ECZEMA, ek'ze'-ma, an acute or chronic disease of the skin, showing a vast variety of changes in the skin itself, and usually accom panied by intense itching, burning or pain. The changes in the slcin at first are usually marked by redness, papules, then small vesicles or pus tules which later become crusted and dry; or the surface is weeping. Infiltrated and scaly patches are common. All• of the different forms of eczema (and no less than a dozen varieties are described by skin specialists) have certain definite changes occurring in the skin. There is usually swelling, congestion and increase of temperature locally. There is almost invariably an exudation of fluid into the tissues, with the formation of vesicles and pustules, as described. There is further a certain amount of plastic exudation which produces in the skin papulous areas that are thickened and infiltrated. Finally there are the subjective symptoms of itching, which may be only a slight tingling.or prickling sensation, or may be so• intense as to demand continued and deep scratching until bleeding or oozing takes place. This itching is, as a rule, intermittent in character, being almost invariably worse at night when the patient is covered, the heat of the body causing the ag gravation. Sometimes exposure to cold brings about intense itching. The disease usually runs an acute course, and may be limited to one region of the body, or may be general. Its general tendency is to progress rather than to get well. It is perhaps one of the most ob stinate of all skin diseases, and at the same time one of the most difficult to diagnose and to treat. The causes are probably many. In gen eral the fundamental pathology seems to be an over-active function of autonomic nerve stimuli going to the skin. This over-autonomic (para
sympathetic) activity may be a primary one or be an imbalance from subacting sym pathetic stimuli. The study of this lack of balance may involve a wide search for physicochemical, sensori motor or phychic dis turbances, and a truly helpful therapy must take into account these underlying features. Inas much as orthodox medicine has found the dis order very intractable it would seem to indi cate the lack of deep consideration of the dynamic factors in human pathology — notably the importance of mental as well as so-called physical factors. The treatment of each case is a particular study. Sometimes the disease is beyond the power of the best skin specialist; usually such cases are psychogenic in their origin and the average skin specialist is too uneducated to know anything about mental causes. At other times corrections of minute errors in diet will bring about cure. So far as household remedies are concerned, only those that can relieve the itching are deserving of notice in this place. One of the best of these is carbolic acid in weak solution —2 to 3 per cent. This may be applied on a bit of absorbent gauze, special care being taken not to enclose a particular part completely with the weak car bolic acid. Bland non-irritating powders, such as calamine and oxide of zinc are often useful. When the disease becomes chronic it is apt to be extremely obstinate. Many of the chronic cases rest upon an endocrinopathic basis, which in its turn often depends upon neurotic dis turbance.