Etiology

It may be regarded as almost axiomatic that the better we understand a disease the better we will be able to treat it. This is especially true as regards eczema. Occasionally cases of acute eczema will be met with that recover under the simplest, application, and even under the influence of a plain, non-medicated dressing. Unfortunately, these cases are rare, and in the chronic forms it is often necessary to avail ourselves of every possible aid to recovery. A thorough appreciation, therefore, of all the causes of the eruption, both actuating and contributing, cannot fail to greatly assist the therapeutist in the proper selection of the remedial agencies applicable to a given case.

Eczema attacks more frequently light, florid-com-plexioned individuals, and is a commoner affection in this country than in Europe. Like the individual who makes a failure in life, eczema usually travels from head to foot as age advances. It appears more particularly on the head in infancy and youth, descends to the trunk and genitals as adult life approaches, and appears on the lower limbs as its victim is tottering to the grave.

Among the exciting causes we may mention irritation of the skin by scratching, by friction of the clothing, by irritating ointments, by oils, by bandages, by artificial legs, trusses, etc., by hot baths, by too high a temperature, by alternation of heat and cold, by heat and moisture, by the injudicious use of Turkish and Russian baths, by strong potash soaps, and by any exciting cause giving rise to hyperaemia of the skin. In quite a number of cases it seems to be hereditary. It is by no means a rare disease in those who are syphilitic, gouty or strumous.

It is frequently dependent upon renal troubles, menstrual irregularities, dentition, dyspepsia and malassimilation, varicose- veins and hemorrhoids. Undoubtedly perverted innervation, with general debility and morbid conditions of the blood, is an important cause.

Overfeeding, the habit of feeding the child too frequently, and of allowing children who have passed the milk-diet period to eat frequently of inappropriate food between meals, will prevent the recovery of chronic cases, despite the administration of the well-selected remedy. When the tongue is coated, the breath foul, and the bowels constipated, the diet requires particular attention. Children kept in warm rooms where the air is vitiated are liable to suffer from this affection, especially if they catch cold easily from the least exposure. Allowing the child to sleep upon a very soft pillow, into which the head becomes buried at night, or feeding "bottle babies" with milk too warm, has seemed to aggravate some cases. Fresh air and sunlight, with attention to hygienic measures, will exert a favorable influence upon this stubborn disease. The diet must be carefully looked after, and all sweets and confections be strictly prohibited. The sleeping apartments must be properly ventilated. Plenty of exercise in the open air must be taken. The clothing must be adapted to the season. Bathing sufficient to meet the requirements of cleanliness should be insisted on, but too frequent or too profuse use of water is not advantageous. The acute stage of eczema is very intolerant of water. If the surface is raw and dis­charging, water aggravates the condition. Water, however, is not to be absolutely excluded from the treatment of eczema. It not frequently happens that very hot water - hot as it is possible for the patient to bear it - will cause immediate cessation of itching; while in chronic cases, with considerable infiltration, systematic use two or three times a day of very hot water will often be followed with the happiest results. A full bath of tepid water, with a pound of sal soda added to it, and taken at night, will generally exert a soothing influence; while in sluggish and chronic cases ten or twelve pounds of common salt added to a full bath will exert a stimulant action and tend to promote the cure.


In all cases search should be made for all possible causes of local irritation, and the first care should be to remove them, if practicable.

The diet of eczematous patients is of the first importance. No hard and fast general dietary laws can be ad­hered to. Each patient must be treated according to his case, and at first be put upon as simple a diet as possible. When this basis is reached, the patient's taste is to be consulted and his diet made more varied, care being taken to avoid anything that is known to disagree with him. Some­times, it is advisable to have a patient increase the number of meals in a day, while decreasing the quantity of one. Some patients do best on solid food alone, leaving out tea, coffee, and the like. Sometimes the best results are obtained by having the patient eat only one sort of food at a meal - whatever he fancies. In many cases of chronic eczema a liberal supply of fluid is useful, and this not taken at once, but often in small quantities. Up to three quarts of water may be taken in this way. The addition of salt to the dietary is also useful. As a rule, you will find that adult sufferers from eczema are decidedly carnivorous in their tastes, eating a good deal of meat with a very scant quota of vegetables and cereals. Many of them are particularly fond of the pleasures of the table, and indulge much more freely than there is any necessity for. As these matters are under the control of the patient himself, no pains should be spared to impress on him the necessity for a change in his habits. It is not well to cut off the supply of meat absolutely, but it should be very decidedly restricted, and a larger proportion of bread, vegetables, and cereals substituted.


Patients often fancy that diet of this sort will reduce their strength and incapacitate them for the amount of labor that their daily vocations necessitate. These fears are groundless, and on trial will soon be dissipated.

A very interesting and important question has been raised as to the propriety of healing completely a discharging eczema, and the fear of driving in the disease has often deterred practitioners from effecting a' speedy cure.

Hebra and his school laugh at this idea, and no doubt in the majority of cases with good reason.

The question at issue, whether an habitual discharge may be suppressed without danger to a patient, depends upon the patient, and not on the disease.

"I attended a child who had lost two younger brothers from some tuberculosis. He had a very extensive eczema of the scalp and face, but otherwise appeared in good health. Under appropriate remedies his eczema rapidly got well, but in disappearance was attended with all the signs of acute hydrocephalus, from which he soon died.

With the family disposition to this disease, it is not unlikely that the child might have succumbed to tuberculosis had the eczema not been cured; but I fear my treatment was injudicious, as the child's disposition to disease of a special and serious kind was not taken into account."

Analogies of the impropriety of rapidly suppressing habitual discharges are common enough. Hemorrhages from the lungs or stomach occur often enough when hemorrhoids, which have been bleeding for years, are suddenly cured, and cases have been recorded in which cerebral hemorrhage has seemed to follow rapid cure of an old ulcer.