Acute cases of the disease occur rarely in adults, but not unfrequently in children. They run their course in three to six weeks without much constitutional disturbance being pro duced, unless the blebs are large and in fre quent crops, when the itching becomes very severe. Only in ill-nourished children, when the eruption is extensive, need any fear of the result be entertained.
Treatment•Nourishing and generous diet is of great importance. The principle medi cine to give is arsenic, but so much caution is necessary for its administration that it should be left entirely in the hands of a physician. Quinine and iron tonic may be given. The skin is to be frequently bathed, and the lysol solution advised for ulcer used.
Eczema (Moist Tetter—Running Scab—see Plate XXIV.) in its beginning consists of an eruption of pimples or vesicles or pustules on inflamed and swollen akin. The vesicles burst, or are torn by scratching, and a red weeping surface is produced. The gummy fluid from the torn surface may dry on the inflamed part and crusts be produced. If the crusts be removed, the dull red surface becomes dry and covered with white scales. Thus the appear , antes presented by the part affected with eczema may vary with the stage of the affec tion. There is usually intense itching, and the scratching that is occasioned leads to an extension of the disease. The chronic forms of eczema are the most common, but acute attacks are also frequent. They may last not more than a fortnight, or may return in succes sive attacks, and finally pass into the chronic type. A sense of chilliness along the back and feverishness usually precede the acute the skin becomes red and swollen, and within 48 hours the eruption appears, which, in a week or ten days, passes through the various stages described. In chronic cases the place affected has often something to do with the appearances produced. In eczema of the head the oozing fluid from the inflamed surface, mixed with secretion from the glands of the hair, readily forms matted crusts among the hair; and, if the part is not kept clean, the condition may spread till the whole scalp is affected. Moreover, in the offensive mass lice, maggots, &c., breed. This is common among ill-nourished unhealthy children (is termed scald-head or milk-crust) and may last for years if not treated. When the scabs are removed, a red thickened surface covered with scales is laid bare. The disease easily extends to the lobes of the ear and into the canal of the ear in the form of red cracked skin, weep ing or scaly, or coated with scabs. The nostrils may be affected and their openings plugged with thick scabs, the skin of the lip being red and swollen. Eyelids and eyebrows are often involved in the disease.
Eczema also occurs on the surfaces of joints, particularly the knee-joint, or the surfaces on which the limb moves when bending takes place. Owing to the frequent movement pain ful cracks are formed, and the skin is red, thickened, and crusted. A similar form occurs
on hands and feet. That of the feet is ascribed to the pressure of boots, and is on the back of the foot usually; that of the hands is commonly due to irritating substances among which the person works. Thus grocer's and baker's itch are forms of eczema, occurring on the hands and arms, and set up by working among salt, sugar, &c., and by the action of heat and moisture. In eczema of the genitals itching is severe and leads to much scratching and tearing. The surface becomes red and thick ened, and the affection may extend down wards along the thigh, upwards towards the abdomen, and back to the anus, where it may lead to the formation of painful itching fissures.
Eczema may be caused by the direct action ' on the skin of irritating agents, examples of which have already been given. Mere scratch ing will sometimes be sufficient to produce it, the pressure of clothes, &c. It also results, however, from constitutional conditions.
Though eczema is curable, relapses are very common.
Treatment.—Eczema is treated chiefly by applications to the affected part, and not by drugs administered internally. It is a common notion, but quite a mistaken one, that the cure of the disease, so far as it affects the skin, will tend to "drive it inwards" on some more im portant organ. No such idea ought ever to be permitted to stand in the way of adopting ap propriate methods to obtain a cure. A great variety of preparations are adopted, and many cases are very obstinate. It is, therefore, necessary to have the treatment guided by a surgeon. The following simple directions may, however, be found useful. In the stage of swelling and heat, cold-water dressing will afford relief. After the eruption has appeared, dusting with finely - powdered starch, white oxide of zinc powder, or chalk, may be tried. Scabs should be removed after softening with oil, or bread-and-water poultice, or, perhaps best of all, pOultices of mashed turnips. These latter are specially valuable in eczema of the scalp. A piece of absorbent wool, soaked in the dilute solution of lysol, and applied as recommended for ulcer, will quickly soften and remove the scabs and crusts. When the scabs have all been removed, simple ointments like vaseline maybe applied. A very valuable ointment is made of the yellow oxide of mer cury (yellow precipitate) 1 drachm, oil of sweet almonds 1 drachm, lard 6 drachms. This oint ment may be applied to the eyes as well as to any other part. For eczema occurring on two surfaces that rub on one another careful bath ing and drying, and then the application of vaseline, are sufficient. In particular all irri tating applications are to be avoided. If the person suffer from depressed health it is advis able to use quinine and iron tonics, and to obtain change of air.