after use and cotton saturated in a disinfectant solution, such as formalin, kept there until the cup is ready for use again. CLEANSING OF THE HANDS This habit once established will become so natural that no thought will be required. It will have a marked effect on increasing the confidence of every patient, for in this day of universal knowledge people soon become informed upon these points. The operator must not only cleanse her hands immedi- ately after caring for the patient but must also cleanse her finger-nails and she must repeat this procedure before she takes another one, no matter whether she has been giving a treatment in the interval or not. It is the care in these little things that are most important. 32 THE SKIN So, no matter who the person is, whether friend, relative or acquaintance, not for one moment should the vigilance be relaxed, but always the same precautions maintained and just as much effort made to avoid infection as though every person treated was a possible source of danger. Constant, scrupulous effort will inevitably be rewarded. Hence, it behooves every operator to bear in mind always that the one great, imperative, crying necessity in every branch of her work is the thorough understanding and the practical, every day use of the principles of sterilization. CHAPTER III THE SKIN AND ITS DIVISIONS The skin is an elastic and flexible membrane covering the entire body. Certain elements are present everywhere and are essential portions of this organ. Others are found only in special regions and are called appendages. These are the hair, sweat and sebaceous glands and the nails. The appearance of the skin varies in different individ- uals and in different parts of the body. The color depends upon the amount of blood contained in the surface vessels and on the pigment deposited in the malpighian layer. The entire surface of the skin with the exception of the soles of the feet and the palms is covered with hair, the true hair on hairy parts and the soft lanugo or woolly fuzz on other sections. The perfect skin is soft, smooth and elastic and moist, varying greatly from the olive of the Spaniard and Italian to the ruddy color of the Scotch, and from the pearl white of the Irish to the pinkish tint found among the Germans. Although, to the naked eye the skin appears smooth, in reality it is transversed by tiniest and finest of lines as well as covered with the soft lanugo or wool hair, in some in- stances resembling the down on a peach. It is greatly due to this peculiarity of structure that the delicacy of appear- ance results. In health, perspiration is excreted by the sweat glands, an oily substance called sebum flows from the sebaceous 33 34 THE SKIN or oil glands, carbonic acid gas and urea are eliminated and oxygen is absorbed. In thickness the skin varies from one-tenth to one- fourth of an inch, being thicker in the palms and the soles than in other portions of the body. Owing to its situation, the skin is particularly exposed to the injurious effects of the heat and cold, thus directly affecting the circulation. Prolonged exposure to the sun or electric light has a caustic action, as in "sunburn." Un- due friction or pressure from the clothing may cause a chafed and sometimes an inflammatory condition. Other sources of irritation are furnished by the constant presence of the various germs always found on the surface of the healthy skin as well as in the sebaceous glands, apparently only waiting for an excuse in order to become active. Ordinarily we distinguish three layers in the skin. The first is called epidermis, epithelium or scarf skin. Next comes the corium, also called cutis-vera and true skin. In this layer we find the glandular, vascular and nervous structure. The third layer is called the subcutis or subcuta- neous tissue and lies directly under the corium containing connective fibers, large and small fat cells, deeper seated follicles and large blood vessels as well as the sweat and sebaceous glands. THE EPIDERMIS Although ordinarily spoken of as epidermis or epithe- lium and considered as one layer, there are in reality four divisions of the outer portion of the skin. The first is called stratum corneum or horny layer, because of the constant shedding of the small scales. Directly under this THE SKIN 35 horny layer comes a poorly defined layer almost like a deli- cate transparent line which is called stratum lucidum. Next comes the stratum granulosum, consisting of two or three layers of flat nucleated cells. Last of all is the malpighian or mucuous layer, also called the rete malpighii. In this layer are situated the pig- ment cells or coloring matter which give to the skin its particular color. An over distribution of pigment produces a dark skin. Irritation, disease, and exposure to the sun often causes an increased deposit of pigment in the shape of freckles, moth-patch or tan. Treatment for discolora- tions must be directed to this spot, and it is for this reason that the galvanic current is so extremely important and by its aid, we can force in the substances that will remedy these conditions. Projecting down from the malpighian layer into the corium are club-shaped processes that fit in between the papillae that extends upwards. But, though this lower layer of the epidermis and the first layer of the corium are thus connected there is one great difference between the first and second layers of the skin that must always be borne in mind, and that is the fact that in the epidermis there is no blood or nerve supply. A common illustration of this fact may be seen in the formation of the ordinary blister, in which the outer skin will be seen to raise and separate from the kwer part. Puncturing the blister will simply allow serum to escape but will not cause any blood to flow. The success of the various methods of removing the skin for the correction of facial blemishes consists in the art of applying a chemical that will blister just deep enough to affect the epidermis, and will not in any way injure the corium or true skin. 36 T H E S K I N THE CORIUM The corium, derma or true skin is considered the most important part of the cutaneous organs. It is a curi- ously complicated combination, making one think of a city, thoroughly riddled by surface cars, in the shape of the blood and nerve supply, elevated roads resembling the papillae and for the subway the follicles and glands, while one may think of the dense network of interlaced connec- tive tissue as the streets. In this layer we find the blood vessels, nerves, lym- phatics, bundles of smooth muscular fiber, the hair and its sheaths, and the ducts of the glands. The corium is in turn divided into the papillary and recticular layers. The upper or papillary layer pro- jects between the club-shaped process of the malpighian layer, containing the blood and lymph supply as well as the nerves. In the appearance known as goose flesh the effect of the papillary layer is plainly shown. In order to keep the skin well nourished this layer must retain every function. When in consequence of ill health both blood sup- ply and the nervous system are affected the papillae lose their elasticity and the skin becomes flabby and wrinkled. When a deep incision is made and the papillary layer is injured a scar results, where if only the epidermis had been affected the scar would in time disappear. Directly below the papillary layer is the recticular layer, distinguished chiefly by a more regular arrange- ment of the connective tissue bundles. The elasticity of the skin is due to this particular arrangement, as curling around each bundle of connective tissue will be found the elastic fibers. THE SKIN 37 THE SUBCUTIS The subcutis or subcutaneous tissue lies beneath the corium. It is composed of connective fibers forming large, loose meshes. Large and small fat cells are also found here, as well as large blood vessels, nervous struc- tures, sweat and sebaceous glands, also the deeper seated hair follicles. The normal skin is of good color, soft luster, firm in texture and unmarked by any defect. Exposure to the sun and air, the use- of strong soaps and impure cosmetics, neglect, all these contribute to bring about abnormal conditions, and must be skillfully treated if any relief is to be obtained. Nature is often more than gracious in presenting us with complexions and healthy skins. Common sense must be brought into use if we are to continue to enjoy these blessings. No matter how good the skin may be originally, constant care must be used if it is to be kept in a good condi- tion past middle life and on into old age. As an example it will be noted that often though the complexion may be muddy and the skin of the face rough, that of the body will be white and clear, because the cloth- ing has protected it from the effects of the sun and air, and the constant gentle friction has kept it in good condi- tion. CHAPTER IV SKIN GLANDS AND THEIR DISEASES The sebaceous or oil glands are situated in the corium or subcutis and are generally connected with the hairs. They are usually from 2 to 6 m. m. in length and secrete an oily material called sebum. In health, the glands throw out just enough of this oily substance to keep the skin flexible and the hair glossy. There are about 600.000 sebaceous glands in the body. When an alteration takes place in the natural secretion, structural changes result, and we find either an excess or a diminution of the secretion. Among the diseases of the sebaceous glands caused by this change in structure we find the following: SEBORRHOEA An over-activity of the sebaceous glands brings about that condition known as seborrhoea, which occurs in two principal forms. The first is the dry form in which the solid, fatty constituents of the sebum appears in the shape of a scaly mass, which we call dandruff. The other form is one in which the oily material pre- dominates and is sometimes seen in the form of drops of oil at the mouth of the ducts, making the skin look and feel as though annointed with oil. MILIA Retention of the sebaceous material sometimes results in a peculiar condition called milia, from the Greek word 38 T H E S K I N '39 meaning millet seed. They are situated chiefly where the skin is thinnest, and appear hard, freely movable masses enveloped in a tiny sac. Left alone the mass may run to- gether, forming a flat, hardened plaque. COMEDONES OR BLACKHEADS Comedones are small portions of sebaceous matter which plug the ducts of the sebaceous glands. The black or brown color of the tip is due partly to the peculiarity of the epithelial cell and partly to dirt. Although usually found on the face, these small pests appear all over the body at times, making the skin look as though sprinkled with gun-powder. When allowed to remain undisturbed, there is a tend- ency to cause inflammation, hence the treatment is to re- move them as quickly as possible and then use manipulation for the purpose of restoring the glands to their natural functions. This subject will be considered at length under the subject — "The Treatment of Blackheads. " THE SUDORIPAROUS GLANDS The sudoriparous or sweat (sometimes called the coil) glands are situated deep in the recticular portion of the corium and in the subcutis. They are small, round yel- low bodies y 2 to 3 m. m. in length, and numbering about two to three thousand to the square inch, or three million to the average body. The secretion of these glands is called sweat. About 28 per cent of the water excreted by the body is by means of these glands. The action of the sudoriparous glands is increased in some forms of disease, and is far greater in summer than in winter. Oftentimes medicated baths and internal reme- 40 THE SKIN dies are used in order to force more work upon the skin and thus relieve the other organs. Common disturbances of the sudoriparous glands are the following: ANIDROSIS Here the secretion is very much diminished, resulting in a peculiarly dry condition of the skin. In some instances this is a congenital condition, in others it is dependent upon some mechanical cause, such as an obstruction of the sweat ducts. The secretion may be totally suppressed, thus caus- ing many other disagreeable results. Massage, friction and the use of hot baths are the usual remedies. HYPERDROSIS An excessive amount of perspiration over either the entire skin or in certain localities is called hyperdrosis. This condition may result from unwonted exertion, mental emotion of a depressing kind (as in cold sweat) or as a rapid form of w r aste associated with a certain disease. When it is localized to the hands and feet it is not only disagree- able but is often painful, causing a thickened, sodden con- dition of the skin, as well as a clammy, slippery feeling. Science has done but little to remedy this condition until during the past few years it has been discovered that certain local applications will not only prevent excessive perspiration, but will also remove any objectionable odor. The application, used in the form of a powder, simply diffuses the secretion in a normal manner. The powder may be used in the arm pits, about the neck, on the hands or on the feet, and after the first few applications but an occasional use is necessary in order to insure comfort. Perspiration Powder is indeed a boon to those who suffer from this disagreeable condition. T H E S K I N 41 BROMIDROSIS Most disagreeable of all of the anomalies of the sudor- iparous glands is that in which the secretion is foul smell- ing. Many people who have been cleanly to the point of being over fastidious, have been so annoyed by the persist- ence of this condition as to be absolutely unfit for society. The odor is so sickening that an idea of bodily filth is nat- urally associated with it. The favorite sites for this trouble seem to be the arm pits, the axillae, and the feet. Scientists are still somewhat undecided as to the cause. Some declare that the offensive odor is caused by the pecu- liarity of the oily substance excreted with the perspiration. Recent research seems to prove that a certain micro-organ- ism is at fault. The most efficacious treatment and indeed the one that has secured the best results, consists in bathing the afflicted parts in a mild solution of formalin, and using the Perspira- tion Powder once or twice a day until the condition is re- lieved. This powder is harmless and will positively cause no bad effects. CHR0M1DR0SIS Under certain conditions the sweat and the sebaceous secretion may become colored. Shades of red, blue, yellow, violet and even a black sweat has been observed. This phe- nomenon is generally localized and is frequently found on the foreheads, cheeks, eyelids and sides of the nose, though others parts of the body may also be affected. It is usually found in people of poor or weakened state of health, so a general treatment is necessary. 42 THE SKIN HEMADROSIS Bloody sweat sometimes occurs as a result of the blood filtering into the coils and the ducts of the sweat glands. This condition is extremely rare, and is seldom observed excepting in people of an excitable temperament, who have been subjected to a great mental strain. Local applications are quite useless in a trouble of this kind and so general treatment for this improvement of the health must be advised. URIDROSIS In this condition the sweat has a urinous smell, owing to the presence of urea and other urinary constituents. In marked cases the excretion may be so pronounced that the entire body is covered with tiny crystals. SUDAMINIA OR MILIARIA Obstructions to the sweat glands cause this trouble. Small vesicles appearing like drops of dew appear on the skin. The fluid is nothing but imprisoned sweat which has been prevented from finding its natural outlet, and so is contained in the vesicles under the horny layer. Epithelial plugs usually cause this condition. Opening the horny layer and extracting the plug is the only remedy known. PRICKLY HEAT OF MILIARIA PAPULOSA An inflammation of the sweat glands called by the scientists miliaria papulosa is one of very frequent occur- rence. Babies and fat people seem to be the chief sufferers. The lesions appear suddenly and prickle or tingle constantly. Treatment consists in the use of soothing lotions, alkaline or bran baths and a carefully selected diet. All cause of irritation in the clothing should be removed. Sponging the T H E S K I N 43 body with a solution of soda followed by dusting the entire surface with a powder made as follows w T ill be found ex- tremely effective : Talcum Powder 2 ounces Boric Acid 1 ounce CHAPTER V LESIONS OF THE SKIN Although the average operator should be wise enough not to attempt any treatment beyond her province, still in order to do justice to the conditions she does treat, she should make a study of the skin and be able to classify the various conditions she finds. Diseases of the skin may sometimes be purely local ; other times they simply represent a disordered condition of the system. Dermatologists call the local symptoms objective and subjective. By subjective is meant that which causes a sensation such as itching, smarting, heat, pain, tingling. By objective, the structural lesions of the skin are meant, that is, the changes that can be detected by observa- tion and by sense of touch. A lesion is a morbid or unnatural condition of the skin. Lesions are divided into two classes, primary and sec- ondary. The primary or elementary lesions or conditions are those with which the disease begins and which may remain unchanged. The secondary lesions are the results of a modifica- tion or alteration of the primary manifestations. Under the primary lesions we have the following : Macule (patch), a flat, circumscribed alteration in the color of the skin, neither depressed nor elevated; for ex- ample, a freckle, or tattoo mark. 44 T H E S K I N 45 Papules are elevations of the skin, either firm or com- pressible, not larger than a pea. They may be round, flat or conical. They are often seen in cases of acne or eczema. Tubercle is a term applied to a large papule. This is a solid elevation varying from the size of a pea to a cherry and is usually deep-seated. This term should not be con- fused with tuberculosis. Tumors are still larger elevations of the skin, either soft or firm, always deep-seated and represent the next stage of tubercle. Sebaceous cysts are examples of tumor. Wheals are round, white or pink elevations of the skin of semi-solid consistency, attended by intense itching. Mos- quito bites and the sting of a nettle cause wheals to appear. Vesicles vary from a pin-head to the size of a pea and look like tiny blisters. The skin is elevated and contains a clear fluid. Blebs, sometimes called bullae, are large vesicles or blisters, varying from a pea to a small Qgg in size and hav- ing fluid contents. Pustules are circumscribed epidermic elevations of various sizes, containing pus, and are found in acne and in pustule eczema. Of these primary lesions may be remembered that vesicles, blebs and pustules are hollow and the others are solid lesions. SECONDARY LESIONS Scale (squamae) are dry attached patches, usually found as a result of some morbid process of the skin and are seen in eczema and psoriasis. Crusts are dried masses of exudations and are also sometimes called scabs. For instance, in acne or eczema 46 THE SKIN -we may have a pus crust, or after a pustule has been opened and bleeding has resulted a blood crust. Excoriations are superficial losses of tissues, for exam- ple, scratch-marks. Fissures are cracks or breaks in the skin, always linear, involving the corium as well as the epidermis, and may be observed very frequently in cases of chapped hands and lips. Ulcers (cores) are either round or irregular, variously sized losses of tissue, resulting from a suppuration in which skin and subcutaneous tissue is involved. Scars (cicatrices) are new formations of connective tissue replacing lost substance. Pigmentations (discolorations) are transitory or per- manent stains often left by cutaneous diseases, like the pur- ple marks seen after cases of acne have been partially cured. In addition to the recognition of the various lesions the operator should also bear in mind the following rules : — "Always use the most soothing treatment in acute in- flammations of the skin. For instance, in an aggravated case of sunburn, or a rash brought about by the use of strong ointments, an absolutely bland preparation should be used in order to avoid further irritation. Use stimulation in chronic diseases. Many operators think because they see the inflamed condition of the skin in acne, eczema and psoriasis, a soothing treatment is indi- cated. Instead, as much stimulation as possible should be given in order to increase the blood supply to these parts and aid in the carrying away of the impurities. Avoid soap and water in acute cases of eczema. This procedure sounds easy, but is often most difficult. Many cases of acute eczema are found on the scalp and the patient absolutely insists upon a shampoo. Each shampoo increases T H E S K I N 47 the trouble, hence the operator should refuse to be per- suaded into doing anything that will aggravate the condi- tions and should explain her reasons to the patient. Be careful not to use preparations unless you know something of their action. For instance, if one ointment should contain sulphur and a lotion containing mercury were to be used, the result would be a black discoloration that would stain the skin. CHAPTER VI THE USE OF COLORED LIGHTS Although colored lights in some form or other are found in nearly every parlor in the country in use on various forms of skin troubles, and in treatment of all disorders of the scalp, but little seems to be known by the operator in regard to the action of the different colors. Whether these lamps are 16 or ioo candle power; made of dipped or stained glass, makes a great deal of difference in treatment, so instead of purchasing a lamp by reason of the name under which it is sold, there should first be an inquiry made as to the kind of lights and the candle power before placing these articles in active service. Whether the article is called "leucedescent rays," "vio- let ray," "therapeutic lamp," or "dermal lamp," something should be known of what may be accomplished before even the first experiment is made. Sunlight has been for years regarded and listed as an excellent germicide. In fact, it may be truly called the best, cheapest and most universally used bactericidal agent. While it cannot be claimed that a short exposure to the sun's rays will kill germs it has been conclusively proven time after time by some thousands of experiments that a prolonged exposure to the rays will kill a great majority of the germs and will always retard the growth of the others, if indeed it does not render them harmless. Exposure to the sun for any length of time always re- sults in what is known as a "sunburn," also called by the name of "erythema solars." 48 THE SKIN 49 As a rule the most exposed portions of the face are most affected. For many years sunburns were attributed to the heat as well as to the chemical rays of the sun. Experiments proved otherwise, so now we know that the greatest and most enduring, and in fact most remarkable effects, are all produced by the chemical rays. As an illustration, it may be stated that travelers in the Arctic region suffer with symptoms identical with our sun- burn, due to the reflection from the snow and ice fields of the sun's rays upon the exposed skin. Professional oarsmen, athletes and in fact all of the white race who are exposed to the rays of the sun for hours at a time without any protection to the skin invariably suffer with "sunburn." That this is due to a chemical and not to a heat action is shown in this manner : Inflammation from sunburn leaves a pigmentation of the skin. The effect of ordinary heat would be to temporarily in- crease the color, but would not cause an increase in pig- ment. Heat rays act through the clothes. The chemical rays act exclusively on parts most exposed to their action. Inflammation caused by exposure to heat would develop immediately. Sunburn, on the other hand, though it may differ from a slight irritation to* a profound and almost unbearable in- flammation, develops slowly and is usually at its height from 12 to 24 hours after exposure. Further experiments have developed the fact that ordi- nary lights or lamps give less, and electric lights give more chemical ravs than the sun, and from these facts have been Showing Use of Therapeutic Lamp in the Treatment of Acne, THE SKIN 51 derived the reasons for giving treatments by means of the electric lights. The great Finsen, after years of study, decided that much of the scarring in smallpox came because the patients were exposed to the rays of light and that the chemical action of these rays produced a great irritation. He therefore suggested that all smallpox patients be kept constantly under the rays of red light. Even the lamps in the rooms were to be covered with red shades and in no instance was there to be any exposure to ordinary sunlight or lamplight, until every trace of suppuration had vanished. As a result of this treatment, not one case so cared for was scarred in the least. In addition the course of the fever was also much affected. Several patients who left before the vesicles were en- tirely healed, however, were affected quite severely in those portions and scars did appear as a result of exposure. Photographers take advantage of this fact, too, by ex- amining sensitive films by a light from which all chemical rays have been excluded. Finsen continued his experiments for some time after- wards by arranging a series of glasses in the order of the spectrum, red, yellow, green and blue and placing these slides over boxes in which he had earth worms. At the end of a few moments, all the worms had moved toward the red glass and away from the chemically irritating blue light. As soon as the worms were settled under the red light he changed the glasses about and immediately the worms traveled back in search of the light, that was most rest f til, the red light. Experiments with other insects that were known to have a preference for the dark corners showed that in every instance they were uneasy and excited under the blue and the green lights, more contented under the yel- 52 T H E S K I N low, and absolutely at home under the red light, as it was free from all chamical rays. As a result of numberless experiments Finsen decided that the colors had the following results : — Red glass, giving pure red rays, gives an effect hardly more marked than shade (or darkness). Yellow glass is but little different. Green glass produces a more marked effect. Blue glass gives a very strong reaction. He speaks of his experiments in this manner: "The evident result of these researches is that the action of the chemical rays (blue violet) on these animals as compared with the heat rays (red) and the light rays (yellow) is very considerable, more than that we find in it the extreme in- fluence of the chemical rays upon the organism. "By my previous remarks I have desired to draw atten- tion to the chemical power of light. This power theoretic- ally parallel to two other forms of solar energy, heat and light, no doubt constitute a means of action too much neg- lected in medicine. We know the chemical rays bring to the body which absorbs them a certain energy transformed in different ways, and we come to see that the most special transformation of this energy from the biological point of view seems to be an excitation of the nervous system, which doubtless influences secondardily all the vital function." In Dr. Finsen's work, he continued until he evolved the Finsen Ray, also sometimes called the "Ultra Violet." Either the sun or a powerful electric light is used, and the light so obtained passed through wonderfully clear lenses until all heat rays as well as the ultra, red, orange and yellow rays had been excluded, and then through a layer of water colored blue, then in concentrated form it must be passed perpendicularly upon the tissues treated. THE SKIN 53 In lupus the effects have been marvelous while in other skin affections great improvement has been made. The approximate cost of the best Finsen apparatus ranged from $1,000 to $50,000, depending upon the number of lenses used. I mention this fact in order that the student may not imagine she is using an "ultra violet" treatment when she manipulates the ordinary blue light. In Finsen's work it must be remembered he excluded all heat rays. In ordinary work with the various lamps, these rays are used, and indeed, many people complain unless they feel the heat. Finsen also realized that even a very thin layer of blood would absorb os many of the light rays that few could pass to the deeper tissues, so in every case treated he applied pressure to remove the blood from the spot until after the treatment was finished. Finsen also concluded that the ultra violet rays pro- duced the greatest germicidal power. Ultra-violet rays must .not be confused with the ordi- nary blue ray. The real ultra-violet apparatus is so con- structed that other rays are excluded. It is furnished either by the manufacture of extremely fine rock crystal lenses or it may be supplied from an electric arc. This last form of ultra-violet apparatus is usually pro- vided with a rheostat enabling one to get the effect of a burning glass or of simply a moderate supply of heat. Rays from this form of lamp directed on the skin for any length of time would produce a decided blister. The blister, however, would not appear for about three hours after the treatment, showing conclusively that it was of a 54 THE SKIN chemical nature. This treatment has frequently been used for deep-seated troubles. Larger forms of light, especially those suspended from the ceiling containing lights of high candle power and sup- plied with screens, will give both blue and ultra-violet rays though there are proportionately few of the latter. The use of the blue light for the purpose of reducing nervous tension is steadily increasing, and it may be inter- esting to the woman in business to know something of the work being done. BLUE LIGHT AS AN ANAESTHETIC In the London Hospital and in various Sanitariums, experiments for some time have been carried on with the blue light to see if it would have an effect on calming the patients. Nerve specialists declare they have seen a difference by simply exposing their patients to the light filtering through an ordinary blue pane of glass. In the hospital, experiments have been conducted by placing the patients beneath the rays of the larger forms of light suspended above them and requesting them to gaze steadily at these lights for some time. In some instances within a very few moments the pu- pils dilated, eyelids drooped, and a deep though natural sleep ensued, allowing the surgeon to perform operations without disturbing the patient in the least. In every case the nervous tension was relieved and the patient declared she felt sleepy. The operator may find a practical application for this fact by using the light on patients who object to the use of the electric needle or to an acne treatment. A trial of T H E S K I N 55 the light for ten or fifteen minutes before treatment will make it much easier. In order that there may be no confusion as to the use of the lights once more mention will be made of their uses. We have mentioned Finsen's deductions regarding the effect on worms and insects, so now it will be no more than fair to devote at least as much space to man. SUMMARY The Pure White Light from an Arc Lamp produces a chemical effect and will blister the skin, has an antiseptic action. Ultra- Violet Light is antiseptic and chemical in action, having even more decidedly bactericidal qualities than any other form of light. It is used more for treatment? of lupus and diseases within the province of the physician. Blue Light is penetrative, antiseptic, tonic and acts as a sedative to the nerves, though it may have a mildly irri- tating effect on the skin. It may be used in all cases of acne, eczema, psoriasis and various scalp troubles. When used for any length of time the light may be suspended some distance above the head and should be used on the bare skin. If used for forcing in creams, it may be em- ployed for a shorter time, it should be used on the bare skin first, and later followed by an application of ointment and then more exposure to the light. The Red Light is stimulating, deeply penetrating and produces more heat rays. Used for any great length of time it will, of course, produce a slight amount of irritation. A short exposure, say for ten or fifteen minutes, seems to soothe the skin. It is excellent for forcing in ointments and for use on all sensitive surfaces. 56 THE SKIN The ordinary lamp is used with either the blue or red lights, and the use of these two, if of good glass, will prove very beneficial, though, of course, the smaller forms of light cannot give the results to be obtained from those specially adapted to deeper effects. Mcintosh Style "G" Dermal Lamp with 50 c. p. Bulb and Ruby and Violet Ray Screens CHAPTER VII ELECTRICITY To many people the mere mention of the name elec- tricity conveys an idea of mysterious contrivances, queer de- vices, and startling treatments. Oftentimes it would take days of patient effort to per- suade a student that electricity was nothing but a natural force and in no way to be feared. The peculiar prejudice, fear or superstition, whatever it might be called, was in reality nothing but a form of igno- rance. Investigation then, as now, always took some time to bring about, but just as inevitably the same result followed — complete conversion. The timid student frequently becomes the most fearless experimenter. All who become at all familiar with the principles that must govern intelligent work unite in enthu- siastic reports on the results positive to be obtained. An excellent education is not necessary as a prelimi- nary to the study of electricity. Many of the best students are those who have had the fewest school advantages, but who do possess the two quali- ties necessary for success in any line of work — an adequate amount of concentration, and the patience to persevere. New lines of thought are really like new lines of work. The first time one attempts to use an instrument of any kind the fingers are awkward and the practice is re- quired to gain skill. So with the first time new thoughts are submitted, per- 57 58 THE SKIN haps the brain is not just receptive enough to receive them, and so "thought practice" must be tried until every fact be- comes plain. Anyone can do it. It just means trying again, and again, and some more, and then again. Occasionally one hears a beginner say, "I would not use electricity, I read the other day a man was killed by it." One might just as sensibly say, "I won't drink water, I knew some one once who was drowned," or, "I will never have a lire in my house because two of my friends were burned to death." The use of electricity by means of portable batteries or by wall plates properly installed will not be at all dan- gerous. When deaths have occurred from the electric current it is because the quantity of current has been tremendous and has come directly from a lighting circuit or wire without having anything interposed to break the force or reduce the strength. Electricity is all about us, we breathe it, eat it and drink it, in latent form. Years ago Thalen, the Greek, discovered that by rub- bing a certain transparent substance vigorously it possessed the power of attracting to it other light substances, such as paper. This light transparent article was called amber — and from it electricitv was named. Centuries later an Englishmen named Gilbert created great interest by repeating these experiments and adding some few more of them, but did not carry his investigation further until in the middle of the eighteenth century, Stephen Gray, of England, and our own Benjamin Frank- lin made important discoveries at about the same time. Since that time investigation and experimentation have been frequent and constant, until today we are living in the T H E S K I N 59 "Electrical Age," and in every department of life making use of this wonderful power. Street cars, telephones, tele- graphs, automobiles, vacuum cleaners, churns and dish- washers all are evidences of what may be done to make life more agreeable. Practical application of electricity for treatment of the various skin diseases is also becoming more and more a matter of "common sense. " Electricity is in reality nothing but a form of energy. Everybody is capable of generating a current of electricity in the body by merely exercising the muscles. The old experiment of scuffing the feet over the carpet and lighting the gas or drawing a spark from the gas jet is so old one almost forgets it is a proof of how electricity may be produced. It certainly illustrates the fact that "Electricity is en- ergy." That definition, however, hardly carries with it enough information, so as an explanation that will more readily give the idea we will accept the following: "Electricity is a mode of motion or form of vibration or some other manifestation of that form of matter we call ether." To understand how electricity penetrates and perme- ates all bodies we must then understand what ether is and here perhaps a little imagination may be necessary. ETHER One cannot see air, yet air assuredly exists. Now im- agine something even finer or thinner than air, an invisi- ble, delicate, intangible something that is fine enough to pen- etrate between the molecules and you have ether or elec- tricity in a latent state. 60 THE SKIN Technically the definition reads: "Ether is a hypothetical medium of great tenacity and extreme tenuity pervading all space, the interior of solid bodies not excepted, and acting as a medium for the trans- mission of heat and light. 7 ' FORMS OF ELECTRICITY By disturbing the equilibrium of ether we have elec- tricity. There is but one kind of electricity, though it may be manifested in many different forms. We usually recognize as being most important : i. Static, also known as Franklinic or f fictional, only used for body treatments and therefore in the province of the physician. 2. Galvanic, the continued or direct current used for the removal of all superfluous hair, warts, moles and naevi, also for cataphoresis, as in bleaching. 3. Faradic, also called the interrupted, induced, or ex- tra current, because of the manner in which it is produced. This current is usually indicated for stimulation. All other currents, such as sinusoi- dal or high frequency, are but modifi- cations of the other forms. In order to provide electricity for the purposes of treatment we have machines called batteries. The process of making a battery is in reality very sim- ple, as shown by the cut. This illustrates what may truth- fully be called THE SIMPLEST FORM OF BATTERY It consists of two dissimilar pieces of metal partially T H E S K I N 61 immersed in a diluted solution of sulphuric acid contained in a glass jar. Should these two metals be placed in the solution with- out being connected or with insulation between them there would be no action from one to the other. When, as shown by the wires "c" is connected to "a," the chemical action is commenced and we have a current passing through the fluid from the zinc to the carbon and back again through the wire from the carbon to the zinc, as shown by the tiny arrows. Current generated in the battery cells always takes this direction so the current from the carbon pole is always positive and that from the zinc always negative. Six, twelve or more cells may be united by the wires and the current then passed from the terminal "c" through a conducting cord to a person and back through the other conducting cord, held by the other hand of the person to u z." The positive current would thus be entering the body through the cord leading from the positive and passing back by means of cord leading to the negative. A very important part of the work of operating a battery is that of knowing just what are the various terms used to describe the parts, and how to use the terms denot- ing electrical measurements. At the first attempt these terms may seem a little diffi- cult, but after a little thought and consideration the effort will not seem half so great, until finally in a short time every phase relating to the use of the current will be easily understood. BATTERY A battery is a machine for the production of electricity. As the electric current is produced and may be used from the simplest form of cell, so this also may properly be called a battery. A combination of cells would be known under 62 THE SKIN McIntosh 12-Cell Combined Galvanic and Faradic Fluid Battery A Simple, Practical, Portable Fluid Cell Battery A Section of the Fluid Battery, Illustrated Above, Showing Base, Elements and Cell T H E S K I N 63 the same name, only designating whether the battery were composed of one, two, twelve or more cells, by mentioning the number in use or by stating it to be connected with city current. THE CIRCUIT The circuit includes the constituents of the battery, the connecting wires and anything with which the free end of the wires may be connected. For instance, in illustration — should the operator hold a connecting wire from "c" in one hand and from "z" in the other, the circuit is completed and is called a "closed circuit!' Should, however, the first u z" and last "c" be connected directly by a short wire or by touching the tips of the connecting cords together, a "short circuit'' is caused, de- stroying the efficiency of the battery by exhausting the cells. An open circuit is made by disconnecting the wires and thus putting the battery out of working order. POLES The points from which the electric current enters and leaves are called the poles. The positive pole is designated by the letter P or the sign +, the negative by the letter i\ or the sign — . BINDING POSTS The metallic posts into which the conducting cords are placed are called "binding posts" and are designated by the letters P and N to show to which pole the cords may be attached in galvanic section, or P and S in faradic section, meaning primary and secondary. 64 T H E S K I N ELECTRODES The instruments to which the conducting cords are fastened are known as electrodes. Thus a hair brush'would be known as a "hair-brush electrode/' a sponge as a "sponge electrode/' the carbon cylinder as the "carbon electrode/' etc. Oftentimes the expression "Apply the positive or the negative pole" confuses the beginner. These terms simply mean to apply the electrode connected with the positive or the negative current. CONDUCTORS All materials or substances such as gold, silver, cop- per, etc., which readily permit electricity to pass over them, are called good conductors. The term conductors is applied to the electrodes and cords by which they are attached to the battery. INSULATORS Substances hindering the passage of electricity are called insulators. Among them may be named glass, rubber, shellac, etc. As an example of the necessity for insulation, the conducting cords may be taken. They are of wire, but are covered with silk or cotton, thus insulating them so that an accidental contact between the wrapped cords can- not produce a "short circuit" and thus exhaust the battery. In some work in which the operator only desires to obtain the action of the electric needle for a certain distance, all but the portion of the needle inserted beneath the skin will be covered with shellac, thus insulating and preventing any trouble from accidental contact. In addition to a knowledge of the names of the various parts of the battery it is absolutely essential that the stu- dent be familiar with the electric measurements, that she T H E S K I N 65 may be able to realize at all times the quantity of current she is employing. The volt, ampere and ohm are the first three measure- ments in electricity. VOLTAGE Voltage, also called electro-motive-force or E. M. F., is one of the component parts of electrical energy. It is in reality the pressure at which electricity is used and repre- sents the "push power. ,, One volt is equivalent to the pres- sure from one Daniells cell. But although we may have a great amount of pressure and must know accurately what proportion we are using, it does not always follow that the quantity of electricity in use will be great, because we must also remember that the pressure is to be exerted against a resisting force. It follows, therefore, that the current avail- able for performing work will be only the excess over what is required to overcome resistance. OHM The ohm is the unit of resistance. Resistance may be well illustrated by this very simple example. Supposing a force of ten pounds were to be utilized for driving a steel pencil into first a block of stone, next a block of wood, and last of all a pat of butter. Naturally the steel would only by the exertion of tremendous force — or voltage — make an impression on the stone, because the resistance would be so great. On the wood the resistance being far less, the same pressure would produce a greater effect, while with the butter the steel would have no difficulty at all, as the resist- ance would be practically nothing. As electricity is constantly used upon bodies having 66 THE SKIN varying grades of resistance the ohm is therefore used as a unit of measurement, and technically one ohm is said to equal the resistance of a column of mercury 106 centimeters in length, having an area of cross-section of one square millimeter, at o degrees C, or 32 degrees F. AMPERAGE The ampere is the unit of current and represents the amount of electricity that can be pushed through a resist- ance of one ohm by one volt of pressure. The ampere would of course be too much current for use in the work of apply- ing the electric current therapeutically, so for convenience sake has been divided into 1,000 parts called milliamperes. The human skin offers a decidedly high resistance to the passage of electricity, representing with ordinary sponge discs from 5,000 to 14,000 ohms. A battery of say 20 dry cells would when fresh represent a voltage of thirty. This interposed against the average body resistance of 6,000 ohms, the quantity of current obtained could be found by dividing the number of volts by the number of ohms show- ing the body resistance and in this instance would therefore represent 1-200 of an ampere or about 5 milliamperes. MANNER OF MEASURING THE CURRENT As all bodies differ in respect to the amount of resist- ance they interpose, and as in the human body different parts vary owing to the texture of the skin, presence of fat, etc., it can easily be seen that the resistance plays an im- portant part in any operation in which electricity is used. Thus although one knows that the average cell when new can exert what is practically equivalent to one and a half volts of pressure, the amount of current used will naturally THE SKIN 67 depend upon the resistance interposed, and hence the neces- sity of knowing with some degree of accuracy how this current may be measured, for the voltage is only the Mclntosb Improved Milliamperemeter Carpenter-Deprez Type. Pocket Form propelling power, it is the current (amperage) that accom- plishes results. The instrument used for the purpose of measuring the current passing through the patient is called a milliamperemeter. By the use of this instrument, we can always tell just how much we are using, no matter what may be the resistance of the subject. It is therefore a very valuable and in fact a necessary part of every battery. MANNER OF CONTROLLING THE CURRENT It has been explained that resistance is a most important factor, and must always be considered in the amount of current used for any treatment. In many batteries of the newer type the direct or street current is used as a means of supply and as the voltage varies from 90 to 500, it is sometimes necessary to interpose a greater resistance than 68 THE SKIN that offered by the body and hence the use of the "rheo- stat." When the rheostat is to be connected with the direct lighting current a Vetter series attaching plug with 1 6 candle The MacLagan Wire Rheostat power lamp should be employed. The attaching cords leading from the Vetter plug should be tested for polarity by dipping them in a glass of water, the negative pole being indicated by a great profusion of fine hydrogen bubbles ; this cord should be attached to the binding post at back of rheostat marked "N," while the other cord should be attached to the binding post marked "P." After the connections are made and the current is turned on the rheostat regulates the current by means of a small arm which may be moved about until the meter registers the amount of current usually employed in the operation. This rheostat is also used in all large batteries and is extremely helpful in regulating the current. HOW TO SELECT A BATTERY After studying the subject of electricity the student THE SKIN 69 naturally desires to purchase a battery and immediately the question occurs, "what kind do I need?" Nine times out of ten, the matter has been decided not by considering the use to which the battery is to be placed, not by the fact that a good battery always costs more than a poor one, but simply by the question of price itself. The utter absurdity of such a course is apparent to anyone who realizes that as the electric current is now 7 used in practically every treatment of the scalp and face, it is imperative to procure a battery that will be capable of fur- nishing the different currents indicated for treatment of the conditions found. Of course, one must also take into consideration the manner in w 7 hich the operator is obliged to employ the cur- rent. For instance if residence work is to be cared for, a portable battery is a necessity, and hence the number of cells must be limited. If one is a long distance from supply stations or is living under climatic conditions that preclude the use of the dry cells, now so commonly employed, a wet cell battery must be purchased, w T hile on the other hand if the work can be done in an office under the most favor- able conditions and the city lighting current is direct, the wall-plate may be utilized. In any event, no matter what economy she may practice in other directions the operator who wishes to obtain posi- tively the best results, should without the slightest hesitation procure the very best outfit for her particular kind of work ; it is really upon the proper use of the electric current united with her other treatments, that she can base her fondest hopes for success. Ordinarily the average operator has purchased the faradic battery and has used it for every operation. The faradic current, the use of which will be explained later, is 70 THE SKIN excellent in many cases, but the operator who hopes to give all treatments successfully by means of it and thus to limit her use of the electric current, cannot hope to do good work. Mcintosh 14 Dry Cell E. & M. Battery Hence it will always be well to procure a battery that combines both currents, the galvanic and the faradic, and in this manner offers a much wider range for a variety of treatments. For a portable battery, combining both currents, noth- ing: better can be found than the form here illustrated. In THE SKIN 71 this there are twelve cells for the galvanic portion* and two for the faradic. It is so constructed that all the instruments in use may be packed closely into a section left for this pur- pose, while either portion may be repaired or changed with- out disturbing the other. A small switch circle makes the increase or decrease of active cells an easy matter. For a beginner this battery will be especially good, for while it is quite all that can be desired for the work of removing super- fluous hair, and minor facial blemishes, scalp stimulation, etc., it is also so simply constructed that the most diffident novice will be able to understand and use it successfully after carefully heeding the directions. The cost of recharging this battery is but trifling, and as with hard usage the cells last for six months, while with average use they will be good for at least eight, it can easily be seen that the battery will but seldom be out of working order, and at such times the delay will only be of a short duration, as the work of replacing the cells is simple indeed As all cells, either wet or dry, are practically of the same strength in the beginning, the same rules that have been given for the use of the other battery will apply in this, and as a rule four cells will be found all that will be necessary to use in the average treatment at first, although six and seven and even eight will usually have to be added gradually in the treatment of moles or warty growths, while ten and twelve may be used in giving the electrolytic massage. A more elaborate dry cell battery, furnished either with or without the rheostat and the milliamperemeter, is also illustrated. The manner of using is the same as with the smaller form and the results will be found most excellent. This battery is decidedly in favor in sections where the direct lighting current cannot be utilized, and yet where the 72 THE SKIN operator 'desired a heavier current for use in cataphoresis as well as for stimulation. THE MC INTOSH "SIMPLIFIED^ 2*] DRY CELL GALVANIC AND FARADIC BATTERY It is of similar construction to the Fourteen Dry Cell Combined Battery, and is fitted with twenty-seven dry cells, Mcintosh "Simplified" 27 Dry Cell Galvanic and Faradic Battery twenty-five being connected in the galvanic circuit and two utilized for the faradic coil. THE MC INTOSH ELABORATE 2"J DRY CELL GALVANIC AND FARADIC BATTERY In this battery the galvanic current is obtained from twenty-five dry cells connected in series, controlled by the MacLagan wire rheostat and measured by the Mcintosh THE SKIN 73 improved milliamperemeter, scale-reading O150, and ob- tained from the binding posts facing the meter. For office work, or where one uses a battery constantly, and can secure the direct dynamo current, a wall plate is most desirable. The great advantage in the use of this bat- tery lies in the fact that it is always ready for work, never Mcintosh "Elaborate" 27 Dry Cell Galvanic and Faradic Battery gets out of order, and provides a current that may be used every hour of the day with practically no deviation in strength. This battery also furnishes a current that may be used for any kind of treatment from the light work necessary in all treatment of facial blemishes to the heavier currents customary where disorders of the system have to be considered. Where one desires to use simply the gal- vanic current, the form of plate illustrated on page 74, embracing rheostat and milliamperemeter only, is practical. 74 THE SKIN The use of the milliamperemeter makes the work far more satisfactory in many ways, as by glancing at the meter one can at a glance see exactly how much current the patient is taking. The combined battery is really the ideal apparatus for the operator who likes to feel that she has at all times at her command, just the kind of current she desires to use on any case. There is very little expense connected with a battery of this kind, and it is so useful and so complete that one who is once accustomed to it will prefer it to anything else. Even in instances where the lighting current is not direct, it is possible to use a wall plate by securing a num- ber of dry cells and making the connection accordingly. This form of battery can also be piovided in a wall cabinet or in a case that will stand on the floor if one desires such THE SKIN 75 an arrangement. For all practical purposes, however, just the plate itself is all that is necessary. So many lighting currents are of the alternating variety that in order to use a wall plate it also becomes necessary to invest in the apparatus called the 4 'current rectifier/' This little arrangement transforms the current from alternating to direct, enabling one to do just the same work as would otherwise be done with the ordinary wall plate and the direct current. Rectifiers of some varieties have been rather un- pleasant, as the current from them has been unequal and stinging. With the new device called the "Potential Equalizer" this pulsation is removed, giving a steady and pleasing current. 76 THE SKIN The small wall plate illustrated is a recent device, that may be procured either with or without the case. It can be used on either current though, of course, on the alternating the Potential Equalizer must also be added, making the cost greater. Mcintosh Improved Alternating Current Rectifier with Potential Equalizer As will be noticed this wall plate has but one switch which is also a current selector, permitting one to use the Faradic or Galvanic, whichever is desired, with but one motion. This wail plate has the MacLagan Rheostat and an excellent milliamperemeter, thus giving one all the ad- THE SKIN 77 vantages of the old style plate and yet not possessing the disadvantages always afforded by a complicated number of switches. A wall plate may seem like more of a first investment than one wishes to consider, but after all it is the onlv really practical form of battery to use because it is always ready. There is no waiting for cells to be repaired, no bill every six months for new cells, but just a smooth working apparatus always ready and always a comfort. A Portable Wall Plate A new apparatus has recently been devised combining all the advantages of a Wall Plate with the convenience of a portable battery, which can be made use of ,in any part of the establishment. The strength of current being constant, 78 THE SKIN you are assured of more uniform results than with a battery. The voltage is perfectly controlled by the MacLagan Wire Rheostat and the current is measured by milliamperemeter, insuring accurate results. Instead of a lot of complicated switches as most Wall Plates and batteries have, it contains a Dial Current Selector, showing the names of the various currents engraved on a dial. Simply turn the knob to the current desired and it is ready for use. Instead of having a Wall Plate placed per- manently in one booth you can use this in any booth and thus double or triple its efficiency. It is the most convenient ar- rangement ever designed for outside work, as it can be used in any home having the lighting current, either direct or alternating, and in places where no current is found you can fall back on the six dry cells contained in the case. This apparatus works on the alternating current as well as on the direct. A small Rectifier consisting of jars which are almost hermetically sealed to prevent possibility of spilling liquid, is contained in the case. If you have direct current, you can get a perfectly graduated galvanic current as mild as you wish it or as strong as you desire; and a faradic current perfectly controlled. If you have alternating current, you can secure galvanic and faradic currents, as above, and you also have the additional value of the sinusoidal current, which many of the most advanced physicians are employing for massage purposes. The sinusoidal current resembles the faradic in its properties, as it is well adapted for facial and scalp massage, but is much more pleasing in character, as it does not have the harsh interruptions possessed by the fara- dic, but, as the name indicates, it is in the form of a sine wave or sinuous curve, to express it more simply. The voltage rises and falls gradually in a smooth curve instead THE SKIN 79 of rising and falling abruptly as it does with the faradic cur- rent. One feature of the sinusoidal current is that it makes absolutely no sound, hence nervous patients will ap- preciate it. If you have no electric current, there are six small dry cells in the case, giving ample strength for faradic current, also sufficient galvanic current for electrolysis. No electrician is needed to install this outfit, as you can simply screw the attachment plug in any lamp socket and follow the simple directions for testing which accompany the outfit and you will know instantly whether you have got direct current or alternating ; then just turn the Dial Selector to the proper point on dial and you get either galvanic, faradic or sinusoidal as desired. The sinusoidal current can only be obtained in connec- tion with the alternating current and can not be had with the direct current. When a fluid battery is found to be a necessity it may be obtained with cells varying from six to twenty- four, as desired. In the use of this form of battery, as in that of the dry cell, it will not be found practical to use anything smaller than the one in which there are twelve cells of the galvanic portion as well as suitable arrange- ment for the faradic section. Before attempting to charge and use a zinc-carbon bichromate fluid battery, the beginner will do well to heed the following directions. It is quite necessary to know how to make the fluid and fill the cell, as it is to make the proper connections and proceed with the work. Much difficulty may be avoided by sufficient care in mastering the prelimi- nary details. The battery fluid is made by means of the following directions : To make the battery fluid : Sulphuric acid, commercial, 80 THE SKIN 3 fluid ounces; powdered bichromate of soda, 3 ounces; water, 16 fluid ounces ; bisulphate of mercury, 2 drachms. Dissolve the bisulphate of mercury in the water; then^add the bichromate of soda. Slowly pour in the sulphuric acid and stir until the ingredients are dissolved, then allow the liquid to cool, as the mingling of the acid and water pro- duces heat, and if the mixture is used when warm it injures the battery. The bisulphate of mercury keeps the zincs well amal- gamated. CHAPTER VIII THE FARADIC CURRENT Although the Faradic Current is in very general use, not one person in a hundred who uses it, knows anything about the way it is produced or the manner in which it should be used to produce the best effect. In fact the average operator rarely mentions the effi- ciency of a battery, she is more interested in the subject of "cost," and limits her outfit to a certain sum regardless of w T hat the price she has decided upon may really procure. The faradic current is also called the "extra," the "induced" and the "interrupted" current, because of the manner in which it is produced. It was discovered in 1831 by Faraday who proved that a current passing through a wire, induced a current in another wire, near by and parallel to it though not con- nected in any way. The wire through which the galvanic current passes directly is called the primary wire, or coil, while the induced current or that passing through the second wire winding is called the secondary wire or coil. The usual definition of the difference between gal- vanism and faradism as given by an operator is the fol- lowing: "the galvanic current is quiet and can take out hair ; the faradic current buzzes and can be used in massage but not for removing hair and moles." There are, however, many really important differences that should be understood if good work is to be c 1 one. Perhaps the hardest thing to understand is why it ' 81 82 THE SKIN should take a large number of cells to produce a galvanic current that can barely be distinguished while with two cells a faradic current may be produced that is too strong to be endured with any degree of comfort. The reason for the increased force of the faradic cur- rent is found in the winding of the wires surrounding the bar of soft iron or magnetic core. A faradic current is always made by surrounding a soft iron core with a primary wire. This is then insulated, that is, covered by a non-conducting substance and a secondary wire is then wound about it. An automatic hammer is also used for interrupting the current from the battery cells. When the current is turned on it goes through the primary to the magnetic core. The iron core then becomes magne- tized and throws out lines of force permeating both the primary and secondary coils. The greater the number of windings in the coil, the more powerful it becomes, though the quantity of the current will be correspondingly lessened. The primary current, therefore, gives more current and less force, whereas the secondary current gives less current and more force. The excellence of the coil depends entirely upon the care with which it is made. A good fara- dic battery must have a good primary coil with enough wire to thoroughly magnetize the core and secondary wire much finer and longer while the interrupter should be so constructed as to vary the number of interruptions from a very few interruptions up to many thousand a minute. The applications of the faradic current are based upon the general assumption that the current is a general tonic in its nature, and is therefore highly stimulating. The interruption of this current produces muscular contraction, not only of the muscles, but also of the con- tractile fibre cells, thus the circulation is stimulated and with it the processes of waste and repair. THE SKIN 83 POLARITY The question of polarity is not of as great importance in the use of faradism as in galvanism. Some manufac- turers omit the letters indicated positive and negative and instead simply letter the windings P. and S., meaning primary and secondary. When polarity is indicated, the same directions that are used in galvanism may be followed in a general way. Of course, the faradic current cannot be used for the re- moval of superfluous hair or growths, but may be used for stimulation and to allay pain. When the portion to be treated is very sensitive, the negative electrode should be placed beneath the feet or in some indifferent portion of the body, while the positive is used over the affected portion, and down the spine using it for a longer period than usual over the portion from which nerves leading to the part affected are given off. Should there, on the other hand, be a desire to stimu- late greatly, the negative electrode is indicated as the active factor while the positive may be held in some indifferent portion. The primary coil has the greater effect on muscular contractions. The secondary coil is used for deeply seated troubles and for effect on the nervous system. Owing to the fineness of the winding of the secondary coil, it gives a much more pleasant effect and is therefore used in all scalp and facial work. General faradization is rarely given by the operator, although it should be understood. By this term is meant a treatment that affects the entire body. The patient's feet are placed on a flat block tin electrode, while the other 84 T H E S K I N electrode is brought slowly from the base of the brain down the spine, then over the chest and abdomen and down the thighs and legs, repeating the process some ten or fifteen times. The effects of this sort of treatment are really quite remarkable. Among other results, the following may be accomplished : EFFECTS PRODUCED BY GENERAL FARADIZATION The entire nervous system is soothed and pain is diminished. Insomnia is frequently cured. Oftentimes patients become so sleepy under treatment that they cannot keep their eyes open. The circulation is improved. Muscles develop in size and hardness. Brain and mental faculties are strengthened. Intense stimulation is followed by a sensation of rest- fulness. Nutrition is improved. A simple experiment showing the action of the faradic current may be easily performed by anyone who cares to make the effort. The arms should be bared, and the cur- rent turned on, the subject grasping both electrodes, one in each hand. As the force of the current is increased it will be observed that the muscles contract and the blood vessels become far more prominent, showing that the cir- culation is directly affected by the use of faradism. Rockwell cites some interesting experiments with far- adism which prove the tonic effects. He subjected a certain number out of a litter of pup- pies to the faradic current while an equal number were left untreated. At the end of four weeks the puppies were T H E S K I N 85 weighed, and not only was there a decided gain in weight on the part of those that had been subjected to this process, but in general appearance they were also more attractive and appeared far stronger. He also states that "the permanent effects of the use of electricity on the person of the operator are :" First, a marked and sometimes rapid growth of the muscles of the arm caused by the muscular contractions and increase of the local processes of waste and repair, etc. Second, a very gradual but decided tonic influence on the system. In the work of the dermatologist as the faradic cur- rent is so generally in use, it is quite possible that the tonic effect of the current when passed through the arms in this manner may also aid in making her work less arduous. In practical work the faradic current is generally employed by passing it through the fingers of the operator, thus conferring a double benefit in treatment, that the subject holds one electrode while the other — or wrist electrode — is fastened about the wrist of the operator and in this manner the current passed through the finger tips onto the face. It can also be used or applied by means of any of the metallic electrodes first covered with moistened cotton. It may be employed when considered advisable in connection with the electrolytic massage cup. It is very frequently used in the treatment of the scalp by means of the hair- brush electrode and is excellent for work in filling out the hollows in the cheek, neck or in the effort to develop the bust. In using this current it must always be remembered that the effects are almost purely mechanical, the primary current giving, it is true, some of the galvanic effect, but 86 THE SKIN to a very limited extent, while the secondary current gives still less. It is a very desirable aid in treatment and fills a de- cided want, but as its action is more or less limited it should preferably be used in combination with the gal- vanic current either after a treatment, before or else by means of a process combining the two. FARADIC CURRENT IN MASSAGE TREATMENTS In connection with massage treatments the faradic current is always employed while the manipulations are be- ing given. The patient holds the moistened cotton-covered carbon electrode in her hand, while the operator has the wrist electrode fastened to her own arm. The current thus passes through the fingers of the operator to the patient producing a decidedly stimulating and restful effect. The strength of the current must always be gauged by the sensations of the patient. Never allow it to become in the least painful and always inquire as to which strength of the current is most enjoyable. A current that is mild and enjoyable over the fatty portions of the cheek or at the back of the head, will be most unbearable about the mouth, over the forehead and around the eyes. When the patient has many filled teeth the use of this current even in a mild form sometimes produces a tooth- ache and cannot be used. If used at N all strong about the eyes and especially when the finger tips are engaged in manipulating the eye- brow, a sharp pain often shoots through the head alarm- ing the sensitive patient and spoiling much of the effect of the treatment. A little caution will soon remedy this. THE SKIN 87 The current is especially effective when used over the temple, at the side of the ears and in the back of the neck. It has a tonic effect on both patient and operator. In fact, many operators trace their increased health to the time when they commenced to use the electric cur- rent. Others never think of closing a day's work until they have given themselves a "general faradic" treatment by placing their bare feet on the metal foot electrode and using the hair-brush electrode for a scalp treatment, thus get- ting a local as well as a general benefit. The current may be used during the entire time the finger manipulations are being given without any danger of giving too much. It does not produce any feeling of dizziness and will not bring about any bad effects. THE FARADIC CURRENT IS NOT INDICATED IN SOME CASES When the face is very florid, the use of faradism will increase this appearance. In treatment of acne rosacea, or in short, in any treatment where there is a desire to decrease the blood supply, the faradic current may be omitted while the finger manipulations are being given. Occasionally in very sensitive subjects, the use of this current with finger manipulation will produce a very slight rash annoying to the patient. When this occurs, the use of the positive galvanic electrode afterwards will be all that is necessary to improve the appearance. THE FARADIC CURRENT IN SCALP TREATMENT As in facial massage the faradic current is used with very good results in connection with the finger manipula- 88 T H E S K I N tions. It is also employed in connection with the use of the hair-brush electrode. When used for manipulation the operator wears the wrist electrode and the patient holds the other. Oftentimes a current that is really painful on the face is not felt at all on the scalp. This is due to the fact that the hair is a bad conductor of electricity and hence the scalp must be well moistened and kept moist dur- ing the entire treatment. In this connection also the faradic current is usually employed in connection with some form of galvanic treat- ment. THE COMBINED CURRENT In this method the attachment is made by connecting the cord from the negative pole of the galvanic portion to the primary of the faradic. The two other cords are then used by inserting them one in the binding post marked pos- itive and the other in the one secondary of the faradic. The current may then be turned on as usual and be added or decreased by bringing into circuit more of the galvanic cells. This process is recommended by Rockwell as a method 4 'in order to secure the advantages of both currents and at the same time avoid the trouble and inconvenience of em- ploying them in succession or alternately. " In practical work it has been employed by the derma- tologist more for the purpose of stimulation, such as in the work of bringing new life to the hair and more vitality to the scalp, for use in the work of developing the arms and neck and bust and for filling out hollows. The use of the combined current is especially good where small portable batteries like the 14 Dry Cell are em- ployed. Often the 12 cells of the galvanic sections seem THE SKIN 89 to produce no appreciable effect in giving a general or a scalp treatment. By combining the currents a marked difference is im- mediately experienced. Tests for polarity should be made and the rules gov- erning the use of the galvanic current followed in giving the various treatments. ELECTRODES Although all or nearly all batteries are provided with the spongio disc electrodes, the operator should remove these coverings and substitute fresh moist cotton for each patient. If a massage roller is used, it should be of carbon and thus easily cleansed. The chamois covered metal roller is not at all sanitary and will not be employed by well informed operators. Carbon handle electrodes are also excellent substitutes for the ordinary disc and can easily be kept clean. CHAPTER IX THE GALVANIC CURRENT i This current is also called the constant or continuous. It has a chemical action on the tissues and is used in every process of electrolysis such as in the removal of super- fluous hair, warts, moles, and naevi, and also in cataphore- sis — or forcing substances into the deeper tissues by means of the constant current. Owing to the fact that this current is noiseless, it is often difficult for the novice to realize that the battery is in good condition and of full strength. A current that cannot be detected by the sensation of touches by placing one finger on the carbon and the other on the zinc electrode, will yet at the same time produce force enough to ring an ordinary door bell. On the skin the galvanic current has a marked effect. Applied mildly, it will stimulate absorption and is much used to remove growths, while when a stronger form of current is used the flesh may be cauterized and tissues destroyed. If the skin is to be bleached the ordinary faradic cur- rent will have no effect, while the proper lotion applied by means of the galvanic current will produce a marked re- sult in one or two treatments. In the treatment of acne the faradic current could only stimulate. Insert a needle from the galvanic current into the pustule and immediately the content becomes liquefied, the portion may be cleansed and the stimulation conse- quently will promote a speedy return to a healthy condition. 90 THE SKIN 91 For many of the ordinary operations in electrolysis a small portable battery is employed. The smallest one that is of practical use in all treatments is that known as the 14 dry cell battery in which 12 cells are devoted to the galvanic section and 2 to the faradic portion. If the operator will remember that the voltage or push power of one dry cell when fresh is about 1 and */£, she will see that the galvanic section yields a voltage of about 18. The 27 cell battery gives about 39 volts, while from the wall plate, we get no volts, quite enough current for any kind of work. This plainly shows that while portable batteries are very excellent for some parts of the work, they are not so w r ell adapted to do the work where a heavier current is required. Much of the terror inspired by the term electrolysis would be removed if everyone could realize how very easy it is to manufacture a battery that will do fairly good work. All that is necessary can be easily procured in any town for one only needs some dry cells, conducting wire, a pair of pliers and the ordinary conducting cords. MAKING A GALVANIC BATTERY A single cell, it has been explained, is a simple battery. More than one cell is a compound battery and for all treatments a larger number of cells or a compound battery is indicated. A number of cells will then be procured, say six or eight, the unlike elements connected by means of the small wires as shown in cut. The pliers will then be used to fasten the wire on each and to the conducting cords. The usual tests for polarity may be made and, behold, one has a battery ready to perform any ordinary work in electrolysis. If the reaction does not appear, either the connec- 92 THE SKIN tions have not been properly made or there has been a mistake in connecting like elements. A little practice and this will be found child's play. HOW TO DETECT THE GALVANIC CURRENT If only a few cells have been used it will be difficult to detect the current by the sense of touch, but at any rate the experiment may be tried. Moisten the cotton covering the electrode thoroughly with a salt water solution and place in .the palm of the hand. Place another electrode similarly covered between the thumb and first finger of the same hand. With the average number of cells a slight pricking sensation will be felt. Another test is to place the tips of both cords in water, when bubbles will appear about the one pole. Still another test is to hold one electrode in the hand and place the tip of the other on the tongue. This will have to be very gently tried as otherwise a burn might result. POLARITY In the application of galvanic electricity, polarity is most important. In fact, upon a knowledge of the action of the current as applied from the positive or from the negative poles depends the entire success of any treatment. T H E S K I N 93 The electric current always flows from the higher to a lower level. The higher portion is known as the amode or positive pole, while the lower part is known as the neg- ative pole or the cathode. In the simplest form of bat- tery — a single cell — it will be noticed that the current flows in the direction indicated from the zinc to the carbon, and as it is a positive current all the time outside of the cell the carbon is spoken of as the positive and the zinc as the negative. The two poles are entirely unlike in their action upon the tissues, but before learning about the various proper- ties one must learn how to determine polarity. HOW TO DETECT POLARITY 1st — Immerse both tips of conducting cords in salt water solution, being careful to see they do not touch each other. Immediately bubbles of hydrogen gas will appear indicating the negative current. 2nd — Wet a piece of blue litmus paper and put the tips of both cords on it. The paper under positive portion will turn red and that under negative will become more intensely blue. 3rd — Insert needles into pieces of fresh beef. The negative needle will slip in and out easily, while the positive will become embedded and all about it the flesh will become black. This takes place in living tissue when a mistake is made and the needle attached to the wrong pole is used. Having learned how to determine the polarity of the current, the next important lesson is that of learning just when and how each pole may best be used. For this reason it will be necessary to study carefully the pages devoted to this subject, as if one pole is indicated 94 THE SKIN and the other by some mistake is used, harm will result rather than good. PROPERTIES OF POSITIVE GALVANISM Releases oxygen, although this process is not observed by the naked eye. Hardens the tissue, hence is excellent in flabby condi- tions and in treatment of large pores. Decreases local heat, consequently can be used over an inflamed surface with good results. Produces a clot, and so is often used to stop bleeding. Has a drying influence. Produces a hard, unyielding scar. Repels soluble salts, consequently solutions of this kind are always applied by means of positive pole and thus "repelled" or sent toward the negative for which they have an affinity. Lessens nerve irritability. For this reason the use of positive electricity often soothes neuralgic pains and stops the toothache. Decreases vascularity, producing a blanched appear- ance very desirable in treatment of red noses. May be used in all acute conditions for reducing in- flammation, decreasing pain and producing a sedative effect excellent after use of needle. Decomposes all metals excepting gold, platinum and aluminum. Hence, the advisability of utilizing the carbon electrode for purposes of treatment. Is never used in removal of superfluous hair. Is occasionally used by means of solid gold or plati- num needle on surface of large growths when "bi-polar" methods are employed. THE SKIN 95 PROPERTIES OF NEGATIVE GALVANISM The negative current releases hydrogen gas, as seen when it is immersed in a salt solution, for bubbles of the gas immediately form about it. Softens the tissue, hence is indicated in all preliminary cleansing methods, also in removal of growths. Increases local heat. Quickens circulation and increases the excitability. Increases vascularity and so is excellent in treatment of anaemic conditions. It has a moistening influence. Aggravates inflammation and hence should never be used over a tender surface unless one wishes to produce intense stimulation as in some chronic cases. Increases irritability of nerves and so should not be used in neuralgic conditions. Useful in increasing local heat. Encourages hemorrhage. Is always used as the active pole in removal of super- fluous hair, warts, moles, and naevi, also in treatment of pimples. Attracts all soluble salts. Does not decompose any metals with the exception of aluminum. Dissolves or disintegrates and liquefies, hence always indicated in every process of electrolysis. The active pole is the name given to the electrode that is placed directly over the portion to be treated. For instance, in the removal of superfluous hair, the active pole would be the needle, while the indifferent pole would be the electrode held in the hand or placed on some portion of the body. 96 T H E S K I N So in treatment when the negative pole is indicated, the electrode attached to that portion is always used as the active pole, and of course, when the positive current is indicated the negative is the indifferent pole and the active electrode is that attached to the positive. PRACTICAL APPLICATION OF RULES GOVERNING NEGATIVE AND POSITIVE GALVANISM With a full understanding of the result one wishes to produce and a knowledge of the properties of both positive and negative galvanism the proper treatment will follow as a matter of course. Does any portion of the body need an increased blood supply? Negative electricity is at once indicated. Should the patient complain of pain as in some instances after the use of the negative current, immediately the positive current may be used and a sedative effect will be produced. In treatment of acne, an already inflamed condition may be seen, but again negative electricity is used because it aids in dissolving the contents of the papules and pustules and in improving nutrition. So, too, in acne rosacea, the negative needle would be used for opening and emptying the capillaries and in all cases the positive electrode employed afterward to aid in blanching the parts and decreasing the irritation. A puffy, inflamed surface might easily be rendered worse by negative galvanism, while the positive current would produce splendid a results. So instances might be multiplied indefinitely, but in every case these same questions arise : "What does the con- dition demand?" The answer can easily be given if the rules governing the current have been learned. CHAPTER X USE OF ELECTRIC NEEDLE IN REMOVAL OF SUPERFLUOUS HAIR AND TATTOOING THE EYEBROWS Removing superfluous hair is neither difficult nor dan- gerous. The process need not be painful, and the results will be uniformly good providing the operator has been well instructed, knows just how long and strong a treat- ment may be safely given, understands how to treat the face after the needle has been used, and is blessed with an ordinary supply of common sense. The causes of this affliction are never apparent and the only really plausible or satisfactory explanation that can be given is that it is a freak of nature. In some instances the tendency to such a growth is certainly hereditary. In others, the face may be absolutely free from any sign of such a growth until all of a sudden a luxuriant growth appears, as though by magic. Some of the victims are found in excel- lent health, others are invalids. Some are married, others are maiden ladies of uncertain age. Some have used mas- sage and ointments for protecting and beautifying the skin, others have never even thought of employing any aid toward beauty and only apply for relief from the growth of hair because they feel it to be a mark of masculinity. In many instances this growth is only found as middle life is approached, and in some cases after the age of fifty, even without the aid of the electric needle, it has disap- peared. In several cases that came under my observation, in which the growth was truly disheartening and was more of the nature of a beard, improvement in general condition 97 98 THE SKIN and a trifling operation seemed to be factors in causing it to disappear. Fox says : "The idea that sea-bathing or the persistent use of vaseline on the face will cause an abnormal growth of hair, is too fantastic for serious discussion. No proof of the assertion is ever shown, and how such an erroneous idea originated, is difficult to imagine." In any event the only practical remedy is the removal of this growth by means of electrolysis. Although much has been written about the various methods, in reality there is only one way of performing this process and that is simplicity itself. It consists in introducing into the hair follicle just enough electricity to dissolve the follicle, destroy the papilla and thus deprive the hair of a home. Deprived of a lodg- ing place and with the path from the papilla to the surface of the skin permanently obliterated, there is absolutely no chance for a new grow T th. Hence if the operator has a steady hand, a sure eye, a good battery and the necessary needles, forceps and other parts of the equipment, she can be perfectly sure of success. Whether the patient is taught to hold her fingers in water, grasp the electrode before or after the needle is inserted or do a dozen and one of the other things men- tioned by different authorities as being necessary, makes no difference at all with the principle of the process. The needle connected to the negative galvanic current must be introduced into the hair follicle, the circuit must be com- pleted by the patient holding the positive current and the process of electrolysis, or dissolving the follicle, must take place before the hair can be successfully removed. That the student's mind may be perfectly clear in regard to the subject, it may be well here to explain the THE SKIN 99 difference between the single, or ordinary method of elec- trolysis and the much advertised multiple needle method. SINGLE NEEDLE ELECTROLYSIS This form of electrolysis is in most general use. One needle at a time is used in the manner just described. The great majority of good operators consider this method the safest, least painful and best, and in addition declare there is less danger of producing scars. MULTIPLE NEEDLE ELECTROLYSIS In this method, there are anywhere from six to ten needles suspended from a sort of crown above the patient's head. The idea being that each needle is to be inserted into a follicle in rotation and that by the time the tenth needle is inserted, the first needle with the hair will be ready to be removed. The objections to this method are many and among them may be given the following : First — The difficulty in limiting the amount of current used. Second — The fact that the average patient objects to one needle and can hardly be persuaded to like the idea of having ten used. Third — The danger from scars. I have seen more scars from this method than from any other. . Fourth — The fact that by this method no allowance is made for the removal of obstinate hairs requiring more current. If a stiff bristly hair were encountered, all the other needles would be used longer than necessary while this hair received the extra attention. It must of course be conceded that some good oper- ators do use this method, but unless some radical changes 100 THE SKIN are evolved, it will never become popular with the greater number of operators. At any rate, if one understands the principle of single needle electrolysis, the multiple method will be found very simple. THE PRINCIPLE OF ELECTROLYSIS As mentioned before, the principle of electrolysis as applied to the removal of superfluous hair is extremely simple. It consists merely in dissolving the hair follicle and its tissue composing the hair papilla by the introduc- tion of the negative galvanic current into the hair follicle, while the subject holds the positive current. The only difficult matter is the removal of the growth with as little destruction of the surrounding tissue as possible. It is for this reason that a knowledge of the proper use of the galvanic current is necessary. Any one can learn how to use the needle for the removal of superfluous hair, but it takes judgment to know just how much current to use in the various conditions encountered. EQUIPMENT First of all, of course, comes the battery. This may be of any kind so that it gives a constant current and it is in good condition. Then one must have the handles, bulbous needles, depilatory forceps for grasping the hair, needle holder, magnifying glass or glasses that may be worn and for very sensitive cases a cataphoresis outfit. Aside from the regular equipment mentioned Fox says : "Good eyesight and a steady hand are as strictly essential as they are in rifle shooting. But many a man thus en- dowed can never acquire the art of repeatedly hitting the THE SKIN 101 bull's eye, and many physicians I have found have failed to acquire the peculiar knack of introducing the needle into the follicle without pricking the skin. Some simply jab it into the skin as near the follicle as possible and thereby give rise to the erroneous impression that the operation is a very painful one and apt to leave scars. " STERILIZATION Although some authors are of the impression that the electric current has the same effect that an antiseptic might have, in reality this is a very erroneous impression. Needles must be sterilized carefully before using. For this purpose a formalin solution will be found excellent. The skin may be cleansed first with a dilute solution of formalin and then with alcohol. Then if any moisture remains, a little antiseptic powder may be dusted on, for instance, a boracic acid powder will be excellent. THE SELECTION OF THE NEEDLE The selection of a needle is an important item in this operation, and the point should always be examined with a strong glass that we may be able to ascertain its shape. An Fig. A. End of Bulbous Needle, Much Magnified ordinary jewelers' broach will do if the point be ground off on an oil stone and its temper drawn by heating, but the bulbous pointed needle, as recommended by the late Dr. P. S. Hayes, a magnified drawing of which is here shown in Figure A, is best suited for the w r ork. There are several very important reasons why a sharp-pointed needle should 102 THE SKIN not be used : First, there is a depression in the epidermis at the base of every hair, very plainly shown in Figure B. The bulbous-pointed needle will always find this depression, while the sharp-pointed needle is just as liable to miss it, and not get into the hair follicle at all. Again, the hair follicles are not al- ways the same depth or the same direction, but the sheath surrounding the hair is tough ; in fact, it takes considerable pressure to force the bulbous-pointed needle through, and it naturally will find the proper depth, while, >Q as Dr. Hayes remarks, "the sharp needle rt^P would in many cases, penetrate the walls of the follicle and wander into the tissue far from the desired point, and failure rather than success would be recorded." Many hairs are removed with sharp-pointed needles, Figure B an( j manv writers advocate their use, but suc- cess is purely accidental. Figure B shows a magnified hair shaft and follicle into which a sharp-pointed needle has been plunged and has not entered the depression at the free surface of the skin, but which has accidentally pene- trated the sheath from without and gained access to the papilla. Of course, such hair will be permanently destroyed. By referring again to Figure B, it will be noticed that the sheath is narrowest at the top or at the point of insertion of the hair shaft into the epidermis, which shows the neces- sity of actually following the hair shaft with the needle in order to be sure of entering the follicle. Again, the bulbous needle presents a larger surface within the hair follicle, thus causing the destructive effect to be more pronounced beneath the surface of the skin, a very apparent benefit. Removal of Superfluous Hair. f'.. rator is Wearing with liinocuiar Magnif. i 104 THE SKIN METHOD OF PROCEDURE The patient should be seated in a comfortable position or possibly, better still, should assume a nearly reclining position in such a manner that the direct light will fall upQn the portion to be operated upon. The battery may then be brought into play and after the current is turned on to say four cells as a beginning, the patient may be instructed to hold the well moistened electrode, and the bulbous needle attached to negative pole should then be passed gently down the side of the hair into the follicle. As shown in the cut on the skin there is a slight construction at the mouth of the follicle, so many times this little impediment to the passage of the needle will occur. Ordinarily, however, the use of the needle causes the entrance to be effected very easily, and in fact it is by the sense of touch as well as by evidence of the eyes that the expert operator knows she is doing good work. In Fig. B the needle is shown after it has entered the follicle, resting by the side of the hair. The object in using a needle attached to the electric cur- rent is to destroy the tissue composing the hair papillae. Naturally, a small portion of the surrounding tissue must be affected by the current, and the proolem confronting the operator is how to remove the hair growth with as little destruction of tissue as possible. It has been found by experiment that the negative current is by far the best for this purpose, and hence it is always employed, as the effect on the tissue is not only less severe, but the danger of scarring is not nearly so great. In order to destroy the hair, it is necessary to enter the follicle with a bulbous or pointed needle, the majority of the operators preferring the bulbous variety. The depth of the follicle varies greatly, in some instances being not THE SKIN 105 more than one-thirty-second of an inch, while in others it is fully one-quarter of an inch. In finding the follicle it will be necessary to insert the needle as closely as possible by the side of the hair. The difference in the sensation of touch when the right path has been entered is usually sufficient proof of success. At any rate, when everything is in readiness the needle is inserted as directed, and is continued until it meets a slight obstacle. There it must pause, while the patient grasps the positive electrode in her hand, thus completing the circuit. If the follicle has been entered, in about twenty seconds bubbles of hydrogen gas will commence to appear about the site of entrance and in about fifty or sixty seconds the hair may be grasped by the epilation forceps and a gentle traction exerted. If the process of destruction is complete the hair will come out easily. If not, the current should be continued for about a minute and then the same effort made. If at this last attempt the hair does not con- sent to come, it will be well to remove it forcibly and then use the needle for still another insertion. This procedure will only be found necessary in a few cases as the expert operator is nearly always able to enter the follicle and thus dislodge the hair. MANNER OF COMPLETING THE CIRCUIT It will be noticed that I recommend giving the patient the electrode to hold before the circuit is completed by the introduction of the needle into the follicle. I do this because practice has convinced me that it is the wisest way. Whenever the patient is informed that she can govern the current by letting the electrode go, she invariably com- mences to experiment, changing from a heavy grasp to a 106 THE SKIN light one, thus often making it necessary for the operator to use more current and causing a number of minor dis- turbances that perplex a novice. Many patients persistently loosen their grasp and thus interfere with the work and others become hysterical unless consulted each time before the hair is withdrawn. Hence the most practical manner is to have the electrode either held in the hand from the very commencement of the treat- ment or else placed on some indifferent portion before the treatment is commenced. STRENGTH OF CURRENT The best work is always done with a low current. When a battery is fresh, two dry cells will often be all that is required. In fact, it is better to begin with that number, increasing if necessary until four or five may be brought into use, and in extreme cases, even eight cells. Always remember, the lower the current, the less the tissue destruction and the less pain. It is better to use a low current a long time, than a high current a short time. If the wall plate is used, one-half a milliampere will be all that is required at first, adding more current gradually as indicated. As a general thing, the use of the street current from a wall plate is far more painful to the patient, owing to the much higher voltage. HOW TO SECURE CONFIDENCE Before attempting to work on the face, the operator should attempt in some manner to remove one or two coarse hairs from an arm or a leg. After one successful attempt, there comes a peculiar sensation difficult of descrip- tion that imparts a positive degree of certainty as to future results. MR •. A The Use of the Positive Electrode After Electrolysis for the Purpose of Reducing Inflammation. 108 THE SKIN EXCEPTIONS TO THE RULE Occasionally, very stiff bristles will be found to require a very much stronger current to remove. In such cases, of course, more cells will be brought into action. Sometimes, even though the hair follicle has been entered and the current properly used, the bubble of hydro- gen gas appears but the hair is not dislodged. This is caused by a twisting back of the hair. In other words it is a freak hair and will need to be removed forcibly by the forceps and the follicle entered afterward by the needle in order to destroy the papilla. At times the insertion of the needle causes blood to appear. Ordinarily, this is because the skin has been punctured by the needle. A little peroxide should be ap- plied and if the bleeding persists, the positive ball electrode used over the spot for a moment. No more hair should be taken out in the same portion during this treatment, but instead work may be done in another section. In rare instances the introduction of the needle is extremely painful and is followed by considerable puffiness. When it is absolutely impossible to use the needle, cata- phoresis may be tried and a solution of cocaine and adre- nalin forced into the skin as described in the treatment of moles. This is a process not to be recommended for general use, however. Very rarely before a treatment is finished, and this usually follows after a small blood vessel has been entered, the skin will become covered with tiny black and blue marks. Immediately the Negative Ball Electrode should be used over the portion affected and the blue light with acne cream afterward. Following this the positive elec- T H E S K I N 109 trode may be applied. In a day or so the marks will disappear. AFTER TREATMENT Immediately after the use of the needle for the removal of superfluous hair some acne cream should be applied and forced into the tissue with the blue light. After a few moments the superfluous cream may be removed by a bit of soft cotton, then the carbon electrode wrapped in moist- ened cotton should be rotated gently over the entire portion (not dragged or scraped, but gently rolled) for about ten or fifteen minutes. Then powder may be dusted on and the patient allowed to depart. She must be instructed, however, not to use any soap or water on portion treated, but instead use a cleansing cream and the ointment indicated, until there is no sensation of discomfort. The reason for the use of the positive electrode can easily be seen ; as by its acid reaction it simply counteracts the alkalinity of the negative current and thus acts as a sedative. On the other hand, compresses of hot water and various other lotions only act as irritants to the surface. DO THE HAIRS RETURN ? If the hair has been properly removed it is impossible for a return to occur, because the follicle has been destroyed. There may be other hair coming in near that same place or perhaps the hair will seem to have a tendency to multiply, but in no case has it been proved that the use of the electric current encouraged such a tendency. Women troubled with these growths are always much more sensitive and consult their mirrors so frequently and so closely after treatments, that they can see many discouraging symptoms 110 T H E S K I N not perceptible to the operator. In any instance, however, the proportion of returns can never be called higher than four per cent when a skillful operator has been employed. Oftentimes the new hairs coming in are a result of the patient's previous efforts to dislodge them some weeks or days before by means of the forceps. LENGTH OF TREATMENT As a rule no treatment should be continued for longer than half an hour, both for the sake of the patient and also because a longer sitting is hard on the eyes of the operator. The use of the glasses illustrated in picture showing removal of hair will sometimes make this work easier by so magnifying the opening into the hair follicle that there is less eye strain. From sixty to ninety hairs may be removed in an hour unless they are extremely obstinate. RULES FOR THE OPERATOR ist — Always bear in mind it is easier to use a weak current for a long time than a strong current for a short time. Always commence with the weaker current, gradually bringing more cells into circuit. 2nd — When the hair is obstinate it is never wise to continue the current for more than a minute or a minute and a quarter unless it is very stiff and bristly. 3rd — In very exceptional cases, if the hair refuses to be dislodged and the needle has been used for some time, it is wise to remove the hair forcibly and immediately enter the follicle with the needle once more. This should be a marked exception, however. Many German authorities now use this method with all obstinate hair, claiming that in this manner both papilla and follicle are surely destroyed. THE SKIN 111 4th — Avoid too many insertions near the same place. By using discretion and working in different sections, work may be continued twice as long as when confined to one portion. 5th — Not only give a thorough treatment after the removal of the hair but be sure to caution the patient against the use of soap and water, rubbing the skin with a harsh towel or any undue irritation. In addition to the removal of hair from the chin, one is sometimes called upon to remove it from the inside of the nose, or the ears. Occasionally some man wants the mustache line made smaller or his forehead made higher, and all of these operations come under the work of removing superfluous hair. Occasionally when the subject is very sensitive, the use of a cataphoresis may be necessary but unless it is impera- tive one should not suggest it as the use of cocaine should at all times be discountenanced rather than encouraged. Another frequent request is the use of the electric needle for tattooing the eyebrows. THE PROPER USE OF A DEPILATORY When, for various reasons, it is impossible to use the electric needle for the removal of hair, it becomes neces- sary to select a depilatory that will accomplish the result. Whether used on the face or arms the procedure is exactly the same. The powdered form seems to be the most effective. It should be kept in a bottle, tightly corked, and only enough poured out for the application. To use it, mix the depilatory powder into a thick paste with water and spread thickly over the part to be treated. From a minute and a half to three minutes will be required 112 THE SKIN to remove the growth, which can then be scraped off with the paste. It will be noticed that the hair is not dissolved, showing that the action of the paste has been to loosen the hair in the follicle. Immediately after scraping off the paste spread over the parts treated a thick coat of acne cream. Allow it to remain for a few moments until any symptoms of burning have subsided, then remove and apply a little talcum powder. When the paste is used on very thin-skinned people, they sometimes complain of a burning sensation almost as soon as it has been applied. In such cases, remove the paste at once, apply the acne cream until the burning has ceased, then rub off some of the acne and again try the paste in the same spot, allowing it to remain until the hairs come too. The average length of time necessary to remove hair is from a minute and a half to two minutes. At no time should the paste be allowed to remain on longer than three minutes and a half. Always use a watch and note the time in order to avoid difficulty. Never use a depilatory on an eczematous skin if you can avoid it, as occasionally an irritation follows. Invariably caution the patient to avoid using soap and water on portions treated until a day or so have elapsed. By following these directions all average hairy growths should be removed without the slightest difficulty. TATTOOING AND THE ELECTRIC NEEDLE FOR IMPROVING THE APPEARANCE The eyebrows may add greatly to the personal appear- ance when pleasing in outline, shading and extent. The THE SKIN 113 eyebrows are seldom so perfect in their natural state that the featural surgeon who is skillful, cannot improve them by his art. No matter how carefully the brows may be trained and cared for, a few stray hairs may be removed to advantage in many cases, while in other instances the shad- ing of the brow may be augmented or modified by judicious tattooing. Many individuals have a distinct connection of the brows in the median line. The connection hairs may be removed to advantage. In other cases, we have stray hairs projecting directly upward at the inner angle of the brow, and no amount of combing or brushing will cause the hairs to lie smoothly so that they can be sacrificed to advantage. Above the brows, stray hairs may be seen in other indi- viduals and their removal will add to the appearance. TATTOOING Tattooing the brows is accomplished with ease and as the results desired are usually intended to be distinct no great degree of care is needed in this work. The tattooing for darkening the brows is performed after the brows have been thoroughly scrubbed and the skin mopped with alco- hol. The hairs are parted and the skin pricked with a sharp needle. The pricking should not extend far enough into the skin to cause bleeding. The tattooing may be at least a single portion of the brow or the entire base of the brow may be sacrificed with the needle before the pigment is rubbed in. A special instrument may be secured for tattooing. This instrument works very rapidly and the pigment is driven into the skin as the punctures are made. 114 THE SKIN THE SCARRED BROW A scar involving the brow may show very plainly as the result of contrast and tattooing cleverly performed may secure a tinting of the scar identical to that of the brqw. Proper tinting of a scar coupled with the removal of all distorted hair may render a scar noticeable. CHAPTER XI REMOVAL OF MOLES, PORT-WINE MARKS, WARTS AND WENS Pigmented elevations of the skin called moles are among the most frequent cosmetic difficulties. Frequently these growths are most disfiguring, and yet the person so afflicted will hesitate at any attempt to remove them, fear- ing that "a cancer might come/' if any such effort should be made. For the comfort of the patient and ease of mind to the operated it may be stated, that at the present day, prac- tically all of the best authorities are united in declaring that the danger does not come from removing these growths but from allowing them to remain. Any mole, wart, or growth of this description is in reality nothing but a combination of misplaced cells. Irri- tation may at any time cause these cells to grow and in turn press upon healthy tissue, thus producing an inflamma- tion. Hence the most practical as well as the only sensible method is to remove every growth of this kind as quickly as possible. Do not wait until it has grown to a certain size but get after every tiny speck and thus prevent larger growths. The danger of scars is regulated by the strength of the current used, and the length of the treatment. The oper- ator who wishes to get through in a hurry and who there- fore uses a strong current for a long time will often need to give one treatment but will almost inevitably destroy normal tissue and leave a scar. 116 THE SKIN 117 On the other hand, a low current, used frequently, will so gradually destroy the portion affected, that in time not a trace of the former site of the growth can be seen. I have removed twenty-eight moles from one side of a Growth in Neck Removed by Electricity in Fifteen Treatments young woman's face without leaving a single scar. Some of these moles were flat and had to be tattooed, others were large and vascular. I probably gave thirty treatments and extended the period over several months, but the results certainly warranted it. 118 THE SKIN In another instance, I removed a growth fully an inch and a half in length and a half inch in width covered with a fine downy hair in twelve treatments leaving but a slight line to mark the place. Of course, all the hairs were removed first and then the edges of the growth treated. In another instance an old lady presented herself for treatment w T ith a large mole right on the tip of her nose. It was well supplied with blood vessels and I tried two or three treatments with a single needle with but poor results. Finally I tried the bi-polar method — that is, placing the negative needle through the base of the growth and just touching the top with the positive gold needle and in two more treatments the growth had disappeared, leaving no trace but just a faint pink mark, which in time disap- peared. In the case here shown, in which the growth is on the young lady's neck, as illustrated, the work was excep- tionally difficult. This growth had been removed several times by a surgeon and in every instance had returned. Every time the needle was inserted blood would flow pro- fusely and it took several treatments to destroy this blood supply. Work was done round the edge of the growths and finally the entire portion dried up and disappeared. USING THE CURRENT FOR DESTRUCTION OF MOLES While one must be careful, as suggested before, not to use too strong a current, on the other hand, it is equally important that one sufficiently strong to do the work shall be employed. Nothing lower than four cells from an ordinary battery should be used while from the wall-plate at least one-half of one milliampere must be given. The use of this current must be continued until growth has become decidedly blanched, and the edges of the growth THE SKIN 119 should be treated first. Some operators feel that if they place a needle in the center they are doing all that is neces- sary. In reality the growth should be considered as the rim of a wheel and the needle should be inserted as though it were one of the spokes, running it as near the normal flesh as possible straight through from one edge to the other, forming by the two insertions subdivisions like a quarter of a circle and then using more if it seems necessary. The positive electrode should be held in the hand, while the negative in the shape of the needle is pushed through the growth in the manner indicated. In order to decrease the pain the flesh surrounding the portion should be held firmly between the thumb and forefinger of the operator, thus aiding in diminishing the blood supply to that section. The treatment may last from three to five or six minutes, according to the size of the growth and the amount of reaction. While all treatments are given much the same, as there are many varieties of these growths, the description of the treatment necessary for each case will be given in the section devoted to an explanation of the meaning of the terms employed. PAINLESS OPERATORS When a patient is extremely nervous and in fact does not seem at all inclined to tolerate the use of the electric needle, a solution of cocaine and adrenalin may be forced into the tissues first, making the operation absolutely painless. The process takes at least ten minutes and it must be remembered that with this anaesthesia comes the temptation 120 THE SKIN to use the current longer than necessary. So due caution should be observed. A full explanation of how to use cataphoresis for any condition will be found in the chapter devoted to that subject. BI-POLAR METHOD When the growth is exceptionally large, or extremely vascular (supplied with much blood) the two needles may be employed at the same time. The negative needle is used right through the growth as near the normal skin as possible. The positive needle, which must always be of solid gold or platinum to avoid leaving a mark, should just touch the upper surface. Care must be taken not to allow the positive and negative needle to touch in the growth, as in this case not only would the process be extremely painful to the patient but also the battery would become short circuited. VARIETIES OF NAEVI AND TREATMENT Moles are also called "soft naevi'' and present in addi- tion to varieties of cell formation, excess of pigment, excess of blood supply and many times a profusion of hair. These growths differ also greatly in size, some are flat, others round, some long and many are composed of papillary structures. In order that the student may rec- ognize the most common varieties and be able to use the names properly should the occasion arise, I have selected the moles most generally found and have not only given the medical name but also the manner of treatment. Naevus Araneus appears as a bright red spot, sometimes tiny red branches are also evident, at others only close examination will reveal them. This variety is com- T H E S K I N 121 monly known as "spider cancer/' Treatment consists in pressing the surrounding flesh between thumb and fore- finger and inserting needle in the portion where blood sup- ply seems most plentiful, allowing it to remain for two or three moments. A slight amount of blood may be lost, but this is advisable. Usually the treatment of the cen- tral portion will also destroy branches. If it does not, each portion may be treated separately after the center has been destroyed. After the use of the needle the positive gal- vanic current may be employed by means of ball electrode covered with cotton that has been moistened in a boracic acid solution. This will reduce inflammation and decrease tendency to redness. All spots of this kind should be destroyed as soon as they appear, as otherwise they become gradually larger and more disfiguring. Naevus Pilosus is the name given to a mole covered with hair. In these instances the hairs must be removed first by the usual method of using the electric needle. Many times the removal of the hair is sufficient to destroy the growth. If not other treatments may be given. The patient should be instructed to be careful not to wash portion treated and should apply acne cream each night. Naevus Linearis is the name given to warty looking or pigmented growths appearing in a systematic shape or line. The usual treatment may be given with the electric needle and the process of destruction may be assisted by forcing tincture of methine into the portion by means of the positive electrode after the negative needle has been used. Methine ointment may also be used at home. Naevus Lipomatodes is the growth that looks like a small, white tumor. The usual treatment with the nega- tive needle will be all that is required here, being careful 122 THE SKIN to encircle the base completely. These growths are also commonly called wens and appear on heads. Naevus Telangiectodes or "vascular over-growth" is the form so commonly seen in which the skin is either stained a red or purplish hue or else a network of small blood vessels is seen distorting the appearance of the nose and cheeks and imparting a coarse, repulsive appear- ance. Many times these telangiectodes surround the naevus araneus. When not too extensive they may be removed by inserting the negative needle into the central blood supply of each group. This is found by pressing flesh between thumb and forefinger when immediately a tiny red protuberance is seen. Following this treatment the positive current with methine tincture should be applied. Often- times cases apparently hopeless have been cured by this method, though the treatments have extended over a long period of time. This condition is always found in, and in reality is a part of acne rosacea. Naevus Vascularis or port wine marks are some- times so deeply seated that no treatment can be of benefit. When the stain is merely a surface matter, tattooing the portion with the disc needle will be of great assistance. The use of methine and positive electrode afterward is also indicated. Methine, it must be remembered, has a certain decided influence on dissolving growths and yet it does not affect the normal skin. It also assists in decreasing blood supply to a spot and is not an irritant so it may be used with perfect confidence. Naevus Verrucosus is a warty looking growth differ- ing from the regulation warts only in that the growth is not hard. Following the use of the negative needle the methine may be used and methine ointment applied at home each night. THE SKIN 123 Verrucae Vulgaris is the title given to warts. Not- withstanding the many household remedies given for the destruction of these pests, they often persist and so the electric needle must be used. When the growth is very hard and horny, it should be softened by placing a bit of cotton moistened with salt and water over it for a few moments before the needle is used. Then the current may be applied using a stronger amount than usual and methine applied afterward. The patient may use methine ointment at home too. When the warts are about the finger tips and under the nails, where it is impossible to reach them with the needle, the outer part may be treated as described, then a little methine tincture poured into a tiny glass dish and the tip to the positive electrode placed in the tincture and fingers immersed. The negative current may be applied on top of the hand and treatment continued with as strong a cur- rent as possible for five or ten minutes. Many times obsti- nate cases are cured in one or two of these treatments. Wens, known as Naevus lipomatodes, are removed as described when located on the face. When found on the head, where the use of the electric needle is attended by some danger of infection, they may be treated by the spark from prismatic ray or they may have the tincture of methine forced in by positive electrode and methine ointment may be used daily until they have disappeared. DANGER OF INFECTION Naturally as a preliminary process, the flesh about the portion to be cleansed with the dilute formalin solution or alcohol, the needles sterilized and the operator's hands carefully cleansed and washed in an antiseptic solution. When these precautions have been taken there is 124 THE SKIN rarely if ever any infection, unless the mole is situated somewhere near the collar or where it may be rubbed and thus inflammation caused. It is for this reason that it is always well to recommend that the little shields like those used after vaccination, be placed over such portions. The patient should also be w r arned not to touch the portion in any effort to cleanse it but instead to use bits of cotton. Accidentally scratching with the finger nails, or removing the crust may easily cause a slight infection so by evading these possibilities this danger is averted. When, however, in spite of any effort such a catas- trophe does occur it is usually easily remedied by just lifting off the top portion and cleansing the interior with peroxide, then placing a wet dressing of boracic acid over the part and changing it twice a day until the inflammation has entirely disappeared. The needle should not be used at any time while the growth is inflamed or until the redness has entirely dis- appeared. CHAPTER XII CATAPHORESIS AS USED IN INSTANTANEOUS BLEACHING, ALLEVIATING PAIN AND IN PRODUCING LOCAL ANESTHESIA This name is given to the process by which the gal- vanic current is used for the purpose of driving a medicine into and through the tissues. In some instances and by a few authorities the gen- eral process is known by the term "phoresis." When the positive electrode is employed, it is called the "anophoresis," and when the negative is used it is called cataphoresis. As this method is somewhat confusing to the student, we shall throughout refer to the process as cataphoresis no matter which electrode is employed. It will be remembered that under the list of properties of the negative pole, it was mentioned that this current gave an alkaline reaction. The positive current, on the contrary, gave an acid reaction. All alkaline solutions, therefore, have an affinity or a tendency to travel toward the negative electrode, while all acid solutions prefer traveling toward the positive. In cataphoresis, when one wishes to force a liquid into the tissues, if it is an alkaline substance, it is applied with the positive electrode and thus repelled or sent toward the negative. If it is an acid, it is applied by the negative and thus repelled or sent toward the positive. In the following examples we will have some practical illustra- tions of the use of this property: 125 126 THE SKIN FORCING INTO THE TISSUES AN ANAESTHETIC Many times even for such trifling operations as the removal of superfluous hair or the treating of a mole or opening of a pustule, it will be found that the patient is so sensitive something will be necessary to relieve the pain. Owing to the danger of infection, no one cares to administer cocaine by means of the hypodermic needle and to place this solution upon the skin alone will have absolutely no effect, unless it can be used on the mucous membrane. It may, however, be successfully forced into the tissues by means of the positive electrode and thus the portion treated without any sensation whatever. The best mixture for this purpose is made by adding to cocaine, adrenalin chloride. This should always be done directlv before it is used, as otherwise the combination will become useless. A GOOD LOCAL ANAESTHETIC 10 per cent Cocaine 9 drams 1-1000 Adrenalin 1 dram Or, as this makes a rather large amount, one may keep the 10 per cent cocaine solution on hand and to every nine drops, add one drop of adrenalin until the desired amount is obtained. In applying this mixture a special electrode is neces- sary and I have found for this purpose nothing so good as one made of a non-corrosive material, such as block tin or carbon, in which the insulated edge comes directly in contact with the skin. The active surface of the electrode may be covered with the cotton saturated with the mixture and some considerable pressure used, while from 15 to 30 ma. of current is passed through the portion treated. THE SKIN 127 About 15 minutes will be sufficient to show a white line of demarkation, showing the zone affected. When the center of the spot is also white, the operation may com- mence. The longer the current is used the more profound Cataphoresis Electrodes with Block Tin Surface Insulated with Hard Rubber the anaesthesia and the greater the length of time it persists. The cotton should remain in contact with the skin from both sides and top. Although this process is an easy one, the drugs used' are expensive and it is not to be recommended as a general thing. It must be remembered too that the cotton needs to be well saturated with the medicine used, and that the other electrode should be placed near the portion treated in order to make the reaction more pronounced, as for instance in work on the face, the positive electrode may be applied to the spot and the negative in the shape of a large flat electrode placed at the back of the neck or between the shoulder blades. 128 THE SKIN BLEACHING THE SKIN As an addition to the regular bleaching process noth- ing can be better than that method of forcing the bleaching lotion into the deeper tissues of the skin by means of the negative electrode. The current should be used as strong as it can be borne and all affected portions treated until the flesh is thoroughly reddened. Obstinate chloasma (moth-patch), discolored streaks from wearing stiff collars and a generally dark appearance may be remedied in this manner. In this connection, it must also be remembered that all oil should first be removed by the use of soda so that the lotion may be forced in easily. This method rarely makes the skin red or irritated and forms a very valuable part of the instantaneous bleaching process. RELIEF OF NEURALGIC PAIN Fifteen or twenty drops of tincture of aconite placed on an electrode already covered with moist cotton and applied by the positive electrode directly over nerve affected will give relief from neuralgia lasting sometimes for five or six hours. USING METHINE In several sections of this book references have been made to a substance called methine. It is much used in both the ointment and the tincture. „ For reducing the redness in acne rosacea, decreasing the blood supply, dissolving watery growths, aiding in caus- ing moles to disappear, soothing inflammatory conditions in acne, nothing has ever been found to equal it. This tincture is always applied by means of the positive elec- T H E S K I N 129 trode and is used for at least ten or fifteen minutes, every day when possible, or three or four times a week, until the condition is remedied. It has no effect on healthy tissues so may be used liberally for it causes no irritation. Unfortunately, however, it does leave a green stain which may best be removed by applying the lettuce cream and allowing it to remain for a few moments and then removing with a bit of gauze saturated in alcohol. Soap and water have no effect upon this stain, so the operator will do well to remember the necessity for using the cream as mentioned. Many other processes might be mentioned, but as the operator is dealing only with ordinary troubles of the skin the list would but prove an additional "something to learn.'* The process of cataphoresis is sure to give satisfaction if it is properly done, and by this is meant, if there is enough of the mediicne used and if the current by which it is applied is used long enough, and strong enough to force it into the tissues. I have heard a number of operators declare they could not get any results with cataphoresis, only to find that they have been endeavoring to use a small dry^cell battery for this purpose. Naturally under such conditions one can not get results. Unless your battery gives from 20 to 30 ma. of cur- rents, you will need to use a current for a much longer time to produce any appreciable result. In using cataphoresis, remember also that the electrode is to be kept as firmly pressed on the skin as possible, for it is necessary to maintain the contact in order to force in the solution. 130 THE SKIN INSTANTANEOUS BLEACHING This process will positively bleach any skin from two to five shades without irritation if care is used in giving the treatment. It is especially good for removing the yellow streak about the neck, and the suspicious traces of yellow on the cheeks. In fact, any skin is brightened and made clear by this treatment. For very tender skins, such as one finds with blonde or red hair, the bleaching lotion should be reduced with witch hazel, the mask left on a shorter time. Tissue food mixed with the whitening cream for massage. If a burning sensation is complained of, the use of tissue food entirely for the massage. Occasionally the day following a bleach, there will be a slight red eruption, but this soon vanishes, leaving the skin clearer than before. Ordinarily there is no difficulty and the results speak for themselves. DIRECTIONS Cleanse with lettuce cream. Remove all traces of oil with soda solution. Apply bleaching lotion with negative galvanic current, for from twelve to fourteen minutes, using full strength of fourteen cells for the process, though of course employing a stronger current from the wall plate, when this is possible. In bleaching, roll the electrode gently but firmly from one section to the other, being careful not to drag, scrape, or use a jerky motion. After completing the use of the lotion, apply tissue food to lips, eyebrows, and eyelashes. T H E S K I N 131 Make a paste by adding lotion to the refining powder until it is thin enough to spread. Cover face, neck and ears with paste. Dry with red light. Remove with tepid water. Apply whitening cream and use red light, giving manipulation without the current. If the skin is very dry use tissue food instead of whitening. Remove the cream by using lavender lotion. Close with positive current and the saline solution. Apply powder. CAUTIONS Do not bleach skins already irritated, or where you find cases of open pustules or eczema. In cases of acne, where it is necessary to bleach the skin, mix one-third of peroxide to two-thirds of witch hazel, and add to the refining powder for making the mask. If the skin seems a little sensitive, use tissue food for massage, otherwise use the whitening cream and go through regular motions without using electricity. Use lavender lotion for removing all traces of the cream and close the pores by the use of the positive galvanic electrode covered with cotton that has been saturated with salt solu- tion. For moth patches or very brown skins, the patient should be instructed to use the whitening cream every night, the bleaching lotion during the day, and the powder always before venturing into the air. The bleaching treatment may be taken two or three times a week. These treatments are especially good for removing a coat of tan accumulated during the summer and can be used with extremely fine results for the bleach- ing of the arms and neck. 132 THE SKIN Always be careful to recommend the lettuce cream for cleansing for a day or two following this treatment, as otherwise the patient may cause an irritated condition by the use of soap and water. In bleaching arms and shoulders, the paste may be left on for fully three-quarters of an hour with excellent effect and the whitening cream spread on liberally after- ward and forced in with the red light. The carbon elec- trode need not be used excepting in extreme cases, as the paste will be usually quite sufficient to do the work. CHAPTER XIII PREPARATION OF FACE FOR MASSAGE USE OF ELECTROLYTIC CUP Massage should never be given unless the skin has first been carefully prepared by applying a cleansing cream that will remove all surface dirt and fatty acids. The ordinary skin food will not do for this purpose, as it simply adds to the accumulation and does not take away from it. The mere application of a cleansing cream and instant removal does not accomplish the desired result. It should be applied and allowed to remain at least five minutes before being removed, carefully including the neck and ears in this treatment in order that all of the exposed surface may appear uniform. When, as in most cases, the electrolytic massage cup is used before the manipulation, the cream may be applied and allowed to remain on the face, while the solution for the tank is being prepared. Then it. must be removed care- fully, leaving just the smallest amount, in fact scarcely a hint of oil, as otherwise the cup could not be used suc- cessfully, but instead would glide over the surface. Too much emphasis can hardly be placed on this one small item. The tendency seems to be so universal, to apply more of an ointment or cream than is really necessary to do the work. As a consequence, whenever an operator has difficulty in the use of the cup, this matter of applying too much cream seems to be the stumbling block in nearly every case. 133 0) r— *■ c/> 3 o CD 0> 3 3 «x 134 T H E S K I N As a means of thorough cleansing nothing can be better than the electrolytic cup. However, even with this excel- lent article there will be found conditions in which it is wiser to adopt some other method and hence the operator must remember the following indications against its use : ist — When the skin is dry and scaly. The use of water in any form simply increases the scaliness and the negative current will have a tendency to irritate, so after using the cleansing cream the cup may be omitted, massage given and after that more cream forced in by means of the red light. 2nd — In some instances one finds an extremely sensi- tive skin. Frequently these people have a very high color and it will be noticed that the surface capillaries are very prominent. Water irritates and in a few cases even the use of finger manipulation is not advisable, so instead one can only cleanse the skin, apply a little cream and perhaps use a little positive electricity. 3rd — In eczematous cases water nearly invariably pro- duces a decidedly unpleasant effect, often bringing about a second eruption. Hence it should always be avoided. Aside from the conditions mentioned the electrolytic cup will be found not only a valuable but an excellent pre- liminary to all massage treatments. It is easily used, is extremely popular and remarkably beneficial. This cup is made of a hard composition, the only metal being the inlet and outlet tubes. Attached to the inlet tube is a small metallic arm into whkh the tip of the conducting cord fits. This cord is attached to the battery. The other cord is attached to an electrode given to the patient and is held during the treatment. The solution in the supply tank flows through the rubber tube into the metallic inlet tube, where THE SKIN 135 it becomes charged with electricity, then against the face of the patient and out from the other tube into the receptacle placed on the floor. Emily Lloyd's Electrolytic Cup As a result of this treatment, the skin is only lifted gently (not stretched) from its old grooves and at the same time cleansed and stimulated in a most remarkable manner. This process is so extremely beneficial in enliven- ing the skin, that even where there is a tendency to irritate and become scaly, an occasional treatment will be found beneficial, while in all other conditions it is invariably productive of the desired results. In all of the treatments the negative galvanic current is employed unless there is a strong indication against its use. It has a tendency to soften and dissolve and hence is especially good for preliminary work. 3 a CD 0) 3 3 136 I HE SKIN When used from a battery of cells, from six to eight cells may be brought into circuit at first, gradually increas- ing these as indicated. With a wall plate, about rive milliamperes may be used, adding or reducing as the occasion demands. The only indication against the use of the negative current is found in neuralgic cases in which this current acts as an irritant or in some instances where there are a great many rilled teeth. SOLUTIONS USED WITH ELECTROLYTIC CUP For ordinary skins, a salt solution is added to the water. This has an invigorating and also a slightly bleach- ing effect. For oily skins, a soda solution is useful as it cuts th^ oil, assists in removing the fatty acids and makes tlie-^lan more receptive. This solution is excellent before the re- moval of comedones. For irritated skins and especially in cases of acne where there is an obstinate trouble, a boracic acid solution is sometimes used with very warm water. For flabby skins the alum solution is excellent, though this is usually employed only in the cold water for closing the treatment. These solutions are kept in saturated form in large bottles and a half cup of the solution added to the water in the supply tank. Before attempting to use the cup on any one, the operator should practice on herself. She will soon find that it is extremely easy to maintain the suction and avoid spilling the water if she will observe these points : ist — See that there is a little water in the bucket to cover the end of the outlet tube, so that no air can be THE SKIN 137 sucked into the tube and thus push the cup away from the face. 2nd — Let the water run through the tube into the pail for a moment in order to find out if there is any obstruc- tion in the upper part of the tube. If there is, remove ii by the use of a long wire. Again test it to see if the obstruction is removed, and then if the water runs freely the treatment may be commenced. USE OF THE ELECTROLYTIC CUP As mentioned before, the cleansing cream may be left on the skin while the solutions are being prepared for the irrigating tank. The water must always be as warm as it can be borne with comfort. To avoid having it too warm, it should be tested by trying with the back of the hand. When the tank is filled and all is in readiness, the cleansing cream may be removed by a bit of soft cotton. The patient may then be given the electrode attached to the positive pole, while the negative cord is fastened to the arm from the inlet tube. From six to eight cells of the small battery may be used or from two to five milliam- peres of the large batter\'. adding or reducing the current according to the sensation experienced. Of course before applying the cup to the face, it will be plunged first in a formalin solution, and then in alco- hol or witch hazel in order that the skin may not be irritated. A very good idea after treatment is to cleanse the cup carefully and then leave a pledget of cotton in it that has first been dipped in the formalin solution. After cleansing the cup, it may be applied to the fleshy portion of the cheek, the shut off opened, and as soon as suction has been established, it may be gently guided about the face, following in general, the same rules for massage. 138 T H E S K I N Great care should be taken to prevent the conducting cord and rubber tubing from touching the face. The out- let tube should always be pointed downward. With these precautions and a well established suction, but little diffi- culty should be encountered. The fingers should not be used to press the cup into the skin but merely as guides to assist in moving over the surface. Over the forehead, a little water may be spilled at first but a little practice soon makes perfect. In any event the operator should practice on herself day after day until she becomes sure of the way to use the cup. Nothing is more detrimental to business, more exas- perating to the patient or more harmful to the reputation of the operator than to have the cup give a shower bath instead of a facial treatment. Practice will positively prevent this, so when water is spilled it is inevitably a sign of a person who would not give to this subject the time and attention it deserves. The effect of the galvanic current taken in this man- ner is extremely exhilarating. Many tired women are so refreshed that they sleep right through it and awaken feel- ing marvelously rested. Some one has called the electrolytic treatment a "men- tal shower bath," and it really seems to deserve that title, because in addition to improving the skin it certainly rests and then stimulates the brain. In giving these treatments, it is well to fill the tank with water, thus giving two quarts of the solution at one treatment. In extremely obstinate conditions of the skin, some operators fill the tank twice. The galvanic current is indicated because of the spe- cial effect it has on the tissues, but the faradic current may be used instead when one has the request. The effect, how- T H E S K I N 139 ever, will be entirely different and not at all the same results obtained. In a very few instances, owing to the presence of a number of filled teeth, the use of the electric current in any form produces a toothache. In such cases, the cup may be used with the solution indicated but omitting the use of current. Warm water is always used for the preliminary work. Following the massage treatment, the tank may be filled with cold water and the positive current used for the pur- pose of closing the pores and making the skin firm. In all of these instances, the alum solution will be found an excel- lent aid. Many operators use only the warm water for the first treatment, utilize the positive current by rolling the car- bon electrode over the face. This may answer in everything but a very flabby skin. In these cases, the beneficial re- sults of prolonged applications of cold water with the alum solution can hardly be over-estimated and too much atten- tion can hardly be paid to the neck and chin under these conditions, for it is in these portions that this tendency is apt to be most marked. Following the use of the electrolytic cup, the finger manipulations will always be given, and if the cup has been properly used with water at the right temperature and the solution indicated the beneficial effects of the treatment will be markedly increased. " : ' i • 1 .# J3J bo = o CHAPTER XIV FACIAL MASSAGE Although there are many methods of facial massage, differing in manner of administration from the most vigor- ous to a very light form, in reality, there are very few operators who give what might be called a really beneficial treatment. Properly administered massage has to do with the muscles. The old expression, "the muscles are best fed when exercising," explains why a treatment should be deep enough to affect them. Merely skimming over a surface that has been thickly coated with cream is not massage. It may be called a superficial rubbing but that is all. Manipulation so deep that it discolors the flesh and makes the muscles sore is even worse, because instead of building up it breaks down the tissue by producing a per- manent soreness and develops sagging and flabbiness thereby. The happy medium must therefore be sought, and by that is meant the massage that is given with an under- standing of the muscular development as well as of the blood and nerve supply. This form of massage means a thorough treatment, not a skimming over the surface nor a punching process, but a method in which the skin is moved beneath the fingers, the muscles lifted, the blood supply stimulated, and the nerves soothed. True, a cream must be used, because otherwise the fric- tion caused by the contact of the fingers with the skin 141 A , THE SKIN 143 would produce an irritation, but there should never be more than just enough cream to allow the fingers to move slowly over the face. Too much makes it impossible to more than slide over the surface. Only a small amount of cream can be absorbed and hence the operator should use due care not to be so lavish in her application that she defeats the real purpose of her work. Persons with fleshy faces need, of course, more vig- orous treatment. Kneading the tissues is here quite neces- sary and deeper pressure must be used, being careful always to work against the blood supply. When the faces are thinner, lighter work is indicated, followed by a generous application of cream and a prolonged use of the red light. Extremely sensitive skins sometimes become irritated under even the lightest treatment but these are exceptions to the rule. In general, massage may be said to be a benefit to every skin excepting where on finding an exceptionally irritated condition. MASSAGE PRODUCES THESE RESULTS 1st — An increase in blood and lymph supply. 2nd — An improvement in the functions of the skin. 3rd — A change for the better in color and texture of the skin. 4th — An increase in nutrition through blood attracted to the surface from internal parts. 5th — Effete matter is destroyed. 6th — Nerves are either stimulated or soothed, depend- ing on treatment. THE SKIN 145 7th— Wrinkles are eradicated, especially the superficial line, while even the deeper ones are less pronounced. 8th — Muscles are developed and tissues made firmer. 9th — A youthful expression is imparted to the face by obliterating the habit and worry lines. In addition to the effect produced by the manipulation much more good is accomplished by selecting the cream appropriate for each condition. Tissue food should always be used when the skin is dry, scaly or poorly nourished and also when it is inclined to slight irritation. Acne cream is indicated in oily and large pored skins and in all cases of blackheads and pimples. Whitening cream is used when the skin is sallow or covered with patches or where one desires to bleach it a few shades lighter. Just enough of the cream should be applied to make the work of manipulation easy. The balls of the fingers should be used for all but the stroking work, and in every event the finger nails should not be long enough to interfere with the use of the fingers. The masseuse who gives the best treatment will be the one who keeps her hands soft and pliable. For this reason it is well for her to avoid any work that will tend to roughen them. After applying the cream, the operator should select a definite plan of treatment. Whether she begins at the chin or the forehead is not so material as that she goes right through the work without slighting any portion of the face. Ordinarily it is well to begin at the forehead, and follow these directions, and always moving the skin beneath the fingers. .a O a o O a bo a "So a & THE SKIN 147 HOW TO GIVE THE MASSAGE MOVEMENTS Begin at left temple of forehead, using the first two fingers of each hand in a straight up and down movement, back and forth from temple to temple, and using a slight pressure over each temple at the finish of the fifth time. Go over forehead again the same number of times, this time with a circular movement, with skin kept firmly be- tween the fingers of the one hand while the first two fingers of the other hand are engaged in the circular movement. Lines between the eyes or right over the bridge of the nose should also be treated at this time by gently hold- ing the flesh between the thumb and first finger of one hand while the other two first fingers are used for rotating over the surface. About the eyes, a circular movement is given. The flesh is held firmly between the thumb and the first finger of the one hand while the other two fingers are used for gently moving the flesh from the outer portion of the eye toward the nose, there the fingers separate and one is placed over the other just beneath the eyebrow and they are moved back to the edge, when again the circular movement is given. This should be repeated with each eye five times. The nose is treated according to the type. If the nos- trils are dilated, manipulate from forehead to nostrils and always working against blood supply. With a very thin nose, the nostrils may be rubbed up- ward, though manipulation from forehead must be straight down and against blood supply at each side of the nose. Nose to mouth lines are treated by resting the thumb at each side of the nose, then using the first and second fingers of each hand to gently lift flesh from the corners of the mouth up toward the side of the nose. The thumbs r > - - "Jfe .' ' ■ i i - 43 H a o +-> o be P o - -t-> 02 THE SKIN 149 must remain stationary and manipulation must always be upward. When lines are very deep, one finger covered with cot- ton may be placed inside the mouth and the other manipu- lated over the most conspicuous portions. The mouth is massaged by placing the forefinger directly in the center below the nose and then drawing the other fingers from the corners of the mouth toward the center, repeating a similar process with the lower lip, by holding finger stationary in center and drawing fingers from each corner. The chin should be treated by a sort of wringing move- ment, using first one hand and then the other. Cheeks should be treated by deep stroking motion, drawing the first forefingers of each hand from chin, cor- ners of mouth and side of nose out and upward, always ending w T ith a slight pressure above the masseter muscle. In this treatment always be careful not to rub in new lines. With very thin, flabby skins it is sometimes necessary to keep the thumbs stationary just above the ear and then use a gentle stroking movement. When the cheeks are thin and hollow a plucking move- ment should also be used in the center of each cheek. The neck should always be treated with a downward movement, afterward bringing the fingers about at the side toward the back of the neck and using a lifting move- ment first on the sternomastoid directly at the side of each ear. This may be repeated several times. Next the same downward motion from the chin and around to the trapezius with slight pressure and a lifting movement. This should be repeated at least three times. Finally the same movement should be given, using the a o o > Q z fcfl THE SKIN 151 pressure not only on the trapezius but continuing it up to the occipitalis. When the chin is very flabby, the downward stroking movements should be given with the flat of the hand and gentle pressure. When there is a hard, firm double chin, then the knead- ing movement may be given, using the thumb and fore- finger for the purpose of reducing the fat cells. The ear should not be neglected but should be given a gentle, stroking treatment in front, beneath and at the back. In addition to the lifting movement given at the back of the head, an excellent addition will be found a few down- ward strokes on the spine itself. The massage treatment is usually finished by a very gentle stroking upward on the '.heeks over the eyes and across the forehead called "rest movements. " AFTER THE MASSAGE Following the manipulation comes the work of remov- ing every trace of the cream from the face. This is best accomplished by using the lavender lotion for all parts of the skin, not forgetting the ears or the nostrils. About the hair alcohol can be used. Especial care must be taken to remove every trace from the eyebrows and beneath the eyes too, as otherwise a greasy appearance is sure to be noted. When every trace has been removed, the treatment may either be finished by the use of the electrolytic massage with cold water and the alum solution or the positive elec- trode may be used by rolling it slowly over the face, first of course wrapping it in cotton that has been saturated in one of the following solutions : u +-> fa o THE SKIN 153 Antiseptic lotion will be used for very oily or very dark skins (this is for closing the pores only), for bleaching it always use the negative pole. Alum solution is always used for flabby skins or for very large pores. Plain cold water for very sensitive skins or those easily irritated. Should the patient complain that her face burns a bit, she must assure her that this is the result of a stimulat- ing treatment, advise her not to use soap and water for the next few days, and especially emphasize the use of cream indicated by condition of skin and powder as a pro- tection. Then the head-band should be carefully removed to avoid disarranging the hair, the waist buttoned, pins put in place, and any necessary help with the wraps tendered as a matter of course. In short, in every instance the patient should be treated as one's guest and should be made as comfortable as possible. If she happens to be disagreeable, the operator should not follow a bad example, but set her a good one, by being more than courteous, always remembering that it is the little things that count. She should consider too that if even a "crank" goes away from her shop looking better than when she came in, she w T ill be a living and strong, though possibly unconscious, advertisement for the work. LAVENDER LOTION This lotion is excellent for removing all trace of oil, is most agreeable to use, and is easily prepared, but in securing the oil of lavender always get the oil of the flower, as it is much more agreeable. .£3 H sa .2 » o l-H P THE SKIN 155 It is made as follows : i dram aromatic spirits of ammonia. 30 drops of oil of sweet lavender flowers. 1 quart distilled water. 2 teaspoonsful bicarbonate soda. Add the oil to the ammonia and pour into the water. Shake well and then last add the bicarbonate of soda. CHAPTER XV I THE PROPER USE OF COSMETICS Just as attention to the smallest detail denotes the expert in any line, so, too, in this work of caring for the skin, the art of using cosmetics must be thoroughly under- stood if the greatest success is to be reached. No one dreams of appearing on the street with a ragged hem at the bottom of the skirt, or a soiled shirtwaist, or a gown that needs pressing — why then not show an equal amount of common sense about the face, hair, and hands, and appear at least well-groomed on all occasions. If through ill health, late hours or hard work, the roses have departed from the cheek, and the skin looks drawn and worn, surely it is better to allow a knowledge of these matters to so supplement Nature that one can always be sure of appearing well. Treatments properly given, certainly rest and refresh the patient. But, how about preparing the face for the street, after the treatment ? If you stop and say to the patient — "Shall I use powder and rouge?" — nine times out of ten the answer will be the same, for she will remark emphatically, "Certainly not r For that reason then do not consult her, but prepare to make her look as attractive and as natural as possible, remembering all the time you are demonstrating the use not the abuse of cosmetics. Directly after the face has been finished by the use of 157 158 THE SKIN the last lotion, the work of making it more attractive begins. Every particle of oil should be removed before using any powder, unless the skin is very rough, in that case if you use dry powder, a little Tissue Food should be rubbed in first. But in any event, if the complexion is a bit sallow, or perhaps colorless, rouge should be applied first. However, before proceeding to the description of how to use these various aids to the toilet, in order to impress on you that even the scientific men have many of them agreed that good cosmetics are harmless, just read this clipping from one of the New York papers : "The use of face creams and makeups is universal and the moral aspect of the question is becoming settled. Our women now fearlessly and scientifically handle the com- plexion brush, the face cream and the powder puff. Why is the face of a country woman of 60 years faded and wrinkled, while the face of a city woman of the same age frequently is smooth and beautiful? On account of protection against the elements. The city woman has been using her cream and powder for forty years, and has yet to experience any deleterious effects. "The idea that the faces of actresses are old looking off the stage is pure superstition. Many an actress courted of our fathers has a complexion the envy of our daughters. These are things the physicians should know and not be afraid to say." Now, with these recommendations to spur you on, go at your work, remembering always, that in order to appre- ciate what cosmetics can do for others, they will also do for you. Little difficulties can be explained, ways of doing things made clear far easier if you know from practical every THE SKIN 159 day experience just what can be done, and if you show by your own appearance that you "practice what you preach." SELECTING A ROUGE There are three kinds to choose from — the liquid, paste and dry. The liquid comes in two shades — light and dark, and has the convenience of sticking on until cream is used to remove it. Ordinarily water does not affect it. It is best applied in this manner : Take a piece of gauze and moisten it with some toilet water. Then hold it against the rouge bottle, and reverse the bottle so that a large drop of rouge is deposited on one side of the gauze. Quickly rub this portion against the other to spread the color and then apply to the cheeks quickly, going over the surface with the finger tips to spread the color evenly. For a very blonde woman the lightest shade is of course selected. Brunettes look best when the darkest color is used. After applying sufficient color to the cheeks, the paste rouge is used for tinting the lobes of the ears and the lips. Just a suspicion of color is sometimes given to the eye- lids also. For the lips, the color is applied on a bit of gauze and is used on the inside first, then the outer edge is con- sidered and the "Cupid's Bow" accentuated. If on the contrary a paste rouge is preferred for the cheeks also, it is applied very easily by using the tips of the fingers and rubbing it in well. The dry rouge is applied after the powder, not before. None of these preparations are in any way harmful. They may be used every day, and even several times a day if necessity compels. 160 T H E S K I N APPLYING THE POWDER With the face nicely tinted, next comes the choice of a powder. Here again we have several things to consider. If dry powder is to be used, the tint nearest the skin must be selected. For the woman of ordinary coloring, cream or flesh will be best, the brunette shade being used only on darker complexions. Weird shades, such as mauve or green or deep ochre, are neither practical nor becoming, and are rarely employed except by extremists. In employing the powder, never rub it on the skin. Instead use the bits of gauze to pat it all over the surface of the face and neck liberally. Then with the flat portion of the hands go over the surface and gently rub it in, apply- ing more if the skin needs it. In this manner, the skin is actually protected from the bad effects of sun and wind, and powder will be found of undoubted and excellent benefit. For evening use, the liquid powder has for years been popular, as it can be employed on both neck and arms to excellent advantage. A recent innovation in powders though has made a new form very popular, for it seems to combine utility with real cosmetic value. This powder comes in cake form in small porcelain receptacles, but it lacks the feeling of powder, for to the sense of touch it seems more like a cream. Absolutely harmless, it has a number of remarkable qualities. When properly applied, it defies detection, does not rub off on the clothing and is not affected by perspira- tion or cold water, but must be removed by the use of a cleansing cream. THE SKIN 161 It is applied by rubbing a piece of gauze or a sponge that has first been moistened with a toilet water, over the surface of the cake, and then over the face, neck or hands. The tips of the fingers are then used swiftly over the sur- face to blend the powder, before dry. In a few moments the surface is uniformly covered, and yet there is no trace of powder, nor is there any arti- ficial appearance. For the neck and hands this powder is a positive boon. Over the inflamed surfaces such as in acne cases it is excellent. Before going on an outing expedition it cannot be excelled. However, in using it one must guard against having any trace of oil on the skin before applying it, as otherwise it will positively not adhere, for oil is the one agent that removes it. With this choice of powders no woman should be at sea as to what she may use. FINISHING THE TREATMENT Caring for the Eyelashes, Eyebrozvs and Hair After the powder has been applied comes the task of removing all traces from the eyelashes by means of a small brush darkened with the water cosmetique. A very good way to do this is to have a bit of gauze placed on the cheek directly under the eyes and then request the patient to close her eyes. When she does so, the brush can be used on the lashes against the gauze, thus removing the powder and darkening the eyelashes at the same time. The eyebrows should then be outlined, taking care to shape them in a fine line, not a broad effect. 162 THE SKIN Next the hair line about the face should be visited with the brush, taking away all signs of the powder, and often at the same time covering up any unwelcome hints of age as shown in the first white hairs. The water cosmetique, by the way, has often done much in that line, for it takes but a moment to apply and does conceal the white or discolored hair. THE LAST TOUCH With the face and neck made presentable, and the head-band removed, 'tis well to glance at the upper part of the forehead to see that no space has been left untreated. Then, just to add to the comfort of the patron, spray some toilet water over her chest, and if you have followed directions you will have succeeded in pleasing five of the seven senses. Your patient will see that she looks better, and this will make her feel happy. Her fingers will touch skin that is pliable and attractive. She will hear your words of advice, smell the delicate flower odors and un- doubtedly will speak of your good work. CHAPTER XVI WRINKLES, THEIR CAUSE AND TREATMENT Even though some people do assert that wrinkles are a mark of an intellectual woman, there are a very few who gaze with anything resembling pride on the first faint tracing of the crow's feet about the eyes, the puckery lines in the mouth or the long, deep lines on the forehead. When wrinkles occur early in life, unless there has been an illness or much exposure to sun and air without due protection, the cause may usually be found in some habit. Raising the eyebrows, scowling, squinting, an attempt to look interested by indulging in facial gymnastics, all aid in the early foundation of marks that certainly do not add to the beauty of the face. Wrinkles that form before the person is 25 are nearly always of this variety and can be easily removed by proper applications, the necessary massage and by insisting that the patient cure herself of the habit of contorting her features by pasting bits of court paster over the portions most lined, after the face has been rubbed smooth. The woman who can be persuaded to promise this and who actually keeps this promise will be decidedly surprised to find how often she is tempted to raise her brows or to scowl, and how much easier it is to resist when these "re- minders" are on guard. Over-tired, hard-working women, often awake in the morning with more creases in their faces than when they retired at night. Sometimes these lines come because they 163 164 THE SKIN have been dreaming and actively engaged in some task or other during this time. At others, it will be found that the early morning sun streaming into the room causes the brows to contract before the person is awake. Once more court plaster will do much to overcome this tendency. Other causes of these premature wrinkles may be found in the use of cosmetics containing metallic astringents, or some of the highly perfumed "greaseless creams" may also assist in the work. Strongly alkaline washes and bleaches, undiluted alcohol, too much benzoin, in fact, all prepara- tions that have an intensely drying effect on the face have a tendency to cause the appearance of lines. Ordinary soap and water must not be overlooked, for the soap decreases and removes the supply of natural oil and exposure to the air after such a cleansing often makes the skin chap and become covered with small lines. Ill health is another factor in causing lines to appear, and in most instances of this kind the skin seems poorly nourished as well, while the lines appear by the dozen, crossing and recrossing the flesh until the face looks like a bit of patchwork. When the skin has the feeling of parch- ment, the lines are apt to be particularly hard to erase, and constant inunctions of oil are necessary to make the com- plexion even presentable. Mechanical appliances are responsible for much trouble and the use of the face steamer may be mentioned as being particularly harmful. The intense heat extracts the fat from the tissues and in time produces a flabby condition of the skin. The pores become large and the wrinkles form quickly. Another potent cause of trouble in this respect may be found in the small glass arrangement provided with a rubber bulb. By placing the glass upon the face and THE SKIN 165 compressing the bulb, the flesh is drawn into the glass by suction. True, the blood rushes to the surface, and the skin becomes uniformly pink, but the mischief comes from the undue stretching that assists in producing fresh lines in- stead of removing the old ones. Treatment for wrinkles will be found always and ever to consist of the proper manipulation given at frequent intervals, the absolute disuse of soap and water, and the use of cleansing cream whenever water would otherwise be indicated. If a whitening cream is also imperative, the tissue food should be used at night and the whitening cream in the morning. The following special treatments have been also used with excellent results, making the skin feel smooth and firm. Although the surgical treatment is described, it must be remembered that this treatment refers only to cases that are of long standing and extremely obstinate. Ordinary treatments such as these described will usually keep the average skin quite free from deep creases. If the skin seems extremely dry, the tissue food may be applied and rubbed in gently, and if there is a scaly appearance when the dry powder is applied, the acacia balm may be used instead. The astringent mask is also excellent for oily skins and will produce very good results when used frequently, remembering, of course, that the skin must be very oily to demand a treatment of this kind. The lotion may be used to finish a face of this kind, as the tissue food would only aggravate the condition. Many times one will find skins in which either the astringent mask or wrinkle treatment will be really impos- 166 THE SKIN sible. Either one causes a dry, peeling effect, and seems to cause new lines instead of obliterating the old ones. In faces of this type, there are apt to be numberless fine lines. The skin appears shriveled and poorly nourished as well as anaemic, while to the touch it is like parchment — lifeless and dry. Massage treatments with a great deal of the faradic current may in these cases be followed by the prolonged use of the red light with a liberal application of tissue food. The electrolytic cup may be used occasionally because of the deep, stimulating effect it produces. Positive elec- tricity may always be employed to close the treatment but as a rule no water should ever touch a skin of this kind. The vigorous manipulation with faradism should be given before the application of much tissue food, for too much cream prevents the giving of a good massage treat- ment. Immediately after this manipulation, however, a generous amount of cream may be placed over the face, neck and ears, then the light should be moved gently and slowly over all portions so treated for a few moments be- fore the rotary work usually done by the tips of the fingers. The amount of cream absorbed in this manner will really be found quite astonishing. A marked improvement in ap- pearance follows every treatment of this kind. With extremely dry skins, treatments may be given every day when possible. Otherwise they should be given at least three times a week, and, of course, the tissue food should be used religiously every night before retiring. If whitening cream is necessary it may be used to finish the treatment or in the morning, but not at night. A skin of this kind resembles nothing so much as a piece of leather that has been exposed to the air, been thoroughly wet and allowed to dry quickly. At first sight, THE SKIN 167 it seems impossible one could make use of it again. It is harsh and disagreeable to the touch. A little oil is applied, rubbed in and in a very few moments the leather is as soft and pliable as before. Experienced travelers make use of this fact to keep their boots in good condition. Surely then, the most conspicuous part of the human being — the face — should receive as much consideration as the traveler's boots. With advancing years, lines and a change in the tex- ture and color of the skin have been considered as natural consequences. Care can and should retard the arrival of these conditions for fully ten or fifteen years beyond the generally accepted age. Just the ordinary things that should be done each day seem to be the most difficult for the average human being. People will suffer for hours rather than work patiently each day for a few moments. Wrinkles may be removed or at least made less noticeable but it takes patient daily work as well as the treatments to accomplish these results. Hence the operator should always bear in mind the necessity for home work on the part of her patients and should also impress upon them the fact that assisting nature is much more sensible than overwhelming her with impossible de- mands. CHAPTER XVII COSMETIC SURGERY IN TREATMENT OF DEEP WRINKLED, FOLDS, BAGS, AND WRINKLES ABOUT THE EYES, HOLLOWS AND CREASES AND SMALL POX PITTINGS DEEP WRINKLES Multitudinous wrinkles appearing on faded or sallow skins oftentimes mean serious worry to the operator who hopes to banish this appearance by means of a series of treatments. If the condition has been of long standing, treatments will improve the appearance but cannot cure the trouble. Here, the conscientious cosmetic surgeon will find a field for some of his best work. The treatment is not one that could be understood or given by any one not especially trained in the work. It consists, of course, in a method of removing the cuticle, but the most successful method is not as yet gener- ally known. The patient is obliged to remain in complete seclusion for from ten days to two weeks. After three weeks the skin will bear exposure and in from four to five weeks it will have regained a normal appearance. By this method, the weakened and relaxed underlying facial muscles are carefully strengthened and built up. The action of the cutis or true skin is re-invigorated and in a surprisingly short time the youthful color and contour are restored to the face. No matter how deep the wrinkles, 168 THE SKIN 169 how faded, sallow or leathery the complexion, this system produces the desired effect, changing the texture of the skin so completely that it once more assumes its original, clear, smooth and velvety appearance. Before going on further to describe other surgical methods, emphasis must be placed on the fact that only the proper treatment will produce this result. Many faces have been marred for life by unscrupulous and unskilled operators who, with a bare smattering of the first crude principles of featural work, have sought to delude the public and in return have brought even the best of the operators under a suspicion that nothing but years of patient work can push aside. The cases that will be illustrated here are those that have been aided by a surgeon who has spent years in per- fecting his methods. He has many original treatments, does not for an instant pretend that every one may be made beautiful, refuses to take any case unless he honestly feels that the person may be benefited, and as a consequence is noted for the successful and artistic work that he does. Much of the cosmetic surgeon's best work is done for the relief of unfortunates who have been shockingly injured in railway accidents. Frequently, if it were not for the skill of experts in these lines, people so afflicted would be obliged to spend the balance of their lives in seclusion owing to the hor- rible conditions in which their faces have been mutilated. In other instances, where perhaps a lucrative position is hanging in the balance, this skill has resulted in helping a person who would otherwise be dismissed, to retain a paying and desirable position. Hence, it must be borne in mind that no matter how 170 THE SKIN many bad results have been obtained by poor operators, uniformly excellent results will always be obtained by ex- perts in every case that is accepted as one that may be benefited. , ■ USE OF TISSUE BUILDERS FOR DEEP CREASES AND HOLLOWS In many instances although the skin is of firm tex- ture, there are found deep creases between the eyes, lines almost like gashes running from the nose to the corners of the mouth with a drooping at the corners and a hollow in each cheek that makes the unfortunate person so afflicted resemble a homeless orphan. Desirous of remedying these conditions, some special- ists decided that an injection of paraffin would be excellent in such cases. In a few cases the success was apparently what had been hoped for, but in the majority of cases hard lumps formed or an infection was caused or some other trouble resulted. As a consequence there is hardly an operator in the United States that has not at least two or three patients under treatment who have suffered from this form of treat- ment Many of them have been compelled to have an opera- tion performed in order to have it removed. A little later than the paraffin filling came the use of a softer substance that seemed to do the work until it was found that this, too, caused trouble. Unless very carefully used it seems to fill in the wrong places, so altering the expression that the lady who had been thin suddenly appeared as though she was suffering from the mumps, and instead of this appearance vanishing T H E S K I N 171 in a few days it remained as a permanent evidence of the treatment. So apparently easy was the injection of this soft fill- ing that many women in business embarked in the work. Utterly ignorant of anything but the fact that they pro- duced the apparatus and material necessary for the opera- tion they have persisted in their attempts until today the reliable operator hardly knows what to believe and what to condemn. For the benefit of those w 7 ho are really anxious to. know what may be safely done I can say there is a treat- ment known as the "Tissue Builder." This can be safely injected not only in the hollow places but also in deep creases. A certain portion of it is absorbed, the rest remains for at least two or three years, acting as a tonic and stimulant to the tissues at first, then gradually becoming assimilated. It is needless to say that this operation can be per- formed properly only by a specialist and should never be attempted by any one who is not a graduate physician. The process is harmless, not at all painful, and is quickly done. In ordinary cases, but one sitting is necessary, though when more work is to be done two or maybe three treat- ments will be advisable. This treatment is of especial advantage in taking away the cross look caused by the line between the eyes as well as in banishing the surly, discontented expression that comes from the deep nose to mouth lines and drooping corners. It frequently takes away ten years from the appearance of age and may be unhesitatingly recommended to the woman who finds it necessary to look youthful for business or professional reasons. 172 THE SKIN FOLDS, BAGS AND WRINKLES OF THE SKIN ABOUT THE EYES These folds and wrinkles frequently develop prema- turely about the eyes, adding years to the apparent age. Bagginess, too, sometimes imparts a dissipated air, not only adding to the appearance of age but also so revolting to sensitive persons that relief is earnestly sought. This condition is easily, effectively and painlessly rem- edied by the excision of a crescent of skin just below the eye. The width of the crescent will, of course, vary with the depth of the wrinkles or the size of the folds. By so arranging that the concave portion of this crescent lies close to the lashes along the lower lid, the line of union is brought in this manner under the shadow of the lashes and is entirely invisible. The artistic operator never in any way takes away from the expression of the eye in this w r ork but sometimes has actually made an improvement by this skillful manner in which the crescent has been shaped, while, of course, the bagginess or folds for which the operation was originally sought will be removed permanently by the chipping away of the extra flesh. This operation is not at all injurious to the eye, and does not make seclusion necessary. REMOVING THE FOLD ABOVE THE EYE Drooping eyelids impart such a suspicious, sinister expression to the face that frequently relief is sought for that reason alone, though, of course, often this extra fold of skin has been known to interfere with the eyesight, too. The operation is comparatively simple, and as painless as that for folds beneath the eyes, consisting simply in cut- ting away the excess of tissue and making an accurate clos- ure of the skin margins. THE SKIN 173 After-treatment and proper dressings are in this in- stance rather important, so as to prevent any strain upon the sutures. FLABBY SKINS When the skin is extremely flabby sections are fre- quently removed and the appearance remarkably improved. This is sometimes the case when the forehead is very much lined and the skin extremely loose. The "side operation/' as it is called, for lifting the muscles that have sagged at each side of the face is not as a rule successful; that is, it is not a permanent success and so is not especially recommended, excepting in extreme cases. Actresses and other professional women frequently in- sist on this operation and cheerfully have it repeated every ten years. SMALL POX PITTINGS The dread and horror with which for generations that fell disease, small-pox, was regarded, is due in no slight measure to the knowledge of the ravages it leaves in its wake. A face scarred and pitted by small-pox is a perpet- ual source of mental suffering to its unfortunate possessor. However, these sufferers need no longer despair. Their faces can be rendered smooth, their complexions as roseate as before they fell victims to the disease. The cure is as radical in its nature as it is complete and permanent. It consists of the deft eradication of the defec- tive tissue w r hich forms the scar or pitting and the subse- quent production of a new cellular growth which allows new living tissue to take the place of the inert matter that has been removed. The success of this treament largely depends on the stimulating effect produced on the surround- 174 THE SKIN ing surface of the skin, and the encouragement of a more perfect circulation. Nature is thereby herself assisted to repair the ravages of the disease. The treatment extends over a comparatively short space of time and is attended by the minimum of inconvenience to the patient. In closing the chapter on surgical treatment of these various defects the writer realizes fully that it will be diffi- cult for many women in business to accept these statements literally. Most cases which they have seen are those where the work has been improperly done. The woman who has been successfully treated rarely tells of it, and often denies absolutely that she ever thought of such a thing. It is for this reason that very good work as well as really good operators are often unknown outside of a select clientele. Cosmetic surgery does not pretend to cure every one, but the average results are so wonderful that it pays well to know something about it. It does not take away from the income of the woman in business, but rather adds to it, for the honest cosmetic surgeon always urges his patrons to keep up the massage and stimulating treatments as a manner of preserving the health of the skin. So, when it is properly understood, this work will be appreciated at its full worth and as a consequence those who have really suffered by reason of years of neglect may be helped speedily and thereafter become grateful as well as constant patrons of the woman who knew what could be done for their benefit. CHAPTER XVIII REMODELING EARS, EXCISING SCARS AND MAKING DIMPLES BY COSMETIC SURGERY So much truly remarkable work is done by the clever cosmetic surgeon that the person who has really been ini- tiated into the possibilities of the work and has seen the originals of all the "Before and After" series, invariably becomes enthusiastic. This condition is natural, for who wants to look at hook noses, thick lips and floppy ears when it is not neces- sary? Landscape gardening is all very well and a nice thing in its way. "The City Beautiful," with its well-kept parks, and white uniformed helpers, looks well in print and is agreeable in reality, but to make the picture complete in every detail, the people who visit the park should be kept up to standard. In this age there is really no excuse for repulsive looking faces. The featural architect can so plan that every unnecessary bump, hump and fold may be re- moved quickly and painlessly; and in every case that is accepted one may be sure the work will also be successful. There is really nothing at all mysterious about this work, though some way the general impression has gone out that every detail is hidden by a veil of mystery. With operators who are not sure of themselves this may be true, but the expert usually explains every step of the process, tells his patients what may and may not be expected, and leaves it to their common sense to decide which of one or two methods will be the best for a particular case. 175 176 THE SKIN The bad results obtained by those who call themselves cosmetic surgeons may, it is true, be seen on every side, but that does not in the least alter the fact that excellent work is done and that almost unbelievable results are really secured by conscientious specialists. There are perhaps fewer successful operators in this field than in any other because of the necessity for a com- bination of qualities not possessed by many people. In addition to scientific knowledge and skill must be added a comprehension of due proportion, an artistic sense as it were, that will enable the surgeon to make the incision just where it is most needed, inject the tissue builder where it will fill out the hollow without producing a puffy appear- ance, remove the folds from beneath the eyes without chang- ing the expression, and alter the shape of the nose in such a manner that no scar is visible. Because some one has gone to a doctor who did not know his business and has been scarred for life is no reason why the clever surgeon, who knows his work thoroughly, should suffer. The woman in business sees evidence of the bad work that has been done every day. She ought also to know of the good work, how and why it may be done — recom- mended in order that she may be able to advise her patients honestly. Many times the operation which may seem trivial to her will be the means of bestowing unmeasured peace of mind upon the person who has for years been seeking for some improvement. Scarless operations are not myths. They are realities and are performed daily with excellent results. But all operators are not uniformly skillful, hence the differences of opinion regarding the merits of this branch of work. THE SKIN 177 One of the most frequently observed defects, and one that certainly makes a great difference in the appearance is that of OUTSTANDING EARS Before detailing methods of operating for the correct- ing of the unduly prominent or outstanding ear it is well to call attention to the factors most frequently causing this condition so that efforts may be encouraged at the proper time in life to prevent the development of the condition. There is no doubt that in early childhood a headdress which turns the ear outward and for- ward and holds it in this position, if used contin- ously over a considerable time, will produce a per- manent effect upon the ) position of the ear. The Outstanding Ears, Before Operatiou physician should always note among the children of his patrons the use of a headdress that holds the ears in an abnormal position, and should advise against the use of such, and in any child where a tendency exists for the ear to project unduly the parents should have their attention called to the condition and be influenced, if possible, to adopt a plan of bandaging during the night to hold the ears snugly against the side of the head. A simple bandage devised for this purpose may be applied during the night without discomfort to the child. By tact and persuasion a child may be influenced to have no objection to the con- trivance. The use of such simple means in early childhood, if 17S THE SKIN persisted in will, in very many instances, correct the con- dition satisfactorily. After adult life is reached the possi- bilities of good results following this plan of treatment are greatly diminished. Attention has been called to the greater frequency of outstanding ears in women than in men, and it has been given as an explanation that the habit of wearing the hair long, and dressed in certain fashions, is responsible for the development of the condition. Parents should be warned of this and should not allow a plan of dressing the hair of their children which is likely to press the ear outward. The normal angle of the ear to the head varies from ten to forty After Operation de S reeS > and an 0T S* n (Courtesy of Dr. g. a. Ward) which exceeds this angle to any appreciable extent is usually conspicuous as an out- standing ear unless it be quite small. Sometimes the small ear which appears very unsatis- factory will be greatly improved by an altered position. The operation for the correction of this trouble is not especially difficult and in some instances does not necessi- tate the removal of any cartilage. After the incision has been made and the ear drawn into the position it ought to occupy, the sutures are placed in such a manner that it is drawn closer to the head and kept m position until the wound has healed. A bandage is usually worn for the first three or four days in order to keep the ears from pulling away. At the most, this bandage will be unnecessary after the sixth day, THE SKIN 179 so there is but little inconvenience attendant on the opera- tion. RECONSTRUCTION OF THE EAR Where, for some cause, the ear has been entirely lost, it is a problem whether to attempt to reconstruct the ear from the soft parts about the site of the organ, or to recom- mend the wearing of an artificial ear. In women, it is frequently advisable to attempt the reconstruction of the auricle, for the hair may be worn in such a manner that the ear may be more or less hidden. With men this is a more difficult matter and hence the false ear is frequently advised. THE EXCESSIVELY LARGE EAR Occasionally the surgeon is requested to diminish the size of one ear in order to make it match the ear on the other side. The operation is not so easily performed, as the operator must carefully judge as to the extent the ear can be reduced. Accurate measures as to the amount of tissue that must be removed will be necessary. The operation is ex- tremely delicate and very difficult, but an improvement can be made in nearly every case unless the difference between the ears is caused by one being excessively small and the other extremely large. REDUCTION OF THE SIZE OF THE LOBULE Lobules are frequently so unusually large and thick that they appear like appendages to the ear rather than parts of it. In cases of this kind surgical measures will be found of great assistance and a decided improvement can be promised. 180 THE SKIN ADHERENT AND UNDEVELOPED LOBULE A very common condition is that in which the inner margin of the lobule of the ear is attached to the head. This is a condition that often mars the appearance because it so often increases the resemblance of the human ear to those of the lower animals. The operation for this defect is not particularly difficult, varying, of course, with the type of ear presented. The result is seen in a marvelously improved expression to the face as well as the change in the appearance of the ear. REPAIR OF CLEFTS OR FISSURES IN THE EXTERNAL EAR Frequently the tearing out of an earring is followed by the appearance of a deep scar or cleft. When it is pos- sible to get to a cosmetic surgeon at once the lacerated edges may be trimmed away and the parts sutured with such care that but little evidence of the trouble will be seen. MICROTIA OR UNDEVELOPED EARS This is a condition seen in one or both ears. The organ or organs are unduly small and imperfectly developed. In such cases the external auditory canal is not infrequently closed and there may be an auricular appendage or an arti- ficial ear worn to a good advantage. Where the ear is small and imperfectly developed an improvement may be secured in its appearance by the ju- dicious use of tissue builder and should the organ be curled and twisted upon itself the cartilage may be divided subcu- taneously in various directions and the parts held in cor- rected position until healing occurs. Where the ear is very much smaller than the normal and the use of the tissue builder is unsuccessful in correct- THE SKIN 181 ing its unnatural appearance, the organ may be removed and an artificial ear worn to a better advantage. EXCISING A SCAR Irregular scars of considerable breadth may be excised and the skin margins so skillfully joined that where before there existed a disfigurement in the shape of a red, broad mark, there will only be seen a tiny hair line to mark the site of the former trouble. The improvement is not only remarkable but follows immediately, so that within a few days after the operation but little trace of it may be noticed. SKIN GRAFTING When a great deal of the surface of the skin has been burned there have been attempts made at skin grafting. This is never very desirable on the face as it is almost impossible to secure a smooth and natural appearance where the edges must be joined. THE FORMATION OF THE DIMPLE Dimples may be easily and swiftly manufactured with but little inconvenience to the patient and but a slight expenditure of time on the part of the operator, though it must be admitted that some skill is necessary to produce just the right kind. After the skin has been carefully cleansed the sharp point of a very fine knife is carried into the cellular and fatty tissues of the cheek, and then these tissues drawn up with a very sharp hook and snipped off. The amount of tissue excised is hard to describe as it will depend largely upon the location selected, also upon the style of a dimple preferred. CHAPTER XIX RESHAPING THE NOSE, ALTERING THE EXPRESSION AND APPEARANCE OF THE MOUTH BY COSMETIC SURGERY As the nose is the most prominent feature of the face it naturally attracts the most attention. No matter how clear the complexion, how expressive the eyes, or how beautiful the other features, a badly shaped nose will posi- tively take away every opportunity for being considered even attractive. Operations on the nose within the past few years have been so remarkably improved that now no scar of any kind is left to show where the incision was made, because all of the best work is done from beneath, through one or both nostrils. This operation has been attempted by many surgeons but has only been uniformly successful in the hands of three men in the United States. In this, as in other delicate operations, much judgment must be exercised in order to bring about a decided improve- ment. A really large nose is rarely sightly. When, in addi- tion, there is a bulbous tip or dilated nostrils, or any one of a hundred other defects, the need of an operation is so imperative that one wonders how any person could possibly hesitate to secure the improvement as quickly as possible. Nose operations are not at all painful, owing to' the injection of local anesthetics before the work is commenced. They rarely take long to accomplish and, best of all, by this new means of operating no disfiguring bandages are used, 182 THE SKIN 183 and hence the patient needs no seclusion at all but can go about the ordinary duties as though nothing had happened. Historians declare that if Cleopatra's nose had been but a quarter of an inch shorter or longer the history of nations would have been changed. One knowing such facts should waste no time in mourn- ing over a poorly shaped nose, but should at once proceed to remedy the trouble. Among the conditions commonly found and quickly remedied are the following: REDUCTION OF THE HUMP OR ROMAN NOSE The exaggerated aquiline nose entirely alters the ex- pression of the individual and the removal of an excess of tissue will often make a striking improvement. The newest, and best operation for the hump is performed as men- tioned before, from beneath, either 1 by working through one or both j nostrils. This does away with any necessity for an incision on the out- side of the nose. The operation is painless. Heal- ing is usually rapid and seclusion unnecessary. THE TIP TILTED NOSE No matter what the mental ca- * pacity of the person, a tip-tilted Nos e Before Operation r . r r (Courtesy Dr. Ward) nose immediately puts one in mind of a pug dog. When the nostrils are also thick, a coarsened expression is added which makes the defect more marked. 184 THE SKIN The operation is not particularly difficult, though with this, as with all nose operations, a certain delicacy of touch acquired only by years of practice, is an absolute essential. The work consists in bringing the tip down and then applying sutures to retain it in its lowered position. If the sides of the nose are very thick a little tissue must be cut from beneath or at the side in order to reduce them to normal proportions. By using care in placing the sutures no adhesion strips are needed on the outside of the nose, so the patient will be obliged to lose no time from ordinary duties. NOSE WITH A BULBOUS TIP The nose with a bulbous tip is frequently seen. Often the bridge is comparatively low. A few years ago, when the fad of injecting paraffin first appeared, such noses were filled out without any idea of the effect that would be produced on the individual. Frequently these fillings had to be cut out later. The nose with the bulbous tip is more sightly than one that is large and coarse in all of its proportions, therefore the possessor of this type of nose should never be treated by any method that fills the nose out from the tip. Instead the tip itself should be reduced to normal proportions by the underneath operation. Following this reduction injections may be made to correct the appearance of the bridge if this appears to be necessary. Nose After Operation (Courtesy Dr. Ward) THE SKIN 185 OTHER NOSE OPERATIONS Many other deformities or defects occur, such as de- pressions in the bridge of the nose or a deflection to one side or something of a similar nature. All of these cor- rective operations are deftly and successfully performed by the cosmetic surgeon. Hump Nose Before Operation Nose After Removal of Hump (Courtesy of Dr. G. A. Ward.) In the illustrations given, but two of the various types will be seen. In each case it will be noted that the improve- ment in the shape of the nose has made a wonderful differ- ence in the entire expression of the face. THE MOUTH Many mouths are never well formed. Others become distorted through a habit of contracting the muscles. The lips are kept tightly compressed to the face. Thus the bow line is destroyed and a straight line made, entirely altering the expression. 186 THE SKIN Pouting is another habit indulged in by many people who are inclined to be despondent. This downward turning of the angles of the mouth gives in extreme cases an expres- sion of sadness. In middle-aged persons deep lines form where these depressions have been and it is for this condi- tion relief is frequently sought. Careful attention to the use of the muscles and practice before the mirror in elevating the angles of the mouth will often develop remarkable control of these muscles. When, through neglect or carelessness, such care is not practiced, an operation can be performed by bunching the muscles. This immediately changes the appearance and always grati- fies the patient. THICK LIPS What at first glance may seem to be a lip of excessive thickness in many instances proves to be an "everted lip/* Thick Lips (Courtesy Dr. G. A. Ward) to Such a condition imparts a decidedly coarse expression the face. By a single procedure entirely within the THE SKIN 187 mouth the lip may be quickly and painlessly restored to a pleasing outline. Sometimes one lip appears too thick or too long, in other instances both lips are affected, in any event an lljJBjgfljj^lf* Lips After Operation (Courtesy Dr. G. A. Ward) excision of tissue well within the mouth may be made and the entire shape of the lips altered to the entire satisfaction of the person so afflicted. THIN LIPS Lips apparently too thin are rarely more than inverted lips, resulting from a long misuse of the muscles. Perhaps it is more or less natural that the face should characterize to some extent the emotions that are felt by the individual, at the same time these emotions depicted by expressions simply represent a lack of self control on the part of the individual, and it is important to all that they learn to sup- press many of the emotional characteristics expressed by the muscles of the face* if they hope to avoid acquiring an unpleasant expression. 188 THE SKIN One of the most common faults is in attempting to sup- press emotion by compressing the lips. By careful examination it is always easy to determine whether the lip is inverted or unduly thin. In the latter case, operations are not advisable excepting when combined with the tissue builder to give the lips the necessary thick- ness. EXTREMELY LARGE MOUTH Many times what appears to be an extremely large mouth is in reality nothing but an undue thickness of the lips, which can be remedied as described. In other instances the trouble is due to protruding teeth and should be corrected by a competent dentist. When neither of these conditions are responsible for the appearances a slight operation may be performed inside the mouth, advancing the corners toward the median line. In extreme cases the upper and lower lips are denuded at the angles of the mouth without removing any tissue. Then the operator carefully draws the denuded area together and sutures them in position. A remarkable change is thus brought about with com- parative ease. TATTOOING TO AID THE APPARENT WIDTH OF THE MOUTH Tattooing is to have a definite place among the opera- tions performed by the featural surgeon. We have seen the effect of the practice for adornment among the savage tribes as well as among some of our own people who are tempted to try the practice for the sport of the thing. That the operation is permanent no one denies. When, therefore, this tattooing is performed to imitate nature there can be no doubt as to its effect. THE SKIN Sometimes it is used to accentuate the bow-shape of the lip. At others it is done in a fine line to aid in overcom- ing the unnaturally thin appeara: This requires an extreme delicacy on the part of the surgeon to secure a tint- ing that will be a shade between the natural color of the lips and normal appearance of the skin. We should never have the natural red matched but should secure a result somewhat lighter, so that should the patient become anae- mic at some future time the red line will not be - on- spicuous. CHAPTER XX TREATMENT OF BLACKHEADS AND MILIA Blackheads or comedones are, as it has been explained, in the Chapter on Diseases of the Skin Glands, nothing but plugs of sebaceous matter which have accumulated in the ducts of the sebaceous or oil glands. A moment's reflec- tion will show that the longer this condition has persisted the more the functions of the gland will be injured, conse- quently the harder it will be to remedy conditions. The demand for this work has never been so great as it is at the present time, for it is only within the past few years that people have realized that affections of this kind could be termed skin diseases rather than blood disorders. Still, notwithstanding the interest manifested in the work, comparatively few of the operators even in the largest cities either understand or practice the art of improving skins so afflicted. In fact, even well-informed parents so far forget their knowlege of physiology as to declare the blackheads should not be removed, but allowed to ''run their course." Their awakening has been indeed bitter, for ordinarily the result of neglect in these cases terminates in most repulsive erup- tions of pimples filled with pus, causing the skin to appear as though it were dotted with festered lumps. In many instances the flesh has become permanently thickened, and the complexion made dull and muddy by this failure to take the proper treatments. The great secret of success in this work is in the exer- cise of constant and untiring care. If all cases of black- 190 THE SKIN 191 heads were taken in hand immediately, and persistently worked upon until cured, there would be more good com- plexions to be seen, while obstinate disorders of this kind would indeed be rare. The term "blackhead" really is not one used by those who wish to be correct, but it is so descriptive that it has become commonly accepted and is universally known. The text-books refer to these obstructions as comedones, while many people still persist in declaring that "flesh worm" describes them perfectly, at the same time insisting that the pests are really alive. In point of fact, whatever may be the term used, these much-discussed and troublesome invaders are nothing but fat, white plugs, formed by accu- mulations of the sebaceous secretions that persist in block- ing up the pores and thus preventing the glands from per- forming their functions. Although at one time supposed to indicate uncleanliness blackheads are so frequently found that the old idea has given way to another in which all authorities declare that they are caused by some peculiar local condition and do not necessarily indicate anything beyond this fact, though func- tional disturbances and lack of sufficient nutrition may be cited as disturbing elements. However, the majority of cases are found in young and robust people who are other- wise models of physical excellence, so this latest idea seems to be based upon sound reason. There are many varieties of these black plagues, all of them requiring much attention and earnest work before they can be persuaded to leave. Some are fine and so tightly embedded in the skin that it seems impossible to dislodge them. Others are large £ind coarse, and even protrude above the surface, leaving deep pits in the skin where removed, thus making much massage necessary in these spots. Still 192 T H E S K I N others seem to possess a tendency to fester, and upon pres- sure, not only the blackhead but pus comes out at the same time. All of them require the same treatment, for if the pores are to be made to appear as they should and the glands are to perform their natural functions, these obstruc- tions must be removed and the applications of ointments made that will assist in the process of reducing the size of the enlarged pores by restoring tone to the glands. In removing blackheads care must be taken not to bruise the tissue, and the habit of squeezing the skin between the thumb nails, using a watch key or any instrument not especially intended for this purpose, is to be strongly con- demned. The use of the face steamer before the work of pressing these blackheads out, is also injurious, as the fat is extracted from the tissues by means of the intense heat and this increases the tendency of the skin to scar. The come- done extractor is provided with a tiny scoop at one end and is made with either a needle point or a knife at the other. This instrument produces the best effect, for it not only removes the blackheads easily by means of gentle pressure, but it also marks the skin but little, and never permanently scars or bruises the flesh. Before commencing any treatments, however, the oper- ator should have an earnest talk with her patient, explain just what is necessary, and insist upon it that home work shall be done in conjunction with the treatments taken at the office. Occasionally with just a few treatments very brilliant results have been shown, but as a rule it will be found that at least several months' work will be necessary to bring about any marked improvement. Even then it requires constant effort on the part of the patient to keep the skin in good condition. Hence the abso- T H E S K I N 193 lute necessity of making each person understand the value of effort at home, and the necessity for a modified diet and frequent bathing. After these preliminaries have been arranged treat- ments may commence. The following method will be found practical : First, cleanse the face with lettuce cream and then use the electrolytic massage with very warm water into which the soda solution has been poured. Next, go over the entire surface with a dilute solution of formalin or alcohol. Then press the cup of the comedone extractor gently down over each black speck and maintain a firm pressure until it is loosened and comes out. Once in a while an obstinate plug will refuse to become dislodged. In this instance connect the needle to the nega- tive galvanic current and gently enter the duct by the side of the blackhead. In a moment it will be loosened and can then be removed without any difficulty. Occasionally one meets with an obstinate condition in which all the blackheads seem so firmly embedded that only very deep pressure can remove them. In this instance, after trying one or two it will be well to stop proceedings until after the skin has been softened by applying the acne cream and holding the blue light over it for ten or fifteen minutes. Then the comedone extractor may be used with Very good results. When the comedones are extremely large the removal seems to leave quite a pit in the face. This can be reme- died by inserting into the cavity the positive platinum or solid gold needle, and rotating it gently around the sides of the opening. Of course the patient holds the negative electrode. Care must be taken to see that the needle is 194 THE SKIN really gold or platinum, as otherwise a permanent black mark will be left on the skin. In all treatments the operator should use only enough pressure to dislodge the blackheads and should not work too long in any one section of the face. Sometimes but little irritation follows this treatment. At others the entire face is flaming red and the after-treatment must be given with a great deal of care. If the skin is leathery and oily looking, a great deal of stimulation is indicated and the treatment may be very vig- orous. The patient should be instructed to bathe the face with warm water and the medicated soap each night for ten minutes and then rub in the acne cream. In the morning use antiseptic lotion and powder. Occasionally it will be found advisable to vary the process by the use of the instantaneous bleaching treatment for general stimulation. If the skin is scaly and sensitive to water lettuce cream must be substituted for water, the methine ointment may be used at night, removed with lettuce cream in the morning and then a little acne used before applying the powder. These blackhead treatments may be finished in a number of ways. Ordinarily, after the extractor has been used, the acne cream is applied, forced in with the blue light and then finger manipulation given with the faradic current. The usual method of cleansing off the oil with the lav- ender lotion and applying the positive ball electrode with antiseptic lotion is then employed before applying the powder. When, however, the skin is red and there are small, red pimples, intermingled with the blackheads, it is wise to give the manipulation as usual and then force the methine THE SKIN 195 tincture into the skin by means of the positive galvanic electrode, using it for about twenty minutes. This will be found especially beneficial. In obstinate cases, treatments should be given at least twice a week, the patient should be requested to work faith- fully at home and use the preparations indicated with the following instructions for additional care : A bath must be taken daily and surface of body scrubbed vigorously with sea salt. In case of constipation — and this by the way is almost always found — a good cathartic should be suggested and the patient given especial caution as to the necessity for using it. For diet nothing but the simplest foods may be eaten. No pastries, candies, soups, gravies, highly spiced dishes, salads at all. Meat must not be taken more than once a day. Vegetables may be eaten plentifully, also bread and milk and eggs. Should the patient seem particularly anaemic or other- wise not in good physical condition advise her to consult her physician and secure something for building her up generally as well. Care and faithful treatment will positively in time banish these pests, but it is impossible to make any honest estimate as to just how 7 long the treatments will have to be given. The use of the electric current is most valuable in this respect, for just as the negative current softens and relaxes the skin, allowing the plugs to be forced out easily, so on the other hand will the positive current harden and produce an astringent action, thus producing a marked efifect in improving the general condition and tone. 196 THE SKIN TREATMENT OF MILIA The retention of the sebaceous matter in a tiny sac is known as milia. Many people call these tiny lumps "whiteheads/' They differ from blackheads in many respects, but principally in the fact that they cannot be pressed out. Instead the tiny sac must be opened by a sharp instrument and the hard lump teased out by means of a large needle or a small pointed steel instrument. Many times the entire face is covered with these pearly particles, giving the skin a peculiar appearance. Massage, steaming or any of the various methods tried for other conditions has absolutely no effect on this condition. The only remedy is the simple one of opening each sac and removing each fatty particle and then giving frequent treatments to keep the skin in normal condition. The following process will be most successful : Cleanse the face as though for massage by use of lettuce cream and then remove oil with lavender lotion or alcohol. Next apply dilute formalin, by means of a small bit of cotton and then open each sac with a sharp pointed knife or large needle, that has, of course, been carefully sterilized. Frequently these sacs prove to be very tough and after one or two attempts the amateur is apt to become discour- aged and leave the task uncompleted. Nothing could be worse. After commencing the work keep at it until the opening is made and then press or tease out the tiny lump. The sac may be opened by means of the electric needle. When this method is used the needle should be rotated gently about for a few seconds before any attempt is made to dislodge the contents. Then just a little pressure will be needed to accomplish the desired result. THE SKIN 197 The use of the electric needle is really preferable when- ever it can conveniently be used, because it not only assists in dissolving the fatty matter but also discourages any recurrence. After the removal of the contents of the milia, the face may be covered with acne cream, and the blue light used for a time before the finger massage is given. Following this the positive galvanic electrode should be used for about ten or fifteen minutes with methine. Then the face may be cleansed with lavender lotion and powdered. Treatments may be given twice weekly until the condition has been cured. CHAPTER XXI ACNE One of the most common as well as obstinate forms of skin disease is that known as acne, or what is commonly called pimples. Authorities differ as to the proper definition. Acne so often follows or is connected with comedones that the majority of the profession declare it to be a chronic inflam- mation of the sebaceous or oil glands. Others, among them Hyde, declare it to be a "peri- folliculitis." Although the treatment of acne may very properly be assigned to the physician, not one professional man in a hundred will be bothered by it, unless he makes a specialty of just such work and charges accordingly. The average practitioner feels that he has neither time nor inclination to spend on these cases, though he is willing to prescribe for them. Consequently, in most small towns, the physician usually gives the prescription and then advises the patient to go to the operator who can remove the blackheads, open the pimples and give deep massage for the purpose of restoring tone to the tissues. There is perhaps no other branch of this work in which so much gratitude is evinced by the patients. Many times these unsightly conditions have persisted for years, making it impossible for the person so afflicted to take part in any social event. 198 THE SKIN 199 Constant brooding over the affliction makes them mor- bid and disinclined to do anything for themselves, so a double duty devolves upon the operator, for home work is absolutely necessary in connection with office treatments. In cases where the desired results are not obtained investigation will usually show that the patient has been neglectful as far as personal efforts are concerned. Acne- is characterized by the appearance of small eleva- tions varying in size from a pinhead to a pea. Sometimes these protuberances are pustular, sometimes papular, many times they are greatly inflamed and frequently they are painful. Although physicians, especially in the smaller cities, usually refer such cases to the operator, she should also be able to recognize the different varieties of acne and therefore know just what it is as well as how to treat the condition. VARIETIES OF ACNE Acne vulgaris, also called acne simplex, is by far the most common type. The lesions are usually of a mixed character and one may find blackheads, papules of varying size and pustules. Sometimes these lesions may have the beginning in a red spot, painful upon pressure. As a rule these lesions are very rapid in developing, appearing and disappearing in a week or ten days, only to be immediately succeeded by a fresh number. Sometimes the papular type proves very obstinate and the hard lumps persist for weeks and months, then gradually disappear, leaving purple discolorations. This form of acne is also frequently seen upon the back and chest. It may persist for years if allowed to remain without treatment, making the skin coarse and leathery, and fre- Acne Vulgaris THE SKIN 201 quently leaving the pores so large that the skin looks pitted. The most marked effect is seen in the mental condi- tion of the patient." Frequently persons so afflicted become so morbid that they refuse to take part in any social gath- ering, never go into the streets unless heavily veiled and persist in regarding themselves as but little less loathsome than a leper. Owing to this depressed condition and utter despair it is often extremely difficult to persuade such patients to indulge in any effort themselves, hence the necessity for a very firm attitude on the part of the operator. If she is wise she w 111 never accept one case unless co-operation is positively promised. Under treatment but little improvement may be seen for the first few weeks, though usually a slight change is observed at once. In any case, however, if the efforts are faithfully continued improvement is certain and in time a cure will result. Acne punctata, also called the "minute papular" form, consists for the most part in lesions about a pinhead in size, with a central comedone or blackhead. The papules are frequently red, so the contrast is all the greater between the central portions and inflamed margin. Acne pustulosa is a type in which the lesions are almost altogether pustular. In size they vary from a pinhead to a pea. Frequently the base is red, and there is a nasty looking yellow tip. This is a most unpleasant form, causing an extremely repulsive appearance, though frequently yielding to treatment quicker than the papular type. Acne indurata, sometimes called acne tuberculosa, is that form in which the lesions are closely crowded, causing a hard, deep-seated base. This form is difficult to treat and usually responds very slowly. Extremely vigorous CD f— f- 3 o CD 0) 13 3 202 THE SKIN efforts being required to make any impression whatever. Deep, continued work with the electric needle or spark for the prismatic ray must supplement all other treatment. Acne cachecticorum is the name given an eruption* more or less general, occurring in weak cachectic persons. The lesions are livid violet or red in color and of the papular pustular type. They appear both of moderate and of large size, develop slowly, respond to treatment unwillingly, often leaving small scars. General treatment, much exercise and out-of-door life is an excellent addition to the ordinary treatments in these cases. Acne artificialis is produced by the use of certain drugs and also occasionally by the use of remedies, such as tar, paraffin, oils, etc. Foods of certain kinds, such as straw- berries and some of the other fruits will cause this eruption. It appears on the body as well as the face, consists of a sort of rash of minute red papules, and usually disappears very rapidly unless the use of the irritant is continued. Soothing applications and the discontinuation of the drug or foods that have produced the trouble are the only indi- cations here. Nervous eruption, a rash resembling the one just described, sometimes appears in certain localities of the body. Although often red it is usually more like tiny vesi- cles, and is nearly sure to be accompanied by severe itching. Soothing applications and internal treatment will be neces- sary. Occasionally these vesicles will appear only on the hands, sometimes on the face and often in a band or zone about the waist. The yellow ointment will often alleviate this itching and help disperse the eruption. Acne rosacea, a chronic congestion of the face, causing an enlargement of the tiny blood vessels and making the nose, cheeks, and sometimes the forehead of an intense red T H E S K I N 203 or purplish hue. This appearance always leads one to sus- pect intemperance, and indeed this form of acne does occur among those who live intemperate lives but it is more fre- quently found among those who suffer from disturbed digestions and intestinal troubles. It is extremely difficult to treat and often resists any attempt at improvement until after months of patient effort. Papules and pustules are also found in this form of acne, and frequently the constant inflammations cause changes in the skin glands and tissues, distorting the fea- tures and completely altering the expression. This form of acne usually manifests itself between the years of 30 and 40. If one is persistent with the use of the positive gal- vanic current after every treatment, or as indicated in the forcing in of certain substances, a marked change will be sure to result. The current should always be taken from a wall plate in the treatment of cases of this kind and used as strong as it can comfortably be applied. CAUSES OF ACNE Acne usually begins between the ages of 14 and 18, when the functions of all the glands are actively develop- ing. It is usually caused by some form of dyspepsia, consti- pation, anaemia or some functional disturbance of the organs. In nine cases out of ten some form of intestinal irrita- tion may be said to be present, no matter how vigorously this assertion is denied. In practically every case medical treatment as well as local attention is necessary and should be persisted in, untii an improvement is seen. Acne caused by the use of exter- nal remedies or by taking certain drugs will in many 204 THE SKIN instances be remedied at once by removal of cause while that caused by other conditions will, of course, require a long, patient and oftentimes a most vigorous form of treatment. TREATMENT OF ACNE In order to arrive at a reasonably accurate rule for treatment all cases of acne may be divided into three classes. 1st — An irritable or inflammatory kind in which the skin is fine and thin and easily irritated by any kind of stim- ulating treatment. All local work in these instances must be of mild character and much stress must be laid upon the general treatment by the physician. If, after a reasonable time, the improvement does not warrant this mild method, more vigorous treatment should be commenced. 2nd — An indolent variety where the skin is thick, rough and oily, with large and obstructed ducts, and where most vigorous local applications are emphatically demanded. 3rd — Cases in which portions of the face exhibit the indolent variety, due to the presence of old papules, while a new eruption is characterized by an excessively tender condition. The successful operator will be she who knows how to vary her treatments to better these different conditions. Before going more explicitly into the subject of treat- ment, however, it must be impressed upon the operator that a very strict surveillance of the personal habits of her patient will be necessary. She must be firm in her demands and must positively impress upon the patient the necessity for constant care if improvement is to be procured. By thus persuading the patient to work with her, results will not only be far quicker but will also become permanent. THE SKIN 205 THE SERUM TREATMENT FOR ACNE Much attention has recently been aroused in a treatment recommended by a number of physicians for an internal treatment for acne by means of the use of a serum injected hypodermically. Results, more or less permanent, and very satisfactory, have been claimed in about sixty per cent of the cases. Unfortunately, however, even where results have been good in one way, the rough, coarsened, repulsive condition of the skin has still remained unless special treatments have also been taken. For this reason, therefore, it is well in difficult cases to enlist the services of some physician who gives the serum treatment, continuing at the same time to give regular attention such cases demand. LOCAL TREATMENTS In considering this subject we will take up two forms of treatment. The one preventative, and the other the care of the established disease. In the prevention of acne attention must be paid to these three things : ist — All superfluous sebum and epithelial accumula- tions must be removed from the mouths of the glands. 2nd — The sebaceous glands must be stimulated to health and activity — for instance, massage, electricity and the use of the lights will do this. 3rd — The skin should be kept antiseptic by means of medicated ointments or lotions. This preventative treatment applies particularly to the beginning of skin trouble where the blackheads are just com- mencing to appear on the face. By getting at the work at 206 THE SKIN once and persisting, future trouble with acne will surely be avoided, while neglect will just as positively result in the appearance of this disease. In the chapter on comedones or blackheads a full description of the necessary treatment will be found. WHEN THE DISEASE IS FULLY DEVELOPED The first step in treatment will be a thorough cleansing before attempting to use any instruments. Begin as in the preparations for massage by applying the lettuce cream and allowing it to remain while the tank is being filled with warm water. The water should be as warm as it can be tolerated and the soda solution should be used. Next, the face should be sponged with a dilute forma- lin solution, the operator's hands sterilized again, and the comedone extractor used for expressing all the comedones possible. If the pustules are very numerous a sharp instrument may be used for opening them and the contents pressed out. If papules are present the electric needle must be used, attached to the negative pole, and allowing it to remain in each papule until the contents are thoroughly softened and may be expressed by pressure. If the surface has been very pustular the finger mas- sage may be omitted and instead a prolonged exposure to the blue light given for twenty minutes. Then acne cream may be placed on the skin and once more the blue light used for five minutes, using the finger tips gently over the sur- face to assist in forcing in the cream. Superfluous cream may then be removed by gauze pledgets, moistened with lav- ender lotion. The positive electrode may then be used over THE SKIN 207 entire surface, powder applied and patient allowed to depart. If, on the other hand, there are many papules and but few pustules, exposure of the bare skin (without cream) to the blue light may be shortened to ten minutes and deep massage with faradic current given afterward, using espe- cially deep manipulation over hardened portions, and finish- ing with the positive electrode as before. In every instance the use of the electric needle, ii inserted long enough, will help to bring about a much quicker cure, although the skin may look more inflamed directly after its use. The blue light used on the bare skin has a penetrating and antiseptic as well as tonic effect that should not be underestimated. In obstinate cases the methine or a special ointment may be used at home each night and the acne cream used in the morning. If the skin is tough and leathery more vigorous treat- ment may be given, and in every case where possible treat- ments should be at least three times a week. HOME TREATMENT In all ordinary cases the face should be bathed in very warm water with either medicated or olive soap for at least ten minutes each night. Either methine or the special ointment should be rubbed in well, and in the morning lettuce cream used for removing any of the green tinge left by methine, then acne cream rubbed in well and powder applied. If the skin does not seem to stand the methine well the acne cream may be used at night and the antiseptic lotion sponged on in the morning before applying the powder. BHHH B HB 1 H 1 3 o K HE BmmVK Mtm,- mmLmmJMMLM^J^G&u o a> 4^nmwmrmmWm*mmE3mMmM a a 208 THE SKIN If the skin is extremely sensitive the lettuce cream may be applied first, then the wash cloth dipped in warm water and held over the surface, patting the skin gently and omit- ting the soap. Following this the cream indicated may be applied. Oftentimes after the first few treatments no trouble will be experienced. Bathing and diet should also receive due attention in addition to all this other home work. ACNE ROSACEA This particular trouble stands in a class by itself and demands a very different treatment. Owing to the vividly red appearance of both nose and cheeks, the patients are usually much disturbed over their appearance and are often super-sensitive. In this condition but little manipulation can be used, as often the use of the finger tips seems to aggravate the condition. Many times the tiny blood vessels seem to be so greatly enlarged that to correct them will be hopeless, but if perse- vered in, a great improvement will be seen in a very few weeks. The most successful treatment yet proposed is based on the use of methine. It may not always cure, but it will positively produce relief, and often has brought about won- derful results in a comparatively short time. It is given as follows : METHINE TREATMENT FOR ROSACEA Use lettuce cream for cleansing. Remove with soda solution. Enter the central supply of some of the greatly en- THE SKIN 209 larged capillaries with the negative needle, being careful not to treat many that are in the same immediate locality. In some instances small hemorrhages will occur. This should be encouraged rather than suppressed. After a sufficient number have been treated, apply methine tincture with positive galvanic ball electrode, for about fifteen or twenty minutes, being careful to gently but firmly press and roll the electrode over the surface, not drag or scrape it. Remove methine with lettuce cream, then apply acne cream and allow it to remain while the blue light is used over the surface for from five to ten minutes. If methine is difficult to remove, use a little alcohol. If the skin is not badly inflamed, gentle manipulation with the finger tips. Then remove cream with lavender lotion, use positive galvanism to close pores and apply powder to finish the treatment. Treatments should be given several times a week. In rosacea, too, serum as administered by a physician has produced some excellent results and has hastened the recovery. Occasionally the use of the electric needle may make the face a little sore and frequently the methine will make it peel. If the use of the electric needle before the use of the methine seems to be too severe it may be used only alternate times. The positive electricity must be used as strong as it can be borne in order to produce the best efifect, and the electrode should be kept in one position some time to be sure that the methine is forced into the tissues. If there seems some difficulty in destroying the blood supply the afifected portion may be taken between the thumb a) i— »- C/> 3 o CD 0) 13 3 Use of High Frequency in Case of Acne THE SKIN 211 and first finger and squeezed until one portion shows plainly a fullness and more evident redness. The needle may then be plunged into the section and it will be found that the tiny capillaries will usually disappear afterward. Home treatment will consist in avoiding the use of any irritating substance, using lettuce cream for cleansing the face, methine ointment at night and acne in the morning. The directions for diet and bathing should be carefully followed, and in addition an effort made to prevent becom- ing overheated, such as by working over a hot stove, exer- cising violently, or anything of that kind. Improvement in these cases often seems slow, but it is also sure if only the treatment is persisted in and directions followed. DIET In very obstinate cases a strict diet of bread and milk should be recommended for at least four weeks. Gradually other foods may be allowed, among them whole wheat bread, all of the fruits, fresh vegetables and eggs. Meat should be taken but seldom, and then the white meat of chickens and fish should be eaten instead of beef. No coffee, tea, liquor of any description, highly spiced or fried foods may be allowed. In connection with the use of the bread and milk diet very excellent results have been secured by adding to it a day or so of fasting, taking on these days nothing but water. If the patient can only be made to see that in adopting this rigid diet she is giving her much tried stomach a needed rest she will really enjoy the experiment. BATHING Not only should one full bath be taken every day, but in addition the body should be scrubbed with sea salt and a Use of High Frequency in Removing Mole on Chin T H E S K I N 213 good friction obtained by drying the surface with a coarse bath towel. In some instances vapor baths or those of the electric light variety will be found a valuable addition to the treat- ment. Internal baths, by flushing the intestinal canal, will also be of great assistance and should be taken at least once a week. CONSTIPATION In the majority of cases constipation will be found to exist even though the patient declares that it does not. For this reason, therefore, in addition to the adoption of a sim- ple diet, which will usually relieve dyspepsia, it will be neces- sary to avoid any symptoms of constipation by the use of some one of the many remedies used for that purpose, and which the physician can or usually will recommend. A very simple and an excellent remedy, especially where there is much congestion, as in acne rosacea, is found in the use of Epsom salts each morning for some three or four weeks. As the use of any of the remedies is sooner or later attended by some failure to take effect, it is better to alter- nate their use and in the meantime by means of exercise and deep breathing bring about a better physical condition. EXERCISE While it is not possible that all patients can take a course of instruction in physical culture, still each one should have impressed upon her the necessity for some form of exercise, such as walking a certain distance each day. Deep breathing is of especial advantage and should not 214 T H E S K I N only be practiced once but at least three times a day, remem- bering always that every breath of this kind adds tremen- dously to the purification of the blood by taking a greater amount of oxygen into the lungs. Sleeping in well ventilated rooms, with the windows wide open, is another important point that should be insisted upon in connection with these treatments. A new treatment for acne and one that has produced very excellent results is found in the use of the prismatic ray, in which every pustule or papule has sparks shot in by means of the fulguration point electrode. This is followed in ordinary acne by use of the flat electrode and antiseptic oil. Then the contents of pustules or papules are expelled and more deep pressure with flat electrode and acne cream given. No finger manipulation is necessary after this, cream may be removed and powder applied. This treat- ment is especially good for old, obstinate cases. In acne rosacea, however, the fulguration point appli- cation is followed by the use of the positive electrode and methine in order to reduce the irritation. In treatment of acne these general rules may be fol- lowed : ist — Where the condition is obstinate and consequently indolent and of long standing, very vigorous treatment is indicated, including not only the use of the cup, but inser- tion of the negative needle, deep massage and frequently a stronger special ointment for home use. The electric needle in such cases may need to be used several days in succession as the first use only seems to increase irritation. Massage and electricity must be used for a long time over all purplish spots in order to restore normal condition. 2nd— When skin is sensitive, covered with old as well as new elevations, the cup may be used for cleansing, but THE SKIN 215 manipulation need not be so vigorous, and after use of the manipulation the positive electrode and methine should be used to reduce irritation. 3rd — If the skin is especially sensitive the cup may be omitted, skin cleansed with lettuce cream, negative needle used, followed by a longer application of the acne cream and the blue light and finish with positive electrode, covered with cotton that has been saturated with antiseptic lotion, methine treatments may be alternated with use of antisepic lotion, with good results. 4th — In the use of the electric needle it must be remem- bered that not only does it dissolve the contents of the pus- tules and papules but it is also useful in reducing old scar tissue. It is a most valuable aid to any treatment, providing the application is only continued long enough to produce results. It tends to prevent, not produce scars. Finally, the operator may rely upon producing a marked improvement in any case, no matter how difficult, if she will insist on co-operation, give treatment very frequently (three times a week, and oftener if necessary) and keep at the work without losing faith. The greater number of failures comes not because this disease is so difficult, but because it is so obstinate. Hence, very frequently the patient loses heart, the operator loses interest, and they both agree that "nothing can be done/' when perhaps just a few more treatments would have proved a decided betterment. For this reason it is particularly important that both patient and operator believe in the possibility of success, though both should understand that rapid results can rarely be promised. The drawbacks are bound to occur, so when the patient is losing hope the operator must bolster her up, 216 THE SKIN be full of faith and "keep on keeping on" until improvement has been secured. Any one can do easy work. It takes brain, persever- ance and real grit to persist in work of this shape. Best of all, it gives one a standing as being in a manner a specialist, just because of the difficulties that are known to exist. CHAPTER XXII ECZEMA Although the treatment of eczema does not properly come within the province of the ordinary operator, still it is necessary that she be able to recognize it, as otherwise she will many times be puzzled by failure to produce the desired results in facial and scalp treatments. A skin will, perhaps, become very much irritated after the use of the water massage or the instantaneous bleaching process, a scalp will be painful and itching after a shampoo and perhaps become covered with tiny vesicles. If the operator knows enough to recognize some of these apparent contradictions as evidences of an eczematous tendency she can avoid the use of water on such patients and thereby succeed in keeping them in a far more com- fortable condition. The word eczema is taken from the Greek, meaning "to boil." Eczema may be an acute, a sub-acute, or a chronic inflammatory condition of the skin. The earlier stages usually present one or more of the following conditions : There may be an erythematous appearance (redness), or vesicular (tiny blisters), or papular (small, hard elevations), or pustular (elevations filled with pus), or a combination of two or more of the lesions. This condition finally results in a certain degree of thickening of the skin, ending either in a discharge or oozing from the surface of the skin and formation of crusts in desquamation (a scaling process). 217 218 THE SKIN VARIETIES OF ECZEMA The erythematous type is most frequently seen upon the face, although it may be found in any region of the body. It begins as a single reddened spot, or several similar Eczema spots may appear at the same time with outlines poorly defined, sometimes very considerable, swelling, itching and burning. This eruption soons becomes more marked, the parts take on a deeper red and occasionally scaly. If the skin is scratched or rubbed, serum will commence to ooze out. The afifected skin is harsh, dry and a red or violet color. The papular kind of eczema is usually found in the shape of an aggregation of closely set papules, varying in THE SKIN 219 size from a pinhead to a pea, of bright red color, and inter- spersed usually by vesicles and pustules. Itching is intense and the extremities of the body, especially the joints, are favorite sites for this trouble. This is a chronic form, some lesions appearing and others disappearing, running on for months at a time until finally a thickened, solid patch results. The vesicular type is usually markedly inflammatory and is accompanied by considerable swelling. Solid sheets of these tiny blisters are sometimes seen. They often rup- ture in the case of a few hours or days, then outbreaks occur and there is a raw weeping as a consequence. The face and scalp of infants, the neck, and surface of the hands and fingers are usually afflicted by this form. It is usually chronic and sooner or later becomes a form of eczema rubrum. The pustular variety is not so common as the other types, but is found oftenest on the head, and is usually met with in poorly nourished types. As in the vesicular type there is a tendency to the rupture of these pustules. Crust- ing usually follows this condition. The squamous type is very frequently found and is usually red as well as scaly sometimes, when found upon the joints, being accompanied by fissures. The itching may be very slight and at times extremely painful. This form is usually a development from other types. Eczema rubrum, or oozing type of eczema, usually results from pustular or vesicular forms. It usually occurs in a red, weeping, raw-looking surface, sometimes accom- panied by crusts. It is most frequently found on the face and scalp of infants and the legs of adults, and is always a chronic form. The fissured type of eczema is that in which a cracking or Assuring of the skin is the most conspicuous feature. It 220 THE SKIN is common upon the joints, more especially upon the fingers, and is accompanied by an attack of erythematous eczema. Fissures may also occur with any type of this disease. This trouble often disappears entirely in warm weather only to return in cold. Regional eczema is a name that is given to a form of eczema that appears in certain parts of the body only. For instance, only the hands may be affected. They feel hot, burn, itch intolerably and soon a patch develops that is perhaps limited to the palms. Other times just the crown of the head will be afflicted or perhaps a spot on the cheek. Frequently these eczemas are of a nervous type and are so accompanied by intense itching that the person is nearly wild with pain. Symptoms of Eczema — Itching, burning and a sensation of heat are usually experienced, either separately or together. As a rule no constitutional symptoms accompany these subjective indications. Causes — The greatest number of authorities agree in declaring both external and constitutional causes results in this disease. Parasites are also present and undoubtedly have an effect in prolonging the trouble, but as yet no specific parasite has been selected as prime factor. The largest number of cases may be said to depend upon constitutional causes. A certain number are inherited. Over-work, errors in diet, tendency to alcoholic stimulants will often provoke an attack. External Causes Are — Sharp, biting winds, too liberal use of certain soa£>s, chemical irritants, vaccination, exposure to poisonous plants, keeping hands in water too much, use of antiseptics on hands very frequently during the day, handling sugar and flour. These last named causes often THE SKIN 221 produce conditions known as "washerwoman's itch," baker's itch, grocer's itch and surgeon's eczema. Treatment — The best treatments will be a combination of constitutional and general treatment. The diet must be plain and nutritious. All fancy dishes, indigestible foods and meats must be avoided. The patient should not eat cucumbers or asparagus, should diminish the quantity of tea and coffee and better still dis- pense with it entirely and absolutely refuse all fermented drinks, and all acid fruits. Eggs, milk and other light articles of diet such as crushed wheat, Pettijohn's breakfast food, etc., may be eaten. The physician in charge will always recommend any internal treatment. Local treatments are most difficult because although it is necessary to remove all crusts before any good may be accomplished, the use of soap and water usually cause more irritations. On the face, the use of the acne cream and prolonged exposure to the blue light followed by the application of the flat electrode of the prismatic ray, several days in suc- cession, will usually produce a clearing up of the spots. Then the flat electrode and the antiseptic oil may be used with the yellow ointment applied each night. In this treat- ment, lettuce cream should be used exclusively for cleans- ing and the cream must be removed by soft bits of cotton and gauze, no lavender lotion applied. Powder may be applied liberally after a treatment. For the scalp, the follicle lotion may be used for the first cleaning the surface, then scalp ointment applied and forced in with the blue light and then the prismatic ray 222 THE SKIN used, or in some instances, the antiseptic oil may be used instead of the scalp food. After six days, a shampoo must be given in order to remove accumulated dirt, and more oily applications may then be applied. CHAPTER XXIII TREATMENT OF CHLOASMA, SALLOW OR MUDDY SKINS AND FRECKLES The presence of a dark, mask-like tint on the forehead, nose, cheeks and occasionally the sides of the neck is known as chloasma or moth-patch. This discoloration may result from the extreme use of an irritant but generally comes from an internal cause. Among the most common causes may be mentioned, use of certain drugs, diseases of the uterus, pregnancy, obstinate constipation, and also liver trouble. It is in fact, from the fact that a disordered liver bears so importantly on the appearance of the skin that another name is given to the appearance of these pigmentations is "liver-spots." Notwithstanding the fact that chloasma comes from internal causes, it often does not disappear when that cause has been removed. Hence the necessity for some form of treatment. Remedies that produce an active desquamation of the skin are regarded favorably, but must be used cautiously, as otherwise a deeper and really permanent pigmentation will result. Oftentimes, the effect of a treatment will be really brilliant, but unless it is continued the discolorations reappear, hence the necessity for constant care in difficult cases. Another condition sometimes confused with chloasma is that known as vitiligo, or leucoderma. 223 224 THE SKIN Here there are spots exceedingly white, surrounded by very much darker looking skin. Many operators do not notice the absence of coloring in the light spots, but seeing only the darker skin, think of this case as chloasma and proceed to give treatments with but little result. Vitiligo is in reality a condition in which there is an absence of pigment. It usually begins as a circular white spot around the margins of which there is a marked increase of pigment. It may occur on the hands, face, neck or body. It often looks worse in summer. No treatment can restore color to the white portion, though bleaching will make the darker portions less evident. The cause is usually of nervous origin. A congenital absence of pigment results in an albino. An acquired absence results in vitiligo or leucoderma. In the treatment of chloasma, sallow and muddy skins may also be included a$ far as internal treatment is con- cerned, though externally of course, not quite such vigorous measures will be necessary. In all external treatment, of course, the object is to have the material employed absorbed as quickly as possible and to have it so well prepared that the work shall be directed particularly to the affected portions. To assist in this process of absorption it is necessary that the skin should be in the most cleanly condition and this is only possible when baths are taken frequently and the pores are kept free from obstructions. The average person has about fourteen square feet of skin to keep clean, and in this surface are approxi- mately 2,000,000 sweat glands and 500,000 oil or sebaceous glands to assist in throwing off the waste matter. The daily bath will thus be seen to be a common necessity if the skin is to be kept as it should be. THE SKIN 225 In addition to this daily bath, it will also be necessary to prescribe some method of aiding the patient to thoroughly cleanse the system of all impurities, and for this purpose it is well to advise the use of copious draughts of water between the meals. Eight and ten glasses are none too many to be taken during the day, with more at night and in the morning before breakfast a good mineral water may also be taken with excellent effect. In connection with this work it will also be well to flush the colon at least twice a week by means of injections of hot water, for in addi- tion to the cleansing of this important reservoir, the use of the water stimulates the functions and nerve centers of all the organs in contact with the colon. In even* case in which the subject admits the presence of constipation, this procedure is a necessity, while in the cases in which no such admission is made the treatment will at least do no harm and should therefore be advocated wherever chloasma is found. In fact, the mere statement that no constipation exists is no sign at all that impacted feces may not be found, for in some of the most obstinate cases of costiveness such statements are not uncommon. It must be remembered that the colon is nor only a reservoir but is also largely endowed with absorbent glands, and that these glands are capable of taking up and carry- ing through the circulation the poisons contained in it. These properties of the colon can also be used for nourish- ing the system and so it is often called the "second stomach." as in cases in which people with cancer of this organ have been unable to take any food by way of the mouth, some- times not being able even to swallow a drop of water, they may be kept alive for days and even weeks by food properly prepared and injected into the colon. So, when one finds a subject with dull eyes, yellow 226 THE SKIN skin and furred tongue, this cleansing treatment of the colon must be insisted upon, for in this way atone can one avoid having poison from the fecal matter absorbed from the colon and carried to the skin, lungs and in fact every organ of the body. Flushing the colon, however, differs from the ordinary injection, inasmuch as the object is to carry the heated water far up into this reservoir and have it retained as long as possible in order to thoroughly soften any of the hardened fecal masses and thus cause a cleansing of the whole canal. When this result cannot be accomplished by the means of the ordinary rectal tube, the long flexible tubes should be obtained and in this manner the water may be carried directly into the sigmoid flexure. Several trials may be necessary before this process can be done successfully, but as the results will show a marked improvement almost immediately after such treatments in both health and appear- ance, the subject is usually sufficiently stimulated to continue her efforts until she understands the best method of performing this task. For local treatments of the skin not only the ordinary massage but also the instantaneous bleaching process and the ecorchement system may be used. Most important in this bleaching process is the use of the antiseptic lotion with the negative galvanic electrode and a current of galvanism strong enough to do the work thoroughly. The ordinary f ourteen-cell battery is not strong enough, so either a twenty-seven cell battery or the wall plate should be used. The current should be applied as strong as it can be borne with comfort and used until the skin is distinctly reddened. THE SKIN 227 Home care is especially necessary and the liberal use of powder should be advocated as a protecting agency. For very obstinate cases of chloasma the ecorchement process may be used. This process is also excellent in the treatment of eczema and obstinate patches will disappear with the mask, leaving the skin soft and smooth. It cannot, however, be performed by any one but a person trained in the work. ECORCHEMENT PROCESS The process is performed as follows: Each day for from five to seven days, a searching, antiseptic ointment is rubbed onto the skin and forced in with the blue light. The applications are made with cotton to prevent staining the finger-tips of the operator. After a few days the skin begins to assume a parchment-like appearance and becomes dry and leathery. As soon as this appearance is uniform, a number of coats of a liquid preparation must be painted on and allowed to dry until it forms a complete mask. After a number of days this mask begins to crack and then the old skin and the mask may be peeled off, leaving a per- fectly formed new skin beneath. Neither the peeling process, nor the application of the ointment, nor the wear- ing of the mask, will be found at all painful, but the results will certainly be all that one could desire. Hence, as the only disagreeable feature is the enforced seclusion for a matter of a week or ten days, the process does not possess many terrors for the truly ambitious soul who is determined to look her best. SALLOW AND MUDDY SKINS Why people in perfect health should have complexions that resemble russet leather is one of the puzzling problems that, all of us meet occasionally. Yet there is rarely a day 228 THE SKIN that one cannot see a woman who might make a fine appear- ance were it not for the sallow hues that make almost any color absolutely impossible. Cases of this kind may be wonderfully benefited by systematic work, but to be effective it must be impressed upon the mind of the patient that- as the skin seems to have this tendency naturally, the daily effort will therefore need to be systematic and persistent if the skin is to be kept in good condition. Complexions of this kind do not need a skin food. It is not powerful enough to bleach the skin and will therefore be superfluous, unless there are lines to rub out, in which instance, of course, it may be used in connection with the whitening and bleaching creme. The masseuse generally has a difficult customer to meet in the person of the woman with a complexion that has been obdurate to treatment. Discouraged and disheartened by past failures, she demands a positive improvement immediately, or she will not attempt the work. The first treatment is therefore a matter of much importance, both to the masseuse and to the patient. If the skin appears not only sallow but muddy and even at a hasty glance as though it needed a good washing, instead of using the lettuce creme as a preliminary to the treatment it is well to wash the face thoroughly with soap and water and then rinse it off with water to which a little borax has been added. Then the undiluted peroxide of hydrogen may be mixed with the refining powder until a paste is made and this paste spread over the skin and allowed to dry. This may then be washed off with luke- warm water and the whitening creme used for massage after forcing it in with the red light of the radio bell. The antiseptic lotion forced in with the negative elec- trode is also of great assistance in the treatment of all of these cases. In fact, in many instances the regular bleach- THE SKIN 229 ing process needs to be taken at least once or twice a week for some time in order to produce the desired effect. Whitening cream, antiseptic lotion and powder must be used daily in connection with the regular treatments. FRECKLES People with unusually fine skins are often afflicted by freckles or, as they are sometimes called, "lentigo/' These spots are caused by exposure to the sun and in some instances become so pronounced as to be very dis- figuring. Ordinarily the protection afforded by a wide- rimmed hat and use of powder will be of avail in keeping them from becoming strongly evident, but often in extremely sensitive skins the skin will become freckled even through thicknesses of cloth. Chloasma is often, in fact is generally, a result of internal trouble. Freckles are always an external cosmetic defect. Some deep-seated freckles cannot be dislodged excepting by processes too dangerous for the operator to use. Fox advocates touching each freckle with a minute drop of carbolic acid. He declares though the immediate effect will be to whiten the spots, that in a few days they will be darker than ever from the epidermis forming into a brown crust. After this has fallen off, however, the bkin will be of a pink hue, gradually fading to normal. Hardaway recommends touching each spot with the electric needle and in many instances this plan has been successful. Bleaching with the carbon electrode wrapped about with cotton saturated in the bleaching lotion and attached to the negative current will have a marked effect on freckles, while, of course, the instantaneous bleaching process will be of especial aid. 230 THE SKIN Home work consists in the use of the lettuce cream for cleansing, the whitening cream at night, bleaching lotion in the morning and an application of powder several times during the day and always before venturing into the air. No matter how dark the freckles, treatment will make them less noticeable. Of course, severe or dark freckles require much more work and it is because of them that so many women insist upon undergoing the "peeling process" each year. Jt is not necessary to remove the cuticle, as so many declare, though to thoroughly bleach the skin may, of course, irri- tate it to some extent. Those who wish to attempt it may use the articles advised and the galvanic treatment as well, discontinuing the use of the lotion when the face becomes decidedly red. No freckles can be kept in subjection with- out work. Those who have them must remember that this tendency is inborn and must be watched and guarded against the same as other blemishes of this kind. In some instances, as people grow older, this inclination or tendency seems less marked, and frequently the skin becomes free from spots, from no particular reason. The majority of sufferers, however, need to use constant care to prevent acquiring more freckles as well as to aid in getting rid of the old ones. In all of this work the habit of protecting the skin is the most important and care should be taken to avoid washing the face either just before or just after exposure to the air. The best manner to use a powder is to apply it after a skin food has been rubbed in well, and in order to make it effective care must be taken to see that the powder is one that will cling to the skin well. No ambi- tious woman will be deterred from this work by the fact that she must be constant in her attentions, for she knows all good results require much and untiring application. CHAPTER XXIV TREATMENT OF OILY AND STIPPLED SKINS, SCALY, AND DRY AND FLABBY SKINS, TAN AND SUNBURN Frequently the afflictions that cause the most grief are apparently of such innocent origin that little is done to relieve them and as a consequence women suffer for years from oily skins, feeling that nothing can be done to cure this trouble. The greased and shining appearance is so marked that nothing can conceal it. Drops of oil stand out in place of the ordinary perspiration and the victim is frequently so mortified that she dreads appearing in society, as the slightest exertion causes this sebaceous secretion to be poured out like an oily coating on the face and scalp and in some instances upon the entire body. The ducts of the sebaceous glands are generally plugged with comedones and the surface of the skin fre- quently appears pallid and poorly nourished. The treatment should be directed not only to the care of the face and scalp but also to the proper care of the entire body, and the diet as well as daily bath must be made matters of much importance. The lettuce cream may be applied most liberally before using this massage treatment in these instances, as the unguent possesses great cleansing qualities. When, after a few moments it is rubbed ofif, the amount of dirt that is found on the towel will be found to be surprisingly great, for the oily skin will naturally attract much soot and dust from the air. In some instances it is even advisable to 231 232 THE SKIN repeat the application and thus cleanse .the skin as thor- oughly as possible before using the massage. In this event the solution of soda may be used in just twice the proportion and hence to every bag of water, one cup of this mixture may be added as the alkaline mixture possesses the same cleansing qualities exhibited by a mild soap. The water may be applied as warm as possible and if the face is extremely oily the first treatment may be prolonged to some extent. The work has much better results where the treatments may be taken at least two or three times a week, for the first two weeks. After this time once a week will be suffi- cient. It is especially necessary to restore tone to the skin and for this purpose the manipulation is extremely beneficial. The diet should be limited to simple nourishing foods and all oily articles resolutely cut out. No sweets or fats or pastries should be eaten, but the fresh vegetables, broiled or roasted meats, and fruits may be eaten in abundance. The warm bath should be taken daily, and if the entire body has this oily appearance it is well to add to the bath one cup of soda and one of salt, allowing the entire body to be immersed in the water for some few moments and then using the shower with clear water. Treatment of the face at home will consist in washing it with warm water and a mild soap each night, the olive soap being particularly fine in such instances. Then acne cream may be rubbed in well until every particle has been absorbed. In the morning cold water with no soap should be used on the face and the lotion applied immediately afterward, then applying powder. The results of this treatment generally become mani- fest in a very short time and improvement will not only become more marked each day but a cure will result if THE SKIN 233 sufficient patience is exercised. Of course, where this ten- dency exists it is always well to watch the diet carefully and in all cases bathing daily will naturally be a part of the life. Stippled skins looking as though the faces had been used formerly for the purpose of a pin-cushion, are also usually found in connection with an oily condition of the skin. In some instances these large pores have been caused by long neglected or chronic cases of blackheads and pim- ples and in such instances the insertion of the negative needle for a time will do much toward helping cleanse the cavity and stimulate the skin. Sometimes this alone will make the opening smaller. When, however, such is not the case, then the positive current, attached to a pure gold needle or platinum (thus leaving no sign of oxidation) can be used with most excellent effect. For generally improving the condition and making the skin look more refined the same mask described in the chapter on chloasma, made by mixing refining powder with bleaching lotion, can be used to great advantage. SCALY AND DRY SKINS Fortunately for the majority of womankind, there are comparatively few who are troubled with abnormally dry or rough skins. In a few instances, this trouble has appeared in every member of a family, and from infancy, upon any exposure to the air, the skin would immediately look as though some strong irritant had been applied. Tiny scales would flake off in great profusion and the skin appear tight and drawn, with hundreds of tiny lines covering the surface as though acting the part of forerunners for wrinkles. A number of people have acquired this tendency 234 T H E S K I N after a severe nervous strain or upon recovering from an illness. The face frequently burns and smarts and when washed becomes red and inflamed, any application of soap making the condition much worse. No powder can be applied to protect the face, and even the slightest exposure always means an increased amount of trouble; the cases seem hopeless indeed. The use of the electrolytic massage is in many instances absolutely impossible, while in others it may in time so harden the skin that the trouble becomes much less than before. When the skin is abnormally sensitive the following method will be found extremely beneficial. The face and neck may be coated well with lettuce cream, and then warm cloths applied, using them as warm as can be borne with comfort. This process may be continued until the flesh becomes uniformly pink, when the superfluous cream may be removed by drawing the softest towels gently over the surface. Then an application of tissue food can be used and the regular finger massage may be given. Occasionally one finds a case in which the use of water at any time is actually impossible, as it produces a rough- ness immediately. In every instance such as this an oil must be used for cleansing the skin, instead of soap and water, and to get the best results it should be used as warm as possible. Complexions of this description need constant care to keep them in good condition, and women who are so afflicted should make up their minds to submit cheerfully to the inevitable in the shape of constant and frequent applications of oils and skin foods in order to keep the skin smooth. The fact that other people use an application of this kind THE SKIN 235 once a day or once in two days should be no guide to the work, for every woman must study her own needs and fulfil them according to the peculiarities of her complexion, regardless of what other people advise. FLABBY AND WITHERED SKINS On many occasions young women have presented them- selves for treatment with skins that looked as though they belonged to women of seventy. In nearly every instance the beginning of the trouble could be traced to some severe illness or protracted strain or nervous occupation. Return- ing health seemingly does not affect the appearance of the skin in such instances, and hence much work is necessary, especially in the line of tonic treatments. The use of the electrolytic massage is exceedingly valuable in these instances, as it gives the necessary stimu- lation. The salt solution may be added to the warm water and the negative current used as in other treatments. Then prolonged finger manipulation should follow and application of the tissue food. The use of the red light, of course, precedes the finger manipulation and it should be continued for at least twenty minutes, gently kneading the skin in the meantime until more and more of the cream is absorbed. The amount that will be taken into the tissue in this manner is really astonishingly great. Following the application of tissue food and use of the red light, the faradic current may be used with finger manipulation. Last of all, the bag should be filled with cold water to which the alum solution has been added and the positive galvanic current used until the water is exhausted. Then the carbon electrode attached to the positive 236 T H E S K I N current and wound about with cotton saturated with the alum solution may be used to close the treatment. The patient is inevitably delighted with the exhilarating effect of this treatment. Home work consists in the use of the lettuce cream for cleansing the tissue food for application at night. In the morning cold water should be dashed over the skin (unless it is too dry to admit of use of water) ; more tissue food may then be rubbed in and powder dusted on. Treatments should be given several times a week and should always include the prolonged use of the light and the tissue food. If the skin is inclined to be yellow, the whitening cream may be used toward the close of the treatment, but tissue food must be the one forced in by the light. The use of the cold water and alum solution is par- ticularly beneficial and should never be omitted. In the meantime the diet and manner of living must be considered also. Cold sponge baths should be taken each morning; a regular course of exercise should be adopted and practiced and all manner of nourishing foods eaten, while pastry, sweets and other indigestible condiments must be strictly prohibited. Where one is compelled to do this work at home the same general rules may be followed with great success, and as nothing but sufficient practice is needed to make the use of the cup possible, no one need feel that her case is hope- less because she is debarred from the privilege of employ- ing an expert in this line. The use of the galvanic current may be alternated with that of the faradic if the patient desires, or it may be con- tinued to the close of the period. Although this treatment is mentioned particularly for younger people, it also does THE SKIN 237 great things for those who are older and as a consequence many of the elderly women who have pride in their appear- ance take these treatments regularly, as the effect is so beneficial. TAN The bronze coloring that is so attractive on the face of the American Indian is not especially becoming to the average young woman. Not only does the color produce a leathery effect but continued exposure to the air will in time so coarsen the skin that it will take a very prolonged course of treatments to cause any marked improvement. When one desires to remove tan, nothing can be better than the use of the instantaneous bleaching process, remem- bering always that after the use of this method the skin is more sensitive and that hence it will be necessary to use a thorough coating of powder in order to protect the com- plexion from adding to the already deep coloring. In addition to the bleaching process the whitening cream must be used at home each night, and a little tissue food used in the morning before applying the protecting coat of powder. No water should be used for cleansing but instead the lettuce cream used, and one should not go about hatless. This same treatment will also prevent tan and when followed will enable one to enjoy all the pleasures of an outing without suffering any of the discomforts. SUN-BURN As the name indicates, this condition is really a burn of the skin caused by the too ardent attention of the sun's rays. It is frequently very painful and any application will usually cause a smarting sensation. 238 THE SKIN After cleansing the surface with lettuce cream, the tissue food may be applied and used with the red light, then a little acne may be used and after the smarting has been subdued the cream may be removed and the surface powdered. The home treatment will consist in the use of lettuce cream for cleansing, tissue food at night and before using the powder each day. The use of water in any case of sun-burn will posi- tively produce an increased irritation and it should there- fore never be used. Sun-burned faces cannot tolerate the bleaching treatment until the surface has been thoroughly healed. By proper care and protection and the generous use of powder, it is never necessary to become burned, no matter how great the exposure may be. The rule to be thoroughly impressed on every person who wishes to avoid this affliction is to use plenty of cream always and on every occasion avoid the use of water. No matter how cool it may seem or how great the temptation to use it, just don't, and half the trouble will be avoided. ■f CHAPTER XXV FACIAL TREATMENTS In order to make the work of giving the ordinary facial treatment easier, it has been thought best to arrange the treatments for which there is the most demand in a chapter by themselves. By following these directions, using the remedies sug- gested, and working with the proper apparatus, but little difficulty should be experienced in attaining the desired results. ACNE TREATMENT WITH HIGH FREQUENCY RAY This treatment is excellent for bringing quick results in the treatment of Acne Vulgaris and all chronic, pustular, papular, acne conditions. Cleanse with lettuce cream and then go over the surface with follicle lotion, express comedone and the contents of pustules, by use of the comedone extractor. If the pustules are painful, or there are very hard papules, use the flat electrode wrapped in cotton and gauze and immersed in antiseptic oil on these affected portions first. Apply this electrode to the portion treated before turning on the current. Then gradually add it and press gently and firmly on flesh for about five or ten minutes until entire portion has been treated. Then with the spark electrode, shoot sparks into each papule or pustule. Remove antiseptic oil with gauze or cotton, wash sur- 239 240 THE SKIN face with follicle lotion and open obstinate places with the extractor, pressing gently to remove pus. Then apply acne cream on flat electrode without cotton for about ten minutes. Give finger manipulation with faradic current. Remove, and use lavender lotion. Then apply positive galvanism and finish the treatment with powder. In difficult cases it is well to alternate by using the antiseptic oil for one treatment and the stronger acne for the other. As both of these substances are inclined to make the skin a yellow tinge, a bleaching treatment given in between and the use of the refining powder and bleaching lotion at home will make the results much more effective. N. B. The process of shooting sparks into affected portions is not difficult if the special electrode is used, plac- ing the glass tip over the skin and then turning on the cur- rent. In many instances the use of the current in this manner will actually abort the formation of a larger pustule. ASTRINGENT MASK TREATMENT Cleanse the skin by the use of lettuce cream. If there is an oily condition and pores are large use the electrolytic cup, otherwise apply acne cream and blue light, giving the manipulation with or without the current, depending upon the degree of stimulation desired. Remove the cream with soda solution so that all oil will be absent. Apply astringent lotion with positive galvanic current from twelve to fifteen minutes. Then paint on the white of an egg until entire surface is covered. As soon as this is dry, apply the yolk of the THE SKIN 241 egg, and dry with a fan. Even before the last coat is dry, the drawing power of this simple mask will manifest itself in a manner unmistakable. In a very few moments the patient will feel as though her face were in a vise. This mask may be allowed to remain on for five minutes and should then be removed by the astringent wash, which is made in this manner : Add one tablespoonful of astringent powder to one pint of water and bring it to a boil. Then dilute to make a quart of water. Use this freely until every particle of the mask has been removed, making two applications if necessary. Use astringent lotion and positive galvanism over the entire surface to close the treatment. Finish by applying powder. Lavender lotion may be used if desired before the powder is applied. DIRECTIONS FOR WRINKLE TREATMENT Cleanse the surface of the skin thoroughly with lettuce cream. Apply acne cream for the astringent effect, or if the skin is too dry, use the tissue food and massage well, using the faradic current. Remove all traces of oil with the soda solution. Then apply mask made by diluting wrinkle paste with either distilled water or witch hazel, using a brush for this purpose. Allow the mask to remain on for some ten or fifteen minutes, until a decided drawing sensation is experienced, then remove it by the use of tepid water. If the skin is very dry, use a little cream before apply- ing the powder and finishing the treatment, otherwise sim- ply apply the powder. Ordinarily there is no unpleasant sensation whatever 242 THE SKIN connected with a treatment of this kind, but occasionally some one with a very sensitive skin will complain of a prick- ing sensation which vanishes after a few moments. In removing the cream from the face, care should be taken to draw the gauze gently over the surface in order to avoid irritation. Powder should be used liberally as a protection from the air. Treatments of this kind may be alternated with the regular massage work and will produce a marked effect for the better on the average person. THE TIRED-EYE TREATMENT The use of the eye cup and finger manipulation in con- junction with the bandlette for tired or inflamed eyes brings great relief. The treatment may be given as an eye treatment or after the regular facial movements and the eye cup used before the face is rouged and powdered. It is essential that the patron sit up for this treatment or else the solution from the cup will be spilt. In the usual eye treatment the cup is used first. The solution being boric acid, if the eye is badly inflamed, one or two drops of witch hazel may be added to the solution. The faradic current is used and it is necessary for the patient to hold the cup and the electrode. The solution is not so apt to be spilt then, and it is impossible for the operator to hold the cup. The sensation is drawing, but soothing, and each eye should have the cup used about three minutes. Then arrange the chair as for a facial. A head band may be applied. Enough tissue food is used to allow the fingers to slip easily. THE SKIN 243 The first movement is shown in the illustration. The patron holds the electrode, and the operator, by means of the wrist electrode, completes the faradic circuit. The movement at the corner of the eyes is a firm pressure up and down, with as strong a current as can be borne, contin- uing for about four minutes. The sensation will be drawing and may occasion some pain but it is obtaining the desired result. Then slide to the temple and give a light rotary movement for a minute or two. The movement on the tem- ple rests all the tired nerves that control the eyes. The bandlette, saturated with witch hazel, is then placed over the eyes. With the fingers together, as shown in the illus- tration, a gentle rotary movement is given on the bandlette over the eye and at the end of each a pause is made of the superorbital nerves. The bandlette treatment requires from three to five minutes. Leaving it over the eyes, the fingers slip to the 244 THE SKIN posterior aricular, pause and rotate, then slip to the cranial nerve. A firm, rotary movement is given here, alternating with a rotary movement on each vertebra of the spine, working up, this to continue from two to four minutes. Remove any cream that may be around the eyes, cleanse with lavender lotion, and powder. The treatment may be given in from twenty to twenty-five minutes. CHAPTER XXVI THE HAIR Before attempting to treat the hair, something should be known of what it is, how it grows, and why cert things may be accomplished. "Wonderful hair took "marvelous hair grow . rtling dandruff cures" fl the market and are even extolled by women in business who should know better. True, many of tl remedk some point c -ilence. They are antiseptic or stimulat- ing, or a combination of both, but as for the cures they can bring about — of course the claims are absurd. Under natural conditions the hair acts only as a body covering. People much i A to the cold often develop a growth of hair over the entire body. Trappers and men are rarely if ever bald. In the warmer climate, where all people live out of dc magnificent hair is the rule, not the exception. Xo care is given to the hair by people who are blessed by an abundance. Shampoos are infrequent, brushing is only used because it imparts a smooth appearance, and yet this luxuriance persists -im- ply because nature is always gracious to those who obey her rules. The more civilized we become, the less hair we have. Heavy hats, rats, pompadours, braids, certainly tend to make the scalp unhealthy. Late hours, undue exertion or worry, indigestible foods and the strain of modern life produce disordered nerves and consequently far from healthy bodies. With this combination it is small wonder that people lose their hair early in life. 245 246 THE SKIN In order to have an intelligent idea of the hair, we must think of it as a plant whose growth will be limited by the quality of the soil, the air and sunlight given to it. Hair is called a columnar epithelian formation, the lower part of which is embedded in the corium or subcutis, while the upper portion projects upward through the epi- dermis and above the level of the skin. Showing Hair Bulb Resting on Papilla. By imagining that a plot of grass resembles a head of hair, and by pulling some of the grass from the plot and noting the difference in the way the roots of grass extend down into the earth, one can readily see why some of the hair is planted in the corium or true skin, while some extends down in the deepest layer of the skin — the subcutis. THE SKIN 247 Whether the downy or lanugo, or the true hair, the method of growth is the same and the same organs, though on a smaller scale, will be found, the only difference being in the point of size. These columnar epithelial cells of the hair are arranged very much like the shingles on the roof. This fact is taken advantage of by the woman who wants to stimulate luxu- riant hair, when she draws the comb the opposite way and "roughs" the hair. The artist in hair dyeing also realizes this point, so when the hair seems to refuse to absorb the dye that is applied in the ordinary way, she simply holds the end of the strand in her hand and draws the brush back again, forcing the dye under the tiny projections of these epithelial cells. The shaft of the hair is the portion projecting about the surface of the skin. The outer layer of the hair consists of the flat epithe- lial columnar shaped cells overlapping one another. Then comes the cortical substance and finally in the center the medulla or marrow, in which the coloring matter of the hair is found. The hair beneath the epidermis or the root of the hair is contained in a tiny sac called the follicle, which is nothing but an inversion of the corium. Imagine the corium turned downward at various points in the shape of a letter "U" that is narrower at the top than at the base, and you will have an idea of the shape of the hair follicle. Projecting up from the base of the follicle is the papilla, a round or cone-shaped affair which contains the nerve, and the blood supply, and the elements necessary for the growth of the hair. Fitting down over the papilla comes the club-shaped depression in the root of the hair known as the hair bulb. 248 THE SKIN The sebaceous or oil glands open into the follicle just a little below the level of the corium where the imaginary letter "U" becomes a little narrower. The health and the strength of the hair, therefore, it will be seen, must depend upon the conditions existing in the hair follicle and the elements contained in the hair papilla. Germ diseases that destroy the follicle must also destroy the hair. The process of electrolysis is nothing but the introduction of a needle into the follicle by the side of the hair. The follicle is dissolved, the hair loosened and re- moved, and no new hair can grow because the process of destruction is complete. The length of the hair depends upon different individ- uals in different climates. Under ordinary conditions the rate of growth is about one-half inch a month. The life of the hair varies from two to five years, while the hair in the eyelash lasts about 150 days. Warmth and frequent cutting promote the growth. The pigment of the hair depends upon the color of the cortical substance and the air contained by the medulla. Soaps, alkalis and peroxide of hydrogen will destroy the color of the hair shaft, though of course the new hair of the natural color will continue to appear. Gray hair is said to be caused by the presence of air in the cortical substance. Cases are on record in which the hair has turned gray in a single night owing to sudden nerv- ous strain or fright. Many people are prematurely gray, the hair beginning to turn at the age of 12 and 14. There has been as yet no process discovered that could retard the approach of grayness. Scalp treatment will keep the hair but will not prevent the appearance of the unwel- come visitors. T H E S K I N 249 Hair may be extended until it is one-third longer, owing to its elastic properties. Upon recoiling it is still 1-18 of an inch longer than before. Although hair is indissoluble in water, nitric acid turns it yellow, and may be dissolved in hydrochloric and sul- phuric acids. Other substances turn it to different shades, a fact that is taken advantage of by the manufacturer of hair dyes. The number of hairs to the inch depends greatly on the color. Witkof has found that the blonde hair is always finer, numbering approximately [82 to the square inch, the brown will be 162 and the black 147. Oken, another scientist who has devoted much thought to the subject, concludes that "the hair formation is the connective link between vegetable and animal tissue," and states his opinion as follows : "As the plant required air and light, so in the animal kingdom the hair appears where it is most exposed to these elements — viz., on the surface. It is not a little remarkable that those mammals which stand nearest man (the apes) are distinguished by their great development of the capillary jtem." To the earnest student these words will give much food for thought, for from it the following deductions may be drawn : 1st — The natural being living the normal life with free exposure to the sun and air will just as naturally be blessed with liberal allowance of hair. 2nd — When human beings deliberately neglect to fol- low the ordinary rules governing these matters, when they persist in living the artificial life, made imperative by the demands of civilization, as a logical consequence — loss of hair must follow. 250 THE SKIN That care will do much for hair no one can doubt, but that it is real care that is needed must be forcibly impressed upon every one who seeks to be improved. "Care" does not mean a haphazard, slap-dash appli- cation of some tonic or other at irregular intervals, but a consistent course of treatment given in a systematic manner. A very desirable Germ-proof Hairbrush. As an aid to the treatment nothing can be better or more effective than the adoption of sensible rules for diet, rational methods of living and just as much exercise as possible. The cleansing of the hair is an important preliminary to the work of treatment and hence that subject will be considered next. CHAPTER XXVII SHAMPOOING THE HAIR Ferhaps no question is more discussed or argued at greater length than that of the shampoo. One authority will say ''shampoo at least once in ten days." Another will declare, "once in four weeks is quite often enough;" while occasionally some one will be found to assert that "once a year is enough for anybody." As a consequence, the operator who wishes to do con- scientious work will have to judge, not by the expression of the extremists, but instead by results in the majority of cases, and whenever she can do so, impress upon her patients that hair should be shampooed at least once in two weeks. Having decided upon the intervals at which the sham- poo may be given, it now becomes necessary to know how to give it, for though it sounds very simple indeed, and looks very easy, it is not really one-half as easy as it might appear. Be not deluded, oh, searcher for knowledge, but one person in ten gives a really thorough and beneficial treat- ment in this line. As a rule, a shampoo should be always given before a new case is taken for scalp treatment, unless there is an inflamed condition as in eczema that demands the applica- tion of ointments for some little time previous to the use of water. The use of the mixture for shampoo depends upon the condition of the scalp. Where it is very tender and sensitive the egg shampoo should be given, occasionally a 251 252 THE SKIN tar mixture may be advisable, for very oily scalps the green soap should be used, while for ordinary conditions the prac- tical shampoo is best. Many operators experiment until they get a shampoo that seems to be really desirable, and then continue to -use it exclusively. After the shampoo has been applied, brisk friction with the finger tips will soon assist in forming a lather. This does not mean scratching the head with the finger tips, but a vigorous rubbing over each inch of the surface with the balls of the fingers about the forehead, sides of the neck and the back. A small brush can be used to great advantage. A choice of shampoo mixture is necessary according to the condition to be treated. For ordinary cases the follow- ing will be found excellent. It is called: PLAIN SHAMPOO Castile soap 12 oz. Ivory soap 12 oz. Borax 2 oz. Oil of lavender and mace . . 2 dr. Antiseptic oil 1 oz. It is made by boiling together the castile and ivory soap, add water until a thick syrupy mixture results, then the borax, which has been previously dissolved in water, may be added and, when nearly cool, the antiseptic oil stirred in well. When quite cool, the oils of lavender and mace may be added to two ounces of alcohol and stirred in. The result is an excellent shampoo that will leave the scalp in good condition, thus creating the reputation for good work on the part of the operator. THE SKIN 253 Too much emphasis can hardly be placed upon the necessity for care in this direction. No matter if some one else does charge less for shampoo. Explain to your callers what you are doing, why you get better results and you can arrange your prices accordingly. When the scalp has been covered with the scalp food or some oil for any length of time, a stronger shampoo is sometimes needed or one that will take out the grease more readily, though it will not necessarily inflame the scalp. STRONG SHAMPOO Green soap 12 oz. Ivory soap 6 oz. Soda y 2 oz. Oil wintergreen 2 dr. Antiseptic oil 1 oz. Alcohol 6 oz. Boil the soap thoroughly and then add soda that has previously been dissolved in water. Next mix in the anti- septic oil and when cool add the alcohol into which has been poured the oil of wintergreen. TAR SHAMPOO Castile soap 1 lb. Tar 4 oz. Alcohol 4 oz. This mixture is made by shaving the soap into small pieces and dissolving in water. Then the tar is added and the mixture boiled until it is the consistency of molasses. It may then be taken from the stove, cooled and the alcohol added. 254 THE SKIN SOAPLESS SHAMPOO LIQUID This mixture has been recommended for very oily scalps. It is not practical for a general shampoo, but may be used with very good results in some cases, and is very easily prepared : Rum 2 qts. Alcohol i qt. Water i qt. Tincture cantharides i oz. Carbonate ammonium / 2 oz. Carbonate potassium i oz. Dissolve the ingredients in the water and add the solu- tion to the other ingredients mixed together and shake well. Moisten the scalp with this mixture by rubbing well so as to form a lather and then wash with cold water. There is a demand for an egg shampoo and this is given in a number of different ways. Some operators use only the yolks of the eggs, others use both. Ordinarily as the albumen of the white part coagulates so rapidly it is better to use just the yolks and proceed as follows : EGG SHAMPOO Yolks 6 eggs. Water i pint. Beat the eggs up thoroughly and add them to the pint of water, warm, not hot, pour over the head and rub thor- oughly, repeating the process until the scalp seems clean. Always be careful not to rinse with hot water, and on finishing be sure to rinse for the last time with water to which the juice of one lemon has been added. THE SKIN 255 For practical purposes egg shampoos are not to be recommended, as they do not cleanse thoroughly, neither can there be any chance of destroying the germs that are always lodged in the hair. Excepting after the use of a hair dye one would hardly care to advise them. If, however, they must be used, remember the use of a lemon is a powerful aid in leaving the hair in good condition. Occasionally when too warm water has been used in an egg shampoo, the hair becomes sticky and covered with a gummy substance. Sometimes with other shampoos, and especially when the water is hard, the soap and water seem to form in a white substance that clings to the hair, making it matted and unmanageable. For this reason it is necessary to have on hand some sort of preparation that may be poured over the entire head and used freely until the hair is once more pliable and silky. The following will be found excellent: AID TO SHAMPOO Water 2 qts. Alcohol 6 oz. Acetic acid 6 oz. Shake well and pour over head and hair, then pour on gradually a little water and rinse as after a shampoo. Usu- ally not more than two applications will be necessary. Electric Singer THE SKIN 257 SINGEING THE HAIR Authorities now unite in declaring that the hair thrives better when the broken or split ends are removed. Naturally the best time of ail to do this is before the shampoo. For this reason, every operator should as a mat- ter of course, examine the ends of the hair, and if they seem dry, broken or split, proceed to give the singe. By means of a new electrical device — a patent hair singer — the heaviest growth of hair can be taken care of in not to exceed ten minutes of time, and done in a way far more satisfactory than by the old clipping method. Singes can be given every time before a shampoo, but at the least should be given once in four weeks. HOW TO GIVE A SHAMPOO Seat the patient comfortably before the mirror, remove the hair-pins, place all extra hair and pins in pan sterilizer, and brush the hair free from all dust. Pour follicle lotion in a small dish, and use a pledget of gauze moistened in this lotion for rubbing over the scalp, being careful to cover the entire portion. Then rub finger tips over the scalp briskly for a few moments. Next, adjust the shampoo board to the desired height. Place a small towel over the neck of the board and arrange other about the neck of the patient so that the cold metal will not touch the flesh. Add the shampoo mixture to half a cup of very warm water and pour this warm mixture over the patient's head very slowly. Always see that the mixture is warm in order to avoid the slimy effect produced by the cold shampoo. Use the brush to rub about the sides of the face and 258 THE SKIN the forehead, and rub the tips of the fingers briskly over the head, adding warm water until a good lather has been formed. Rinse off the soap and apply the second appli- cation of shampoo in the same way, rubbing and rinsing thoroughly. If the scalp is entirely cleansed and the hair not sticky, continue the rinsing process with a little cooler water. Wring the water out of the hair. Place a bath towel over the head and press out all the dampness possible. Rub the fingers briskly over the scalp, and then turn the warm air from the dryer on the head. Be sure the air is warm, as otherwise a serious cold may result. When the hair is practically dry, apply more follicle lotion over the entire scalp and rub briskly with the finger tips for a few moments until a tingling sensation is expe- rienced. The object in using the follicle lotion is two-fold. In the first place it cleanses the scalp thoroughly and prepares for the shampoo mixture. Used at the last it is a mild antiseptic and leaves the scalp and hair in excellent condi- tion, free from the appearances of excessive dryness so invariably seen when strongly alkaline substances are used. Giving a good shampoo means being thorough in every detail and inevitably builds up a reputation for the one who can do the work well. SHAMPOOING BEFORE A HAIR DYE No matter what the dye may be, the real object of a shampoo before a hair dye is to remove all traces of oil. So whether one is to have a henna or other dye, in addition to the use of the regular shampoo mixture, about a quarter of a box of baking soda should be emptied into the basin of THE SKIN 259 water and poured over the head in connection with the use of the shampoo itself. Continue to rub and rinse until the hair is free from every trace of oil. Then, after also being certain that all the soda has been removed by rinsing process, the hair may be dried and the dye applied. SHAMPOOING STICKY OR MATTED HAIR Occasionally one finds patients who have used peroxide on their hair. In cases of this kind it is almost impossible to give a satisfactory shampoo. The hair feels gummy and sticks to the comb. Inexperienced operators are apt to blame the shampoo mixture, while the patient declares her head is not clean. Here, too, a little soda in the water helps matters (recol- lect, common home baking soda, not washing soda). Several applications of the shampoo mixture must be made and the hair very thoroughly rinsed in water and finished by having a finishing rinse of the juice of one lemon added to a pint of water, or half an ounce of acetic acid used in the same manner. SHAMPOOING AFTER A HOT OIL TREATMENT When the hair has been saturated with oil, it naturallv follows that more shampoo must be used to get the scalp free from any such appearance. Hence, often it will be necessary to use the soda in the water and repeat the applications of shampoo mixture sev- eral times until every particle of oil has disappeared. An easy way for the novice to test this fact is to hold up a lock of hair. Then if the bubbles of water seem to separate and cling to the hair it denotes an oily condition. Otherwise there will be a uniform appearance. 260 THE SKIN THINGS TO REMEMBER Before commencing the shampoo see that the gown is thoroughly protected and the lady seated in a comfortable position. Use a small brush about the sides of the head, front and back in order to thoroughly cleanse. If there is a thick coating of grease on the scalp use a little alcohol on cotton before applying the shampoo. Be careful to have the shampoo mixture warm before pouring it on the head. Nothing is more disagreeable than the cold, slimy feeling from the unheated mixture. Rub the scalp with the finger tips. Don't scratch. If the hair is long, pour the shampoo over different sections and rub thoroughly. Use plenty of water for rinsing, beginning always with warm and ending with cool. Never be persuaded to rub the hair dry. You use too much friction to be good for the scalp and do not produce as good a result as with the mild heat of a good dryer. Do not confound a sunbath with drying the hair in the sun. The former is excellent, the latter makes it streaked. Never direct a current of cold air, even in summer, against the patient's head. It is dangerous and may pro- duce a number of bad results. In winter be sure that the shampoo room is warm and be very particular that the hair is perfectly dry before your patient leaves the shop. In fact at no season of the year should there be any carelessness in this respect. In treatment of all scalp diseases add the antiseptic oil to the shampoo for the germicidal effect. Always apply follicle lotion after the shampoo, as it leaves the scalp in excellent condition. THE SKIN 261 Be sure to use a fresh comb and brush both before and after the shampoo. Never use the same articles twice. Cleanse the shampoo board with soap and water first, then use a four per cent solution of formalin after each shampoo. Don't forget to cleanse the under as well as the upper part of the shampoo board. Bear in mind that the more pleasing the shampoo, the oftener will your patron return. CHAPTER XXVIII CARE OF THE SCALP One of the greatest drawbacks to the successful giving of scalp treatments is the fact that the great majority of people never consider the necessity for frequent and sys- tematic exercise of the scalp until a marked hair loss has commenced. Sometimes the person so afflicted waits for months before consulting the specialist and then is only willing to come at irregular intervals, objects to the use of oily sub- stances, thinks electricity harmful and has a hundred and one other fanciful objections to offer to the woman who is trying to do good work. It is small wonder then, that with all sorts of things working against her efforts and with but little knowledge of the subject, the great majority of people w T ho are engaged in this line of work have but little faith in the real efficiency of scalp treatments. It is for this reason there exists the positive necessity for a real understanding of what the hair is, how it grows and what may be done toward keeping it in a healthy condition. Added to this knowledge must be personality so posi- tive that the patient will be perfectly willing to promise obedience in following directions and in taking treatments as frequently as the case demands. With these requisites and a sufficient stock of patience, any operator can be reasonably sure of acquiring more than a local reputation for her skill in caring for the scalp. 262 THE SKIN 263 The care of the hair forms a more important part of our daily lives than most people realize. Among savages, or those who expose the uncovered head to the light and air, disease is seldom encountered, while long, luxuriant locks are the rule. Trappers, hunters, sailors, and in fact all men who live a normal out-of-door life and are not addicted to dissipation prove this rule. Civilization on the other hand tends to weaken this growth. Heavy hats, quantities of extra hair, hairpins kept firmly in place, warm rooms, late hours, indigestible foods, all tend to reduce the quantity as well as the quality of the hair. When in normal condition the hair is glossy, flexible and full of life. Ill or indifferent health at once shows its effects by the dull lustreless appearance that results. Any serious alteration in the blood is sure to tell sooner or later upon the hair. Increasing experience will convince any one that the hair is often an index to the general health and that in obstinate cases of falling hair systematic as well as local treatment is needed. Among the disorders that play an important part in hair loss are found anemia, indigestion, constipation, rheu- matism, nervous disorders and any form of dissipation. Specialists are also now convinced that practically every case of hair loss, dandruff, premature greyness, excessive dryness or oiliness, in short, all ordinary troubles are greatly assisted by the presence of germs. The hair being a very good trap for dust and germs is of course constantly covered with these tiny micro- organisms. In good health they may be almost harmless, but as soon as the physical condition is less vigorous and the resistance lowered, they find the watched for oppor- 264 T H E S K I N tunity and commence at once to lend their aid to the process of destruction. Modern treatment must then be based on the use of antiseptics that will at least render these germs harmless. In addition, manipulation, electrical treatments and certain applications are indicated for the purpose of increasing the blood supply to the scalp and making the surface flexible and healthy. Before taking any case of treatment the operator should, however, be thoroughly informed on the necessity of sterili- zation. ADVICE TO THE PATIENT The patient should be advised that it is absolutely neces- sary to pay strict attention to her own combs and brushes at home, that they must not only be washed and cleansed, but also sterilized with the formalin solution at least once a week in order to keep them in good condition. When the patient applies for treatment, she should have a careful explanation of the germ theory and the operator should insist upon sterilizing all of the extra hair and giving a shampoo before a treatment. The patient must also promise to have her own brush and comb cleansed and sterilized immediately upon returning home. In this way alone can one combat germ troubles suc- cessfully, as otherwise treatment would only help tempo- rarily. The cleansing of the superfluous hair is easily accom- plished by rinsing it in gasoline to which a little formalin has been added and then placing in a sterilizer exposed to the fumes of the formalin while the treatment is given. Unless this precaution is taken, the operator is posi- tively avoiding her duty and should be severely reprimanded. Ijvenient. C 1 Fingers in Rotary Motion 266 THE SKIN Many cases of scalp treatment owe their retarded re- covery to the operator who is not strong enough to insist upon her directions being carried out. In addition to the sterilization of brushes and extra hair, there should be a positive rule that a shampoo be given at least every two weeks and that the treatments themselves are taken whenever they are necessary, and not when it happens to suit the convenience of the patient. With scalp treatments as with many great enterprises we do not meet results, except by reiterated efforts and often the first proof of success comes at the instant when we had almost despaired of success. In the directions for the treatment that will follow, the only requisite for success is patience and conscientious adherence to the suggestions. Success is sure to follow. The most important requisites for a really fine condition of both hair and scalp apart from the very necessary cleanli- ness are ventilation and the proper amount of friction. In many instances where delicate children have the trouble of scanty locks as well, the systematic care after weekly sham- poos has done wonders. No matter whether the hair is extremely oily, or exceptionally dry, long or short, the foun- dation of all good work is based on the adoption of cer- tain sensible rules, and it may be confidently asserted that if more people would understand and practice these instruc- tions there would be few cases of bald heads. The process of giving scalp massage is daily gaining a wider recognition on account of the immense benefit de- rived wherever this practice has been faithfully carried out. It is given for the purpose of causing a healthy con- dition of the scalp, and always follows the application of something like the follicle cleanser, a mild antiseptic much used for cleansing the surface of the face or scalp. Scalp Movement. Holding Fingers Firmly and Pressing in Alternate Directions 268 THE SKIN Naturally in very much diseased conditions, the scalp massage cannot be given, but instead local application may be made and the use of the flat electrode in the prismatic ray treatment made to replace the fingers. Otherwise, however, after the scalp is. thoroughly cleansed with the follicle cleanser, the faradic current may be procured and the operator will fasten the electrode to her own wrist. The patient will hold the other electrode, the scalp will be thoroughly moistened with the tonic indi- cated by conditions found, and the treatment will proceed as follows : First, hair should be parted in straight lines from the forehead to the back of the neck. Then commence from the forehead and use the first two fingers of each hand in a rotary movement that affects the entire scalp, moving toward the crown of the head. Continue this from all parts of the head, back and front toward the crown. Next, with the thumbs kept stationary, and fingers spread out under the hair, a general circular movement should be given that will move the scalp, first in one direc- tion and then in another as shown in illustration. By these movements continued over entire scalp a very thorough treatment may be given. The operator must re- member not to draw her fingers over the hair in a brisk rubbing but to move the scalp under her fingers in a deep rotary movement. The scalp must be kept very moist as the hair is a non- conductor of electricity and unless it is dampened, the cur- rent will have no appreciable effect. Following the manipulation will usually come the use of the sanitary hair brush with the galvanic current that is indicated, or the prismatic ray may be used. In the use of the brush it must be dragged slowly over THE SKIN 269 the scalp so that each portion is affected by the electric current, always remembering that the scalp must be kept moist. A brisk rubbing makes the treatment absolutely use- less as no particular sensation can be felt. The sanitary hair bush is much used because it can be cleansed so thoroughly and will last a lifetime no matter how often it is sterilized, whereas those with the rubber backs are not only uncleanly but are short-lived affairs. In ordinary treatments, the following rules are ob- served : First, the scalp is cleansed with the follicle lotion. The hair is parted and tonic indicated applied. Next, faradic current is used with finger manipulation. Last, more tonic and use of the galvanic current indi- cated by means of the sanitary hair brush electrode. Blue lights may also be used last of all to aid in dry- ing the tonic from the hair and also for the antiseptic effect of the light. CHAPTER XXIX COMMON DISEASES OF THE HAIR AND SCALP Usually the first thing an operator is asked is, "Can you help me from losing all my hair?" There may be a dozen reasons for this condition, but none of them count with the patient. What she wants is relief and that as quickly as possible. The operator, on the other hand, before making any promise at all, must examine the scalp, note whether it is anemic or irritated, examine the hair and see whether it feels full of life, soft and silky, or harsh and brittle. An observation should also be made of the general appearance of the patient to see whether she appears in good or bad health. Then and then only, can an intelligent answer be given. Naturally a well trained operator will be able to recog- nize all of the ordinary scalp diseases and call them by their proper names. She may not, in fact she usually will not, consider any attempt at treating difficult cases, but she should be able to recognize them. In the study of scalp diseases, the term Alopecia is very frequently encountered. It always means a falling of the hair. The word associated with it simply indicating what one of the various forms of hair loss is indicated. Alopecia Areata means a falling in patches or areas as shown in illustration (page 271). The trouble may come on suddenly, within twenty-four hours in fact. The hair may be most luxuriant and apparently healthy and yet suddenly perfectly bald and shiny white patches will appear without one spear of hair. 270 1 * If! ^ Use of High Frequency for Alopecia Areata 272 THE SKIN Specialists differ as to trie causes. Some declare the trouble to be of germ and others saying it is of nervous origin. As it usually comes after a nervous shock or strain, there are more who favor the theory of nervous origin, but at any rate, in order to be on the safe side, treatment should be so planned that both conditions may be considered. Alopecia Areata First of all, a thorough sterilization of extra hair, combs, brushes and even the inside of hat linings should be given and the patient instructed to carry out the same process at home. A shampoo must be given before treatments and then the entire surface carefully treated by the follicle lotion. If the scalp is very dry, hair tonic for dry scalp may then be used, and if oily the other tonic should be applied and THE SKIN 273 faradic current with finger manipulation given. Then the negative current should be used as strong as it can be borne, devoting especial attention to the affected portions and continuing the stimulation as long as the patient will allow it. Last of all, a little of the scalp ointment may be rubbed in and the blue lights used over the entire surface, or the prismatic ray used in conjunction with the scalp food. When possible electricity and application of the scalp food and prismatic ray treatment should be given for six days in succession and then a shampoo given. Then the same treatment may be repeated and the scalp food applied two or three times a week for at least two months. The patient in the meantime of course using the tonic indicated at home. As a result of this treatment, a fine growth of hair will soon be seen. Oftentimes this new growth comes in per- fectly white, but many times the use of electricity and proper remedies seems to aid in bringing it back to the natural color. Alopecia Congenita — A natural absence of the hair — is rarely amenable to treatment. There are cases in which this condition has been found generation after genera- tion in the same family. Occasionally people are born who are totally bald. With others there is a thinness of the hair in certain sections, for instance on the back of the head or on the crown. At other times, there is merely a generally thin condition. In cases of this kind, just the stimulating scalp treat- ment may be given and the patient told that nothing can be promised in he way of producing an abundant growth, thus the scalp and hair can be kept in a healthful condition by proper attention. 274 THE SKIN Alopecia Pityrodes — also called Pityriasis and some- times considered as Seborrhoea Sicca, is a form of hair loss in which the scalp is covered with fine or bran-like scales, and is usually accompanied by intense itching, the scalp itself feels dry and parchment-like and hair is hars'h and lustreless. This condition is frequently a result of constitutional trouble and is often difficult to treat. Pityriasis First, of course, the shampoo must be given and then the follicle lotion used. If the scalp is extremely sensi- tive, the finger manipulation with the faradic current may be omitted and the scalp food applied with prismatic ray or blue light. The reason for the use of the scalp food in this case is especially for the germicidal effect and also THE SKIN 275 because of its action on the oil glands. The follicle lotion should be used once a day and the scalp food applied with the blue light until after the sixth day, the shampoo may be given and this may be followed by a stimulating Alopecia Senilis treatment and use of the antiseptic oil instead of the scalp food. These remedies may then be alternated and for some two or three months giving treatments at least three times a week and shampoos once a week until condition has improved. Great care must of course be taken in sterilization of hair brushes and hat linings. Alopecia Senilis is the natural loss of hair occurring in old age. Hair becomes lustreless, shining and gray. If 276 THE SKIN the scalp appears shining and tense, little can be promised. Otherwise repeated effort may bring out a fresh growth of hair. The treatment will be stimulating, using tonic indi- cated by condition of the scalp and much blue light and antiseptic oil should be used occasionally also. Alopecia Symptomatica is the name given to a fall- ing of hair that is caused by some general disturbance. The treatment here must be entirely stimulating and should be continued for an indefinite period. Much stimulation, a great deal of the faradic current, use of the blue light and prismatic ray will all be of benefit in these cases. Brittleness of the Hair — This condition is usually found in cases of disturbed nutrition. It may be due to nervous strain, to a fever or to some local disease. Split ends frequently appear and the hair breaks off so that it never gets beyond a certain length. In addition to a general tonic, much attention should be paid to the most stimulating form of scalp treatment with the use of the follicle lotion alternated with the tonic, each night at home and much rubbing with the fingers. Office Treatment will consist of first cleansing with the follicle lotion, then manipulation with the faradic cur- rent, then use of either the negative galvanic current or the prismatic ray. The blue light will be used at the last to remove superfluous moisture and also because of the effect on the scalp. In all these cases, the split ends should be clipped off and not singed. Canities, also called grayness of the hair or whiteness of the hair. This condition is said to be brought about by the absence of the pigment and the appearance of air spaces in the cortical substance of the hair. When the grayness is due to loss of pigment there is observed a slight or some- Use of Ideal Scalp Electrode with High Frequency for Scalp Treatments 278 THE SKIN times a pronounced yellow tint. When due to presence of air spaces, it appears gray or snow-white. Canities is of two forms — congenital and acquired. In the congenital kind, we find the albinos, who are also afflicted by an absence of pigment in the rest of the skin. Frequently, too, there are found people who have been born with a white streak or tuft of hair which has been handed down for generations. Acquired canities may be premature, senile or acci- dental. In the premature form, children of fourteen have been known to have perfectly white hair, while it is quite com- mon to see cases that have turned white at eighteen and twenty. In these instances, no treatment has any effect whatever. Senile canities is the natural accompaniment of old age and cannot be helped by treatment. The only remedy is a dye. Accidental canities in the form occasionally encoun- tered in which a patch of hair will come in perfectly white as in after a case of alopecia areata, and perhaps this streak will occur after a severe attack of neuralgia. Treatment is seldom productive of good results in restoring color in either the premature or senile canities. Though cases are on record where the prolonged use of the electric current has brought back the natural color. Often in cases of accidental canities, treatment has made the hair a uniform color. This of course was the ordinary scalp treatment. Eberhart reports cases in which the use of high fre- quency currents was productive of the desired results. This, however, only occurred after months of treatment. THE SKI X Consequently when one desires to conceal the appear- ance of grayness, there is only one immediate remedy and that is the use of a dye. Ordinary scalp treatments must be conducted with great care, because of the tendency to make the hair yellow. Shampoos should be given very cautiously, only the special hair tonic indicated should be used and at no time should a very hot iron be used. Stimulation by electricity, the use of the blue light and brushing imparts a brilliance to pure white hair that is very beautiful. Dandruff, see Seborrhoea. Eczema, as described in the chapter devoted to that subject, is frequently found on the scalp. It is many times associated with seborrhoea and sometimes confused with psoriasis. The distinguishing point between eczema and seborrhoea is that one is a greasy but not inflamed surface, while with eczema there is frequently inflammation and often an oozing of serum. Eczema may also be told from psoriasis because of the difference in way of forming, eczema usually appearing in confluent patches, while in psoriasis there is a tendency to a circular shape. The scales in eczema are usually yellow, while those in psoriasis are silvery white. Lifting the scales or crusts in eczema leaves an inflamed surface with serum, while in psoriasis a tiny bleeding portion is disclosed. Pediculosis, use of hair dyes, scratching the head are all causes for the appearance of this trouble, aside from the original constitutional tendenck Treatment coi> n the cleansing off of the patch This can usually only be accomplished by the application of the scalp ointment or the antiseptic oil for several days in succession, until crusts are softened. Then a shampoo may 280 THE SKIN be given. The follicle lotion may also be used for cleans- ing the surface before use of the scalp food. The blue light should always be used for forcing in the scalp food. Prismatic ray is of especial benefit in all of these cases. . •■ ES1K •" - lit '<$*"- '„ ' -- ." Favus Favus is not commonly seen in America. It is due to a fungus that invades the hair follicle and tends to grow up and out in the shape of a tiny cup. Beginning as a small red spot, it gradually turns yellow, forming a cup-shaped orifice. The hair in affected areas always fall out, rarely to return. It is a disease said to be communicated by cats and may attack other sections of the body, including the nails. It is extremely objectionable and can always be told from THE SKIN 281 the mouse-like odor emanating from the affected portions. Treatment should not be attempted at the office. Treatment consists in removing with epilation forceps every affected hair. Surface may then be swabbed with antiseptic oil and the scalp food forced in with the blue light, continuing this treatment for a week, when shampoo may be given and treatment continued until the scalp is clear. The affected hair must be in the meantime removed. Operator should wear rubber gloves and everything should be scrupulously sterilized, that is in or about the patient. Gray xess of Hair, see Canities. Body Lous Louse Nit Pediculosis Capitis is the term used to describe the ordinary head-louse. These parasites are found as a rule among uncleanly people but are often seen among those of the wealthy classes and may be easily communicated in street cars, berths on the sleeping cars, or in toilet shops where extreme caution is not maintained. Although harmless in themselves, these pediculi cause an irritation that induces an intense scratching and from this many forms of disease may result, such as eczema. The pediculi themselves are easily killed but their eggs in the shape of "nits" frequently resist ordinary measures 282 THE SKIN and hatch out in a few days, producing fresh crops of these pests much to the mortification of the victim. Any one of the well known antiseptics, such as formalin, carbolic acid or a mercury preparation will kill the pediculi but these preparations will not affect the nits or eggs. These are fastened to the hair by a gummy substance ap- pearing like little white or grayish lumps. Many times when the scalp has been neglected the hair is covered with these nits for a distance of an inch or so. Cheap hair is frequently sold just because of the pres- ence of nits. The purchaser buys it ignorantly and in a few days finds her head swarming with the pests that have been hatched out by the warmth of the scalp. Treatment of course consists in an application that will at once destroy the parasites and will also aid in dis- solving the nits. For this purpose nothing is better, less harmful to the hair and less dangerous to the patient than the use of tinc- ture of larkspur. The hair should be saturated with it and the patient made to sit for an hour or so before the shampoo is given. Then the scalp food (also excellent for destruc- tion of the pediculi) may be rubbed in. The next day more larkspur should be applied the length of the hair ; and the following day another shampoo given. Repeat the application of the scalp food again. The hair should then be examined for "nits," and if more are present more larkspur should be used and this treatment continued until every trace has been destroyed. In this connection, too, one must be careful to see that hat linings be treated also, as occasionally stray pediculi are found there. When the hair is much infested, treatment should be given at the patient's home and not at the office. It is T H E S K I N 283 customary to make a reasonably large charge for this atten- tion. Psoriasis though not as common as eczema is still very frequently found and is usually accompanied by intense itching. Psoriasis It is found over the entire body as well as on the scalp and is told from eczema by the following points of differ- ence. It tends to form in circumscribed patches, not in con- fluent masses. It is formed of silvery or at least white looking scales that are found in eczema. When scales or patches are lifted, tiny bleeding points are seen beneath, whereas in eczema an inflamed and usually oozing surface is disclosed. 284 THE SKIN No authorities promise a cure for this condition, though marked relief can certainly be obtained through persisting and never ending attention. Treatment is as follows : First, cleanse the scalp with the follicle lotion, then apply the scalp ointment and force Ringworm in with the blue light or glass electrode of prismatic ray. If latter treatment is used, the electrode may be moved about sections affected until surrounding skin looks pink. The application of scalp food should be continued until patches are dryer and may be lifted off when an application directly over the affected surface should oe made. Shampoo may not be given until scalp is covered with dry patches. The negative ball electrode may also be used over surface after patches have been removed, though prismatic ray will be found the cleanest and most effective treatment. THE SKIN 285 Ringworm or Trycophytosis is an inflammatory dis- ease resulting from a parasitic growth. This disease is found both upon the body and the scalp and is manifested by small round patches in which the hair appears as broken off all about the edges while the center is often clear or covered with fine scales. Sometimes half spheres filled with, semi-fluid, very painful to the touch, are found. This disease is extremely contagious and one would not care to have the average person touch it, hence it should always be referred to the physician. The operator runs too great chances of infecting herself and other patients to treat it. If in a small town where no physician will attempt it, the antiseptic oil alternated with scalp food may be applied, all affected hair must be removed with epilation forceps and applications continued daily until conditions are improved. Ringed Hair — Quite frequently persons will apply for treatment, stating that the hair is changing in color. Some- times it will be of a uniform shade to a certain distance and then all of a sudden an abrupt and decidedly artificial look- ing change of color will be presented. Occasionally, the entire length of the hair will have a banded appearance, looking as though white rings had been alternated with the original color. This condition may affect the entire head or just single clumps. It is often found in connection with the white spots of the nails and is usually associated with some nervous disturbance. Noth- ing in the way of treatment can be said to be of positive benefit, though of course manipulation and electricity with a stimulating tonic will be of use in improving the condition of the scalp and in time this will affect the hair. Seborrhoea, commonly called dandruff, is a functional disease of the sebaceous glands characterized by an exces- 286 THE SKIN sive deposit of sebum. It is the commonest cause of bald- ness and it is very frequently found in connection with anaemia, dyspepsia, constipation, rheumatic troubles and after convalescence of severe illness. Although no separate germ has been selected as being the chief factor in seborrhoea, the majority of specialists now declare that is is of an infective nature by watching whole families in which there is a tendency to this scurvy condition. Seborrhoea may take on several different forms from the yellow cradle crust of the infant, which if neglected often causes thin hair for the rest of life, to the drops of oil exuding about the nose, forehead and cheeks of the colored people, and also from some of the white races. Occasionally one will find cases in which there has been an excessive deposit of seborrhoea that has persisted for years and yet both hair and scalp are otherwise healthy. These cases of course form such a marked exception that they should not be taken as guides, for sooner or later, trouble is sure to ensue. Aggravated cases of seborrhoea are sometimes mistaken for eczema and are occasionally confounded with psoriasis, but as mentioned before, can usually be told because of the fact that a removal of the crusts or plaques leaves no in- flammatory condition. - When persons are in good general health, there is every chance of arresting this process and restoring the scalp to a healthy condition, though of course after fifty, one can- not expect as good results as from those of fewer years. Still there are cases on record in which people of seventy years, have under the constant use of electricity and manip- ulation been rewarded by a fine growth of hair. Patience T H E S K I N 287 and perseverance will no doubt work most wonderful effects but treatments must begin at regular intervals. Seborrhoea is manifested in two forms. Seborrhoea Sicca is the dry, powdery form in which the scalp itself feels dry, and is covered with fine, white scales that dust off, powdering the clothes and causing a generally untidy appearance. The hair is usually dry and lustreless. Seborrhoea Oleosa denotes an extremely oily condi- tion characterized by the exudation of drops of oil found on the face as well as the scalp and making the hair greasy and unpleasant to touch. Often in these conditions, the scalp appears anaemic. Another form of seborrhoea oleosa is that in which the head is covered with plaques of greasy deposit, requiring quite a bit of effort to remove. Seborrhoea oleosa requires the use of oily substances at first because the oil glands themselves must be reached by the various medication in order to really remedy the trouble. Just a plain shampoo will not sufficiently cleanse the scalp, so when the condition is extremely obstinate the follicle cleanser should be first used, then the scalp food forced in with the blue light and after this the stronger shampoo should be given with the faradic current after a liberal application of the tonic for oily scalps. Following this, if the condition has been very obstinate, the positive galvanic current may be used and then more scalp food forced in with the blue light or the scalp food may be rubbed into the scalp well and the prismatic ray used for forcing it in and also for stimulation. The patient should apply the oily hair tonic each morning, rubbing the scalp briskly for at least ten minutes. The scalp food should be used every night and at least three scalp treatments given the first week. On the sixth day, another shampoo 288 T H E S K I N may be given and then the use of the tonic for oily scalp resumed, using it at night instead of the morning. The scalp ointment may be applied twice the second week and once the week after and continue the same until a decided improvement is manifested. Seborrhoea Sicca — Dry dandruff requires rather a different treatment. In this, after the scalp has been cleansed with the follicle lotion, the manipulation may be given with the faradic current and then use the hair tonic for dry scalp followed by the use of the negative galvanic current. Then the antiseptic oil may be applied, using the blue light or the prismatic ray. The patient should have three treatments a week and use the antiseptic oil at night and the tonic in the morning for six days, when a shampoo may be given and the antiseptic oil discontinued for three days when it should be applied at night and the tonic used in the morning. In three days this oil should be applied again and after that only the use of the tonic will be neces- sary at home if the office treatments are continued. Of course the oil is always applied before a shampoo. HINTS TO OPERATORS Impress upon your patients the importance of the sterilization of their own combs and brushes at least once a week. Never take a case for scalp treatment without first giving a thorough shampoo and also sterilizing the extra hair. When in doubt about an infectious disease, add more antiseptic oil to the shampoo. Remember that greasiness, irritation and dandruff indi- cate a diseased condition of the scalp even when no other symptoms are present. T H E S K I N 289 Never attempt the treatment of a badly diseased scalp when it is possible to avoid it. When in certain emergencies such attention is necessary, do your work only at the patient's home, remembering always the danger of infection to yourself and to other patients. Do not lose sight of the fact that in the earlier stages of disease all ordinary forms of scalp trouble are curable. Tn more advanced cases hair loss may be checked or a healthy growth induced, though former luxuriance cannot be promised. The blue light not only has a germicidal effect, but is valuable in increasing the glossy appearance of the hair. Do not neglect to inform your patient that nearly all cases of falling hair can be traced directly to neglected dandruff or an irritable condition that has sometimes per- sisted for years. Be firm in your insistence regarding the scalp food. It is one of the most valuable assistants you have because of its marked germicidal effect. By using care, the hair will not appear so oily and the results will be excellent. In talking to your patient do not promise wonders. Insist upon at least three months' work IN ANY CASE. Reflect that the average healthy growth of hair is only about six inches a year. Therefore, if stimulation does bring about a new growth it can hardly be perceived inside of three or four months, while a year's treatment is none too long for difficult cases. Don't worry if the first few treatments seem to increase the hair loss. Often the manipulation will aid the old hair in dropping out, but by the same token it will also aid the new hair in coming quickly. Always refer difficult cases to a physician and then if he so decides you may work under his direction. 290 THE SKIN Ringworm, itch, favus, and sycosis will be frequently encountered, but one should never be anxious to treat such cases as there is always danger of infection not only for yourself, but also a chance that you may infect your other patients. In acute scalp diseases, where there is a complaint of much irritation, examine carefully to see if this trouble may not be caused by the presence of pediculosis. Remember that it is rarely necessary to cut the hair in order to successfully treat obstinate scalp diseases. Avoid any unnecessary responsibility. The more you know, the less you will think you know. Limit your work to just the cases you feel you can care for successfully and always refer anything of a doubtful character to a physician. Don't criticize. Remember the other operator may be just as sincere as you are. The woman who is absolutely and always and without any shadow of a doubt successful would be too wonderful to be true. Above all, in every treatment of any kind of trouble be scrupulously clean and thus limit the chances for an infection. CHAPTER XXX SCALP TREATMENTS HOW TO GIVE THEM FOR RESULTS Although various treatments have been suggested after each form of scalp trouble mentioned, but little stress has been placed on the best method of giving the every day work. Many times people suffering from hair loss positively refuse to consult a physician and insist on having scalp treatments with their shampoos, hence a system of using certain antiseptics, some form of stimulation, and a general method of procedure is really a necessity. It has been agreed that most scalp trouble originates from germs, and these invaders continue to make trouble unless they are dislodged by some vigorous action. Oily substances penetrate the follicles easily and with them carry the medications necessary to discourage further trouble. Many times where scalps are unusually tender very mild antiseptics are necessary and for this reason the antiseptic oil has been selected. It penetrates, heals, stimulates, and yet rarely if ever irritates. It may be used absolutely pure with no injury, but in the majority of cases it is better to add it to four parts of pure castor oil. The idea in using the castor oil is to select an oil with some curative properties, as well as one that is decidedly softening to the hair — for in many scalp troubles, the hair becomes harsh and dry. Therefore, if you would obtain the best results always mix the antiseptic oil with the castor oil and do not try 291 292 THE SKIN something "just as good," recommended by some one who knows nothing of the subject. The oils may be mixed ready for use, but should not be heated and then poured back. Hence, only pour from the bottle enough for each treatment, and keep tightly corked the rest of the time. HOT OIL TREATMENT This treatment is given for the relief of itching scalps, seborrhoea sicca and hair loss. When the hair is very dry the application should be made down the entire length. For the scalp alone, about two tablespoonsful are neces- sary. In aggravated cases, the pure oil is used. As conditions improve, the mixture may be made less until finally the original proportion of one to four is em- ployed. Any scalp is benefited by an occasional treatment. The procedure is as follows : First, go over the entire scalp with a pledget made by wrapping gauze around cotton saturated with follicle lotion. Next, pour two tablespoonsful of the mixed oils into a small enamel dish and heat. Apply this to the scalp as hot as it can be borne. If the hair is very dry, use more oil and apply down the entire length. For ordinary cases bear in mind the mixture is made by adding one part of antiseptic oil to four of castor oil. For stubborn cases equal parts should be applied. For extreme cases the pure oil may be used. As soon as the application has been made, a treatment with the prismatic ray, lasting for about fifteen minutes, should be given, using for this purpose the special scalp electrode. nmBsua THE SKIN 293 If the patient cannot allow the oil to remain on over night, the head is then enveloped in a towel for from thirty minutes to an hour and then a shampoo is given. In very difficult cases it is well to allow the mixture to remain on over night. Hot oil treatments should be given once a week in bad cases, and once in two weeks for ordinary conditions. TREATMENT FOR DRY SCALPS AND SEBORRHOEA Begin the course of treatments with hot oil treatment, continuing the use of the oil down the entire length of the hair, and leaving it on all night. Next day cleanse with follicle lotion, give manipula- tion with faradism for about fifteen minutes and then use tonic for dry scalp with negative galvanic current for the same length of time. If the scalp is also covered with small scaly deposit, apply scalp food next, and force in with blue light. If hair is dry and brittle, and there is much hair loss, use tar tonic and the blue light. For home treatment, alternate the use of the tonic for dry scalp and tar tonic, using the scalp pomade for office treatments or vice versa. Sometimes work is necessary for more than six months before a radical improvement is noticed — and of course the bodily condition will also have a bearing on this question. Where there is a wasting disease, or where the patient is extremely nervous, a longer time will be necessary. PRISMATIC RAY TREATMENTS FOR DRY SCALP The same procedure is followed, only using the pris- matic ray in place of the faradic current and applying the sedative current in the beginning of the treatments. 294 THE SKIN In any case it must be remembered the use of the tar tonic should follow the use of the prismatic ray, and should not be used with the current at any time, owing to the danger of causing a conflagration. The heat generated from the electrode and the tiny sparks that sometimes fly make it impossible to use any substance in which there is alcohol without some danger of igniting it and thus scorching the hair. ECZEMATOUS SCALPS Very often, especially in the smaller cities, physicians will send to the cosmeticians patients who are suffering from an eczematous condition of the scalp in which a shampoo is absolutely prohibited, until the scalp is better. The following treatment will absolutely help almost any condition : Cleanse the scalp by applying follicle lotion on gauze pledgets, by pressing gently over each section. If there are spots, exuding serum, after this cleansing process, hold the flat electrode of the prismatic ray some distance from the spots and gently spark the surface for about five minutes. Then apply pure antiseptic oil to the parts affected, using the flat electrode over entire surface with a very low current. Repeat this treatment every other day until surface is healed, and then shampoo with eggs and bran water, applying the oil immediately afterwards. In some instances, it is necessary to use nothing but this mild shampoo, for some months, continuing with the antiseptic oil until condition is entirely relieved. THE SKIN 295 FALLING HAIR Where there is an excessive hair loss, without any apparent physical cause, nothing has given quicker results than the use of the tar tonic. After cleansing the scalp as usual with follicle lotion, and giving finger manipulation with the faradic current, the stimulating current of the prismatic should be used for fully fifteen minutes and after this the tar tonic applied. In order to avoid getting it all over the hair, it may be applied with cotton fastened to the end of the orange wood stick, or by means of a special applicator. The tonic should also be used at home and a shampoo taken once a week until conditions are much better. Where excessive dandruff accompanies this loss of hair, the scalp pomade and tar tonic may be alternated. The remarkable results attendant on the use of this antiseptic, not only in checking hair loss, but also in pro- moting a new growth of hair, have been so remarkable that it is not at all difficult to persuade patients to overlook the odor and persist in frequent applications. ITCHING SCALPS Very frequently one finds instances in which there is such an intolerable itching of the scalp that the patient is nearly wild. Oftentimes this condition is an accompaniment of psoriasis, and the victims are really beside themselves for want of relief. For this purpose nothing has been found better than the application of the scalp pomade and the use of the prismatic ray. In very severe instances where there is an excessive 296 T H E S K I N deposit, it is not well to apply the finger tips to the scalp at all. Hence the advantage of this treatment : Cleanse the scalp with follicle lotion applied by means of gauze, being careful to "dab" and not "rub" it on to the surface. Then apply scalp pomade in the same manner. Use the blue light for forcing it in and then use the prismatic ray, sedative current. If possible give these treatments daily for six days and then shampoo, applying the scalp pomade again and always insisting that itching spots be coated with this substance once a day until conditions are better. While a cure cannot be promised, relief has in every instance followed this treatment. TREATMENT FOR OILY SCALPS AND SEBORRHOEA The trouble is so obstinate that it requires much time and patience to produce results. Hence the idea of giving treatments at least twice a week, and alternating with the preparations used. Begin with the hot oil treatment, to which one-half spoonful of scalp pomade has been added. The next treatment will require the following pro- cedure : Cleanse with follicle lotion and manipulate with the finger tips, using faradic current. Then apply tonic for oily scalp and use negative gal- vanic current for about fifteen minutes. Use tar tonic and force it in with the radio bell. If the patient can not allow this mixture to remain on over night, shampoo and instruct her to use the oily hair tonic one night and the tar tonic the next night, rubbing well with the finger tips. T H E S K I N 297 For the third treatment, give manipulations as usual, use negative current with tonic, use positive galvanic cur- rent, then apply scalp pomade and blue light. Fourth treatment, give hot oil with scalp food as before and continue in the same method till the condition has so improved that it will be only necessary to use the tonic for oily scalps at home. Naturally the patient objects to the oily condition and the use of antiseptics of so decided an odor, but results soon quiet these objections, so on this point be firm. The use of shampooline at home after the use of any of the oils will entirely remove the sticky appearance and thus do away with much trouble. PRISMATIC RAN' TREATMENT FOR OILY SCALPS When this form of electricity is used as an adjunct to the treatment, and in fact in nearly every case it is neces- sary, the use of the faradic current should be omitted. After the scalp pomade has been applied the stimulat- ing current may also be used with the flat or, better, the special scalp electrode for about ten minutes until the scalp tingles. Should any irritation result from the use of this stimu- lation and the antiseptics, omit the use of any preparations but the follicle lotion until the scalp is normal, and then use the tonic for oily scalps and positive galvanism, followed by the antiseptic oil alone, full strength, next two treatments. Where the tar tonic is to be used, the prismatic ray must be applied first, and the tonic afterward. REMOVING SNARLS FROM HAIR After a protracted illness, frequently the hair becomes so snarled that nothing but the scissors seems to afiford any way of again using a comb. 298 THE SKIN Many women dread the loss of hair in this manner, so usually the cosmetician is sought in the hope of avoiding such a calamity. Two remedies have proved efficacious, but both entail hours of work. The one is the use of a powder obtained from any drug store, called Lycopodium. This is sprinkled over the hair very lavishly. Then beginning at the ends and combing up gradually, with a coarse comb, the work is commenced and continued until finally the hair is in normal condition. If the patient seems too weak to stand all the treatment in one day, the process may be continued for several days until the work is finished. Another method is to soak the scalp and hair with olive oil and attempt the same thing, using the comb from the ends of the hair and always attempting to avoid any undue pulling. CHAPTER XXXI HOW TO FURNISH THE TREATMENT ROOMS One very decided rule that may be applied to the fur- nishing of all treatment rooms is that nothing but the really necessary articles should ever be included in the list. Each room or booth should be equipped completely so that there may be no necessity for the operator to rush wildly about in search of the necessary electrode or indis- pensable something else that is always in the "other booth." Tiled floors, or at least linoleum, should be used for sanitary reasons, and either sanitas or painted walls. No decorations of any kind should be found in the operating department. While the careful operator, especially if she treats people of both sexes, will avoid the appearance of having too much privacy, still it is absolutely necessary for the success of any business that each booth be screened or cur- tained from observation. Xo matter how intimate two friends may be, they often will avoid going to the same person for treatment simply because they feel there is not enough privacy and one does not wish the other person to know just what her treatment may be. Whether it is in facial treatments, scalp work, hair dressing or shampooing, this rule prevails, for in any of this work there is always more or less of a chance to see whether there is much of the natural woman or whether most of her is due to art. 299 300 T H E S K I N The only part of the work about which there is abso- lutely no timidity is manicuring. Therefore, when the space is at all crowded the reception room may easily and wisely be used for the manicure tables, thus arranging for more privacy in the other departments. One of the most successful and popular women in business of whom I know never loses a patron, because even from the first day that she started her shop she never addressed anyone by name when they entered the reception room. She would say, "How do you do ?" and assign the per- son to a booth. The operator, also equally well trained, did not converse, and as a consequence the next neighbor could not know who the newcomer might be. This desire for privacy is so widespread and universal that no one can possibly make a mistake by arranging to gratify the wishes of the people in this respect. Many places of business have not been prosperous simply because the owners did not realize this fact, and as a consequence never secured the same patron twice. The cost of the equipment is a matter of taste and judgment. Prices vary so that it would be unsafe for any- one to give, as I did some years ago, a list of the prices then in vogue. In the meantime, the manufacturer changed his prices, and as a consequence I was subjected to so many different kinds of grief in trying to explain why the dif- ference existed that I then and there resolved never again to give even an approximate estimate, but, on the other hand, to adhere to generalities, for they are much safer. For a small shop, at least six dozen each of the three sized towels should be used — the Turkish, second size, and the small hand towels used for the manicure table. THE SKIN 301 A dozen at least of the cloths to protect the clothes from the hair should be made and as many for the facial department. Three dozen head bands will be sufficient because they may be laundered each day and so one does not run out of this supply. Two rubber shampoo capes will be invaluable to prevent the shoulders of the patient from becoming damp. Aprons should be supplied liberally, as there is always some trouble in getting them from the laundry. By using a little care in this respect and securing at least nine for each operator, one should always be presentable. In giving the suggestions for fitting the various rooms, my idea is not to frighten the prospective woman in business but to give her a definite plan from which to work. If the young woman who reads this has only one small room in which she manages a reception portion, with all other departments in the various corners behind screens, she should not be discouraged but work away with an idea of some time getting things as she wants them and :is they should be. From the smallest beginnings often spring the greatest undertakings. No matter what the difficulties may seem to be, I am positive that with ability to do and faith to keep on, no impediment will be found too great to be overcome. To become strong the individual needs something to fight, something to overcome. Muscle was never developed from idleness. So, whether the hindrances are financial, mental or social, resolution will make them vanish if the effort is made persistently. 302 THE SKIN In the fitting up of the room for facial work, elec- trolysis will of course be considered as a part of that department. The massage chair and stool, whenever possible, should be of the kind that will allow the operator to sit while she does her work. The back of the chair should be so planned that she can get at the back of the head and neck of the patient as a part of every facial treatment. The ordinary Morris chair does not make this pro- cedure possible. The battery may vary in cost from $15.75 to $5°> de- pending upon the desires of the operator and the voltage of the current. Whenever it is possible the wall battery will be found excellent, as it is always ready for work. In general this equipment will be found all that is required. FOR FACIAL ROOM 1 massage chair and stool. 1 small white table for jars of cotton and gauze, cream, instruments, etc. This table must have a glass top with railing, and glass shelves. It should also be arranged so irrigating apparatus can be attached, thus saving floor space. 1 cabinet sterilizer for instruments when not in use. 1 small sterilizer for instruments when in use (contain- ing formalin solution). 1 battery. 1 prismatic ray. 1 apparatus for colored lights. 1 irrigating apparatus for use with electrolytic cup. 1 mirror. THE SKIN 303 In addition to the large pieces will be found the small electrodes, including carbon handles, articles for cataphore- sis, needle holder, electric needles and all the small items. If one wishes to equip two facial booths, this list will only need to be doubled. FOR SHAMPOO ROOM If the bowl is not already installed, of course it will be necessary to have one placed. In addition to this hot and cold water will be necessities. If the city water is not heated by the building, a tank for this purpose may be procured and placed by the side of the bowl. In addition there will be necessary : i hair dryer (standard always preferable with good motor). i shampoo board or one chair and board. I tank for holding liquid shampoo. I cabinet sterilizer for holding brushes. I small sterilizer (holding formalin solution). I mirror. i dressing table with gas stove for* heating curling iron, etc. A few small brushes for use on the hair. Aside from this nothing else will be necessary. Care should be taken to secure the best dryer. Small, cheap portable ones are not only far from practical but they take the operator's time and make it impossible to manipulate the head while hair is being dried. FOR THE HAIR DRESSING ROOM As this room will also be used for scalp treatments, the battery and prismatic ray with necessary electrodes should A Practical Facial and Shampoo Booth Combined THE SKIN 305 be a part of the equipment, also the colored lights. In addition, nothing more is necessary excepting the dressing table with arrangements for curling iron and gas heater. Of course, if the electric iron is used, no gas connection will be necessary. When one is a bit limited for space it is well to arrange a dressing table in the shampoo room as mentioned. The first person that is shampooed can ha ^e her hair dried and be taken right to the hair-dressing room. The next one can remain in the shampoo room after the shampoo and have the same work done there. HAIR WEAVING DEPARTMENT No part of this work should ever be visible to the patrons. It is always disagreeable in appearance and it is almost impossible to keep the hair from flying about. Hence, it should always be done in a partitioned space adapted particularly to this purpose. CHIROPODY ROOM Whenever it can be arranged, this work should be done in a booth especially arranged for it. A small platform is necessary. On this will be placed a comfortable arm chair, thus allowing the patient to be comfortable while undergoing treatment. A high stool of peculiar pattern will be furnished, upon which the patient's feet will rest. The operator will be seated on another low stool so that she can work easily. In addition to the regulation instruments, there will be special apparatus for sterilizing by heat, with a wall cabinet for holding the various medicines necessary, and a sta- tionary cabinet for the instruments when not in use. 306 THE SKIN MANICURE DEPARTMENT As mentioned before, this department of work can be carried on in the reception room if necessary. Either good light from the windows or plenty of artifi- cial light will be necessary, so plans should be made accordingly. Aside from the regular instruments nothing but manicure tables, chairs and stools and the glass dishes for containing soap and water will be requisite. Sterilizers have been mentioned frequently because they are a necessity in each booth. One can hardly have too many, although it is very easy not to have enough. Before furnishing rooms or planning for booths the floor space should be planned carefully so that water, gas and electric connections may be made economically and wisely. When it is possible to have running water in each booth it is very desirable, but it is not necessary. However, in all of this work an effort should be made to avoid running through another department to get water, so at least one small tank for general supply should be arranged in addition to that obtained in shampoo room. The reception room will, of course, be furnished according to the individual taste. Here, too, it is well to have nothing unnecessary in the way of drapings, though, of course, window hangings are always allowable. A writing desk for the convenience of patrons, table covered with books or magazines for those who are obliged to wait, and several comfortable chairs will be considered necessities. Display cabinets containing articles for sale should also be added to this room. THE SKIN 307 The cost of furnishing varies exactly with the kind of an outfit purchased and the ideas of the person who is buying it. It is said, and truthfully, that in no other business is there so great an income in proportion to the first investment. There is never an utterly dead season in this work, for at all times of tlje year someone needs something done. There is never an old stock to be considered worthless or at least very greatly reduced in value unless it is sold at once or during the season. In fact, an entire business can be started, including even the cost of tuition, for very little more than it costs to buy the elaborate fittings in some of the large millinery shops. Many women who have been suddenly thrown on their own resources have entered this work, as a last resort, only to find" that in a few years they were able to replace the original capital, had paid all living expenses, and had a nice bank balance running up into the thousands besides. The demand today is for the trained operator who has been willing to spend the time and money to secure the proper foundation. Given the necessary instruction and the proper equipment in the town where there is a reasonable demand for the work, success is not a possibility but a positive certainty. N. B. — It has been the aim of the author to make this book a practical system of instruction for all women who wish to use the newest and most approved methods. Any points that are not clearly understood will be cheerfully explained to all who will enclose a stamped and addressed envelope, sending to EMILY LLOYD, 1404 Mailers Bldg., Chicago, III. INDEX PAGE Acne 198 Acne, Causes of 203 Acne, Rosacea 208 Acne, The Serum Treatment of 205 Acne, Treatment of 204 Acne, Varieties of 199 Advice to Patient 264 After the Massage 151 After Treatment 109 Aid to Shampoo 255 Amperage 66 Anaesthetic, A Good Local 126 Anaesthetic, Blue Light as an 54 Andirosis 40 Antiseptic, Most Practical 27 Antiseptics that May Be Used 24 Applying the Powder 160 Astringent Mask Treatment 240 Bathing . . , . 211 Battery 61 Battery, Galvanic and Faradic 62-72 Battery, How to Select 68 Battery, Making a Galvanic 91 Battery, Simplest Forms of 60 Binding Posts 63 Bi-Polar Method 120 Blackheads or Comedones 39 Bleaching, Face, Instantaneous 130 Bleaching the Skin 128 Blue Light as an Anaesthetic 54 Bromidrosis . 41 Brow, Scarred 114 Care of the Scalp 262 Cataphoresis 125 Causes of Acne 203 Chiropody Room 305 Chloasma, Treatment of 223 Chromidrosis 41 Circuit, The ^ Circuit, Manner of Completing I0 5 309 310 INDEX PAGE Cleansing of the Hands 31 Colored Lights, Use of '. 48 Combined Current , 88 Comedones or Blackheads 39 Conductors 64 Constipation 213 -Contents, Table of io-n-12-13 Controlling the Current, Manner of 67 Corium, The 36 Cosmetics, The Proper Use of 157 Current, Combined 88 Current, Faradic 81 Current, Faradic, in Scalp Treatment 87 Current, Faradic, Not Indicated in Some Cases 87 Current for Destruction of Moles 118 Current, Galvanic 90 Current, How to Detect Galvanic 92 Current, Manner of Controlling 67 Current, Manner of Measuring 66 Current, Strength of 106 Danger of Infection 123 Dedication 6 Depilatory, Proper Use of ill Destruction of Moles 118 Diet 211 Dimple, Formation of 181 Diseases of Hair and Scalp 270 Do the Hairs Return 109 Ear, Excessively Large 179 Ear, Micotia or Undeveloped 180 Ear, Reconstruction of 179 Ear, Repair of Clefts in External 180 Ears, Outstanding 177 Ecorchement Process '. 227 Eczema 217 Eczema, Varieties of 218 Eczematous Scalps 294 Effects Produced by Faradization 84 Egg Shampoo 254 Electricity 57 Electricity, Forms of 60 Electric Needle, Use of « 97 Electrodes 64-89 Electrolysis, Principle of 100 Electrolysis, Single and Multiple Needle 99 Electrolyptic Cup, Solutions Used with 136 Electrolyptic Cup, Use of 137 INDEX 311 PAGE Epidermis, The 34 Equipment 100 Ether 59 Exceptions to the Rule 108 Excising a Scar 181 Exercise 213 Extremely Large Mouth 188 Eace Bleaching Instantaneous 130 Facial Massage 141 Facial Room 302 Facial Treatments 239 Falling Hair 295 Earache Current, The 81 Faradic Current in Ma-sage Treatments 86 Faradic Current in Scalp Treatment 87 Earache Current Not Indicated in Some Cases 87 Faradic and Galvanic Battery 62-72 Faradization, Effects Produced by General 84 Finishing the Treatment 161 Flabby Skins 173 Flabby and Withered Skins 235 Folds, Bags and Wrinkles of the Skin about the Eyes 172 Forcing Into the Tissues an Anaesthetic 126 Formation of Dimple 181 Forms of Electricity 60 Freckles 229 Galvanic Battery, Making a 91 Galvanic Current 90 Galvanic Current. to Delect 92 Galvanic and Faradic Battery 62-72 Galvanism, Negative, Properties of 95 Galvanism. Positive, Properties of 94 Gland-, Skin and Their Diseases 38 Glands, Sudoriparous 39 Hair-Dressing Room 303 Hair, Falling 295 Hair, Singeing the 257 Hair-Weaving Department 305 Hands. Cleansing of the 31 Hemadrosis 42 Hints to Operators 288 Home Treatment 207 Hot Oil Treatment 292 How to Detect Polarity 93 How to Detect the Galvanic Current 92 How to Furnish Treatment Rooms 299 312 INDEX PAGE How to Give Massage Movements „ 147 How to Give a Shampoo 257 How to Secure Confidence 106 How to Select a Battery • 68 Hyperdrosis ' 40 Ideal Woman in Business 15 Illustrations, List of 14 Itching Scalps . 295 Instantaneous Face Bleaching 130 Insulators 64 Introduction 7-8-9 Lavender Lotion 153 Length of Treatment no Lesions of the Skin 44 Lesions, Secondary 45 Light, Blue, As an Anaesthetic 54 Lights, Colored, Use of 48 Lips, Thick 186 Lips, Thin 187 Lobule, Adherent and Undeveloped 180 Lobule, Reduction of Size of 179 Local Treatments 205 Lotion, Lavender 153 Making a Galvanic Battery 91 Manicure Department 306 Manner of Completing Circuit 105 Manner of Controlling Current 67 Manner of Measuring Current 66 Massage, After the 151 Massage, Face, Preparation of 133 Massage,. Facial 141 Massage Movements, How to Give 147 Massage Produces These Results 143 Mcintosh Galvanic and Faradic Battery 62-72 Measuring the Current, Manner of 66 Methine, Using 128 Method, Bi-Polar 120 Method of Procedure 104 Milia 38 Milia, Treatment of 196 Miliaria or Sudaminia 42 Miliaria Papulosa or Prickly Heat 42 Moles, Removal of 116 Mouth, The 185 Mouth, Extremely Large 188 Multiple Needle Electrolysis 99 INDEX 313 PAGE Naevi and Treatment, Varieties of 120 Needle, Electric, Use of 97-1 12 Needle, Selection of the 101 Negative Galvanism, Properties of 95 Nose Operations 185 Nose, Reduction of Hump or Roman 183 Nose, Tip-Tilted 183 Nose with Bulbous Tip 184 Ohm 65 Oily and Stippled Skins 231 Operations, Nose 185 Operators, Hints to 288 Operators, Painless 119 Painless Operators 119 Plain Shampoo 252 Polarity 83-92 Polarity, How to Detect 93 Poles 63 Port Wine Marks, Removal of 1 16 Positive Galvanism, Properties of 94 Posts, Binding 63 Powder, Applying the 160 Practical Antiseptic, The Most 27 Practical Application of Rules Governing Galvanism 96 Preparation of Face for Massage 133 Prickly Heat or Miliaria Papulosa 42 Principle of Electrolysis 100 Prismatic Ray Treatments for Dry Scalp 293 Procedure, Method of 104 Properties of Negative Galvanism 95 Properties of Positive Galvanism 94 Proper Use of a Depilatory, The 1 1 1 Reconstruction of the Ear 179 Reduction of the Hump or Roman Nose 183 Reduction of Size of Lobule 179 Relief of Neuralgic Pain 128 Removal of Moles, Port Wine Marks, Warts and Wens 116 Removing the Fold Above the Eye 172 Removing Snarls from Hair 297 Repair of Clefts or Fissures in External Ear. 180 Rouge, Selecting a 159 Rules for the Operator no Rules Governing Galvanism, Practical Application of 96 Sallow or Muddy Skins 227 Scalp, Care of the 262 314 INDEX PAGE Scalp, Common Diseases of 270 Scalp Treatments 291 Scalp Treatment, Faradic Current in ,. 87 Scalps, Itching 295 Scaly or Dry Skins 233 Scar, Excising 181 Scarred Brow, The 114 Seborrhoea 38 Secondary Lesions 45 Selecting a Rouge 159 Selection of the Needle, The 101 Serum Treatment for Acne, The 205 Shampoo, Aid to 255 Shampoo, Egg 254 Shampoo, How to Give 257 Shampoo, Liquid, Soapless 254 Shampoo, Plain 252 Shampoo Room 303 Shampoo, Strong 253 Shampoo, Tar 253 Shampooing After a Hot Oil Treatment 259 Shampooing Before a Hair Dye 258 Shampooing Sticky or Matted Hair 259 Shampooing the Hair , 251 Simplest Form of Battery 60 Singeing the Hair 257 Single Needle Electrolysis 99 Skin, Bleaching the 128 Skin and Its Divisions, The '. 33 Skin Glands and Their Diseases , 38 Skin Grafting 181 Skin, Lesions of the , 44 Skin, Sallow and Muddy , , 227 Skins, Flabby 173 Skins, Flabby and Withered 235 Skins, Oily and Stippled 231 Skins, Scaly and Dry 233 Small Pox Pittings 173 Soapless Shampoo Liquid 254 Solutions Used with Electrolyptic Cup 136 Sterilization 22-101 Strength of Current 106 Strong Shampoo 253 Subcutis, The 37 Sudaminia or Miliaria 42 Sudoriparous Glands, The 39 Summary 55 Sunburn 237 INDEX 315 PAGE Tan 237 Tar Shampoo 253 Tattooing and the Electric Needle 112 Tattooing 113 Tattooing to Aid Apparent Width of Month 188 Thick Lips 186 Thin Lips 187 Things to Remember 260 Tip-Tilted Nose, The 183 Tired-Eye Treatment 242 Tissue Builders, Use of 170 Treatment, Astringent Mask 240 Treatment, Finishing the 161 Treatment for Dry Scalps and Seborrhoea 293 Treatment, Hot Oil 292 Treatment, Length of no Treatment of Acne 239 Treatment of Blackheads and Milia 190 Treatment of Chloasma 223 Treatment Rooms, How to Furnish 299 Treatment, The Tired-Eye 242 Treatment, Wrinkle 241 Treatments, Facial 239 Treatments, Local 205 Treatments, Scalp 291 Uridrosis 42 Use of Colored Lights 48 Use of Electric Needle 97 Use of Electrolyptic Cup 133 Use of Tissue Builders 170 Using Methine 128 Varieties of Acne 199 Varieties of Eczema 218 Varieties of Naevi and Treatment 120 Voltage 65 Warts and Wens, Removal of 116 When the Disease is Fully Developed 206 Wrinkles, Cause and Treatment 163 Wrinkles, Deep 168 McINTOSH NO. 5 VIOLET = — =RAY OUTFIT Success in Scalp Treatment The violet ray is the best and surest means of invigorating the scalp^ by increasing the flow of blood, as well as its germicidal effect in destroying the parasite which causes baldness. A healthy glow is experienced as soon as the electrode comes in contact with the scalp and all irritation is at once relieved. Price, complete, as shown, including facial and scalp electrode, cataphoresis electrode, fuiguration point electrode, metal and our new non-sparking electrode handle electrode, fulguration point electrode, metal handle, two cords