Immoderate habits in the use of cer tain foods, drinks, and drugs also in directly or directly have an influence, such as alcoholic drinks, narcotic drugs, and excessive tea- or coffee- drinking.
Overwork, especially of a mental char acter, in those of hereditary eczematous tendency will often be provocative of an attack. That the hereditary disposition to the disease exists in many families cannot be denied.
Among the external exciting factors may be mentioned cold and heat, espe cially the former; sharp, biting winds; and too liberal use of certain soaps; the handling of dyestuffs, chemical irritants, and the like; vaccination, and exposure to certain plants. Having the hands fre quently in water, as with washerwomen, the handling of sugar and flour, and re peated antiseptic cleansing of the hands often bring about the various conditions of eczema of these parts.known respect ively under the names of washerwomen's itch, baker's itch, and grocer's itch, and surgeon's eczema. So far as known the disease does not possess contagious prop erties, and in a disease so frequent as this if such existed it would have been clearly demonstrated.
In some cases of markedly inflamma tory eczema, especially when of the pus tular type, swelling of the neighboring lymphatic glands is noticed, but this rarely leads to suppurative change, the swelling and pain disappearing as soon as the inflammatory symptoms have abated. In some cases of eczema a con
dition of furunculosis is occasionally ob served.
Pathological Anatomy.—Eczema is es sentially a catarrhal inflammation of the skin, and is seated chiefly in the Tete and papillary layer; in long-continued and severe cases the lower part of the corium and even the subcutaneous tissue may be more or less involved, but never destruct ively. Hypermia and exudation are to be found in all cases, either as punctate, localized, or more or less diffused. The vascular changes are the same as ob served in all inflammations.
Diagnosis.—Eczema is to be distin guished chiefly from erysipelas, psoriasis, seborrhoea, sycosis, scabies, and ring W01111.
ERYSIPELAS.—Markedly acute eczema about the face sometimes presents early in the course of the attack a resemblance to erysipelas, but in the latter disease the border is sharply defined and elevated.; it usually starts from one point and spreads rapidly, and is accompanied by systemic symptoms of more or less violence.