ECZEMA.
The bewildering catalogue of remedies employed by specialists is a trial to the young physician who approaches the treatment of a case of eczema for the first time, and his confusion is not lessened by a perusal of the pathological literature of the disease, some authorities persisting in the view that the main factor in the disease is a constitutional cause, whilst others regard it as a purely local phenomenon. The truth lies in neither of these views; a state of the blood, like gout, for example, undoubtedly causes a condition of the skin in which trivial local irritation may bring on an attack of eczema which cannot be removed by purely constitutional agents, but which may speedily yield to local remedies. Though local applications must be considered as more effective than constitutional remedies, every departure from the normal standard of health must be closely investigated and rectified.
'Enna's microbic theory is true as regards the pustular type of eczema in which secondary pyogenic organisms are grafted on the original skin inflammation, but the acceptance of a microbic cause of the disease in its ordinary forms only leads to failure in the treatment of these.
If the principle enunciated in the articles on dyspepsia and diarrhoea be applied to eczema its treatment becomes simplified. Many cases are nothing else than the local manifestations of irritating stimuli applied to the skin from accidental contact with unsuspected vegetable, animal or chemical substances, or from the exposure of the part to changes of temper ature, mechanical irritants, &c. It would be quite as rational to regard the effects of such irritations as examples of true eczema as it would be to label the results of a rubefacient liniment by the same title, and the teach ing of Walker may be accepted when he states regarding these forms of dermatitis " that the more one knows about skin diseases the fewer cases he finds it necessary to label eczema." More recently Heimann strikes the same note by insisting that the term Eczema should be discarded for Dermatitis.
Constitutional Treatment.—The diet of the eczematous subject should be carefully attended to; as a rule it should be generous and varied, and made to embrace a good supply of fresh properly cooked vegetables and not an over-abundance of animal food. Certain articles of diet have been so commonly found to increase the irritability of the diseased skin that they should he rigidly proscribed; amongst such are salted meats, spices, shellfish, fresh pork, pickles, cheese, raw sweet fruits, sugar and coffee.
As the effect of other articles in some patients is so easily demonstrated by experience the individual peculiarities should serve as a guide. Thus, some subjects feel that the smallest sip of wine, in a very short time after being swallowed, produces tingling and itching in the scat of the eczema, and this is especially true if the head, face, or neck is affected. Upon the whole, stimulants must be allowed in very sparing quantity, and, where indicated, whiskey is the best. Acid wines are especially hurtful, and beer, as a rule, should be forbidden. In the presence of dyspepsia or other gastric trouble, the dietary suitable to the patient's needs must be prescribed. C. J. White's plan of detecting the patient's sensitisation to various articles of dietary consists in applying the suspected item as egg albumin, milk, butter, &c., to minute incisions in the skin, when the offending ingredient will be detected by its local reaction.
The periods of labour, rest, exercise and sleep, the clothing, sunshine, cookery, etc., must be seen to when found to be faulty, and the general hygienic surroundings improved when possible; thus change of air, scene and occupation affords marked benefit in some cases, but a bracing sea air is not to be recommended.
Dyspepsia, or acidity, should be counteracted by appropriate remedies, and constipation by laxatives or purgatives. The use of these latter in chronic eczema is universally acknowledged. Salines are valuable, especially in the form of a natural purgative water like Rubinat or White Mixture, containing 2 drs. Epsom Salt with 3o grs. Carbonate of Magnesia in each wineglassful, given early in the morning whilst fasting, so as to produce one or two copious motions of watery consistence; or the following may be prescribed : Magnesii Sulphatis, Ferri Sulphatis, 3ss.; Acid. Sulphurici Dil., 3ij.; Aquze Destillate, ad misce. Signa.—" A large wincglassful to be taken in half a tumblerful of water every second morn ing, and to be repeated in three hours if the bowels be not well moved." The saline should be occasionally preceded by a good dose of Blue Pill, given at bed-time.