The Superficial Mycoses 129 



general, an alcoholic solution is probably superior to a salve when used 



on the webs ol the toes or on the palms or soles. On other locations it is 

 best to use a grease, Since there is less irritation. Francis stated that he 

 obtained satisfactory results with a mixture ol camphor and phenol. He 

 gave the following directions lor making and using the preparation : 



Melt U.S.P. phenol and measure out 3 CC. into a mortar; weigh 3 Gm. of U.S. P. 

 camphor, break into small pieces and add to tlu 1 melted phenol. Huh until the entire 

 mass is liquefied. Transfer into a vial with a stopper suitable tor use as a dauber. Keep 

 stoppered when not in use. Experiments indicate that the ingredients may be mixed 

 in the proportion ol 3 parts phenol and 1 part camphor. 



The mixture is nonirritating to the skin and may he painted between the toes sev- 

 eral times a day, the small rubber stopper ol the vial being used as a dauber. The sock 

 may he replaced immediately without danger of corrosion. There is no discoloration 

 ot the clothing. Relief from itching is immediate. It should he pointed out, however, 

 that the phenol-camphor preparation should not he applied to the wet skin, since 

 water causes a breakdown ot the preparation, with the result that it heeomes caustic. 



Confirmation is lacking that the combination of drugs is both safe and 

 effective. Glenn and Hailey reported indifferent results in a series of 85 pa- 

 tients. We have seen the preparation misused and believe that unfortunate 

 publicity through a lay periodical has resulted in considerable self-treatment 

 with poor general results. Danger from local necrosis or from absorption 

 makes the use of camphor-phenol undesirable. 



In treatment of chronic infection of the feet due to T. purpureum, the 

 use of the following paste was advocated by Glaze and by King: 



Salicylic acid 3 oz. 



Starch 3 dr. 



Petrolatum 3 oz. 



Only two applications, made on successive nights, are advised. A layer 

 /s in. (0.32 cm.) thick is placed on the entire affected area, covered with a 

 bandage, left overnight and wiped off in the morning. No washing, however, 

 is permitted. The result is the separation of the superficial cutaneous layers 

 from the deeper parts, usually in a cast. There may be an acute inflammatory 

 reaction. In several instances we have been impressed with the rapidity of 

 response 1 in patients who have used various other remedies without any 

 improvement. 



C. Fungicides. The exact mechanism of the lethal action ot drugs on fungi 

 is not fullx explained. Some drugs apparently act as reducing agents. There 

 is usually a certain degree of stimulation to the vascular supply. The degree 

 of direct poisonous effect on the fungus is difficult to determine. 



In choosing a fungicide, one may determine its activity in vitro and 

 note its power to irritate human tissues and its effect after clinical trial. 

 There have been several thorough investigations of various drugs. The 



