Anamia should he remedied by small doses of Iron, and in chronic cases associated with enlarged veins and a weak heart or diseased mitral valve, the eczema of the lower extremities is much improved by a combination of Iron and Digitalis.
Sedatives may he called for to allay itching and sleeplessness, but opium, morphia, or chloral should be used for this purpose with the greatest caution. (Chloral may he more safely administered to children when the itching is very severe.) Trional, in 2o-gr. doses, may be tried, but large doses of the Bromide of Sodium (3o grs.) allay restlessness without pro ducing any untoward results; it may well be combined with Hyoscyamus, and the itching is sometimes relieved by a small dose of Antipyrine.
No drug administered internally can be regarded as possessing any real specific action. The usual rule is to give Tartarised Antimony in the acute and subacute types, and Arsenic in the chronic stages, and, whatever difference of opinion there may be regarding the value of both these in the early stages, there should be no doubt about the beneficial effects of arsenic in very chronic scaly eczema, and the nearer the disease approaches in character to psoriasis the more valuable is arsenic. The writer never prescribes it under any circumstances for acute eczema, or even for the chronic weeping type of the disease. 3 to 5 min. doses of Fowler's solution are sufficient, and these amounts should rarely be increased. Turpentine has gained some reputation, but its value is doubt ful. Pilocarpine has been advocated in the forms of eczema associated with great dryness of skin. Where there is much edematous swelling following the eruption in acute erythematous cases Chloride of Calcium possesses almost specific action in checking the local anasarca and itching. Robert-Simon recommends subcutaneous injections of fresh Sea Water, beginning with 3o c.c. increased to 5o c.c. of a mixture of sea water 2, fresh water 5 parts, which form an isotonic solution. The sea water is taken in sterilised flasks from deep areas zo miles from the shore, and must not be sterilised by heating.
Thyroid Extract has been much recommended especially in the eczema of infants and children, and especially in the arthritic type of the disease.
Local Treatment.—The long list of remedial agents proves that there is
no specific for eczema—no royal road to its successful treatment—though there are few diseased conditions so susceptible to improvement or permanent cure. The secret of success in treating eczema lies for the most part in the ability of the physician to use the proper remedy at each stage of the disease. The class of agents so valuable in the acute are worth less in the very chronic stages, whilst remedies of unfailing power when used in the chronic cases are fraught with serious danger when applied at the earlier stages of acute cases. The physician who wishes to treat the protean forms of eczema with success must learn to be patient, ever remembering that in the majority of cases the progress towards recovery is a slow one, and having fixed firmly before him the principle upon which his treatment is based, he should be content to wait till his local remedy has had time to act before its failure is accepted. The constant chopping and changing of applications from day to day is one of the great causes of failure in the management of chronic or acute eczema.
Acute Eczema must be treated as a dermatitis. Only the blandest and least irritating of applications should be applied. Any attempt at treating the disease by antiparasitic agents at this stage is certain to seriously aggravate matters. The first step should be to cleanse the surface of all crusts or dried secretion, and for this purpose Chamber's method of apply ing lint soaked in Normal Saline Solution, covered over with impervious tissue, is perhaps the best. The writer's practice has always been when possible to cleanse the part by gentle and patient mopping of it with cotton-wool soaked in pure Olive Oil. When the crusts are hardened into scabs, a more efficacious method is to apply warm Boric Acid com presses; even then soap may be necessary, but the use of this cleanser must be dispensed with as soon as the scabs have been detached, and it should if possible never be resumed till the disease has been conquered. Afterwards an overfatted basis soap must be employed. During the progress of the treatment any hardened secretion which from time to time forms may be gently removed by friction with an oiled swab.