to the views which we have laid down in the remarks on etiology, the treatment of eczema is both general and local. The general IreaIntent must in the first place take into consideration the etiological factor in eczema of nurslings and of older children, Should a child exhibit the lymphatic or scrofulous diathesis, it will be necessary to try and improve the general condition by appropriate treatment. Similarly, intestinal dioorders, constipation, etc., should be energetically treated. In nurslings very great care ohould be bestowed upon the question of nutrition and regulation of diet. Overfeeding with milk, to which attention has been called by Bolan, Comby, Bella and Czerny, is also in my opinion without doubt one of the ehief causes of nurslings' eczema. I have observed in a number of cases that from the day feeding was reduced, the eczema improved both with unchanged loeal therapy and with entire cessation of local treat ment. It is therefore necessary to pay special attention to the con sistency of the human milk, its fat percentage, etc.; in the case of artificially fed babies (who, as we know, furnish the niajority of eczema eases) the quantity and consistency (dilution or mixture) should be prop erly controlled. Also in older children overfeeding has unquestionably an untoward effect, and here again improvement will frequently be achieved by a change in diet, omission of eggs and carbohydrates, giving prefer ence to a inixed diet of milk, vegetables and fruit. The mother's milk, too, should be influenced under given eireumstanceo through appro priate diet. Aside from the question of diet and overfeeding the possi bility of underfeeding should not be lost sight•of, and attention paid to the connection between eczema and nervous affections (eczema of denti tion, etc.). A.naunia should be treated by iodide of iron and codliver oil.
The general treatment by internal medication is comparatively simple. Small quantities of arsenic; may be administered in milk in long-continued eczema; in amemia iron preparations are indicated, and the exeessive itching should be relieved by antipyrin (antipyrin 1.50 Gm. (22 gr.) aqua, syrupus ao 25.() Gm. (I oz.) 1-2 teaspoonfuls). Ilesides, in all gastric disorders the well-known laxatives and intestinal disinfectants should be prescribed (calomel 0.01 Grn. gr.) 3-4 times a day, benzonaphthol 0.2 Gm. (3 gr.) sodium bicarbonicum, magnesia calc. aa 0.25 Gm. (31 gr.) nux vomica 0.005 Gni. (Y.y gr.) per day according to age).
Local Treatment.—The chief endeavor will be to prevent children from scratching themselves, in which respect they display a marvellous inventive talent. It will therefore frequently be necessary to bandage the hands or to put on gloves after cutting the nails, tie the hands to the bed by gauze strips leaving the arms free to move but not sufficiently to admit of scratching. Similarly under given circumstances cuffs or small splints should be affixed to the elbow-joints so as to prevent flexion of the arms and consequent scratching.
Precaution is needed in washing babies with soap. Generally speaking, moist infantile eczema eases (except perhaps in the very acute stage) can bear baths quite well, but it is frequently found that each washing of acute and subacute eczema cases is followed by irritation and exacerbation. For these cases washing with some spirits 11 per cent. spirits of thymol and 10 per cent. glycerin) or cleansing the skin with cold cream and vaselin is to be. recommended. Baths, generally speaking, may therefore be given, the cleansing of the body alone re quiring regular baths in the case of nurslings; especially bran, chamomile or* wild thyme baths are borne excellently. The only requisite is that
immediately after each bath corresponding medication is applied to the skin (powders, ointments, pastes) and it should be remembered that with children it is not enough to simply put the ointment on the skin but that a bandage should be applied over it. Nearly every- child, especially nurslings, would soon rub the ointment off and scratch open the eczema, unless every possibility of doing so has been destroyed by a firm bandage. Eczema will not heal unless the air is shut off and patients are absolutely prevented from scratching the wound open every (lay, and unless proper medieation for each condition has been correctly applied and used for a sufficiently long time. The medication should of course be always adapted to the various stages of the disease.
Thus, in the erythematous and popillous stage washing with 1 per cent. spirits of thymol, .1 per cent. spirits of carbolic acid, 2 per cent. spirits of boric acid would be indicated, followed by dusting with pow der, which may also be applied without previous washing. The best is mineral powder (talcum with oxide of zinc, VElSCDOi powder), because vegetable preparations easily form a paste with the eczematous exudate. Dry paintings are also to be recommended with either Boeck's or Neis ser's preparation (see p. 437) and these are best followed up with powder.
In the stadium madidans the treatment will consist in producing an absorbing and antiphlogistic effect by means of moist bandages (acetic alumina 1:10,3 per cent. boric acid, per cent. resorein). As soon as the exudation is stopped, absorbing pastes (starch, vaselin aa 20.0 being the cheapest; oxide of zinc, starch, lanolin, vaselin aa 10.0 being the best) should be applied to effect a complete desiccation and im provement of the inflammation. An addition to this paste of 1-5 per cent. lenigallol has tin excellent effect in these exudative eczemas. The effect of lenigallol is not only curative, including the inflamed and changed tissue, but also caustic by drying the acute inflammatory places and favoring scab formation of the eczematous surface. In order to minimize the irritation from itching 1-5 per cent. tumenol may be added to the zinc paste, and as soon as the eczema approaches the final healing stage, a very weak concentration of tar may be added (see p..139). It is a mistake to apply fatty ointments to exuding places, because the serous exudate collects under the fat layer and serves to accentuate the irritation of the skin. ln the crusty stage the crust should first be softened by an oil bandage and removed, after which the exuda tive and still hyperremic and exposed skin should be immediately treated with paste. The tztadium squamosam, in which the acute mani festations, the exudations and irritability of the skin are becoming less, requires a softening of the thick, chronically infiltrated places by ointtnents and plasters. Hebra's ointment (or better still unguentum vaselini plumb., which is prepared with equal parts of vaselin and lead plaster, to which 1 per cent. of carbolic acid is added for better keeping): bismuth and zinc aa 1.0, ung. leniens, ung. simplex aa 10.0, Neisser's ointment, and RiIle's ointment; salicylic acid 0.5, lanolin 60.0, vaselin 30.0 are all useful. Among plasters I have found Piek-Arning's 2?.. to 11) per cent. salicylic soap plaster the best. It will often be necessary in this stage to produce an inflammatory and macerating effect in order to soften old places. For this purpose al° per cent. concentration of the above-mentioned soap plaster, also pyrogallus ointments 0.-5 per cent., weak chrysarobin ointments) and especially ointments containing tar.