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disease, usually, skin, rash, appear, vesicles and fluid

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, one of the commonest of skin diseases in early life, and often one of the most obstinate, is characterised by an eruption of papules, vesicles, and sometimes of pustules. The rash forms more or less extensive patches of redness. These secrete a thin gummy fluid which dries into scales and crusts. The disease is accompanied by much irritation, and in severe cases the constant itching interferes with sleep and keeps the unfortunate pa tient in a state of constant restlessness and distress. It may attack chil dren of all ages, and in infants especially (eczema infantile) is apt to assume a sub-acute form which persists for months or even years with varying in tensity, and is very difficult of cure.

Causation.—Infants attacked by the disease are usually of sturdy build without other sign of ill-health. In such cases it is by no means easy to discover any cause to which the complaint can be attributed. Often one child of the family is alone affected, although the conditions of life appear to be the same in the case of the patient as in that of his more fortunate brothers and sisters. Sometimes, if the child is at the breast, we can de tect by careful inquiry the existence of dyspepsia in the mother, or of some error in diet which affects the quality of her milk. In hand-fed babies ex cess of starchy food may seem to be inducing an acid state of the alimen tary canal which may promote and maintain the cutaneous eruption. In some cases a gouty or rheumatic family tendency may exist, and it appears extremely- probable that this constitutional disposition is often to blame for the occurrence of eczema in young children. It has certainly seemed to me that infantile eczema is more common in such families than in others where no such proclivity exists. Again, we not unfrequently find, especially in scrofulous subjects, that the eczematous rash appears as a sequel of one of the acute specific fevers. Thus, it may come on after measles, scar let fever, or sinall-pox. The disease is, however, often met with in cases where no error in management can be discovered, where the animal func tions appear to be satisfactorily performed, where the child has not lately suffered from fever, and where no family tendency to gout or rheumatism can be found to prevail.

Dentition is often supposed to be an exciting cause of the cutaneous affection, and no doubt a limited amount of eczema is often present in teething infants. But it is common for the rash to appear at the fifth or sixth month, before teething troubles have begun ; and the eruption not unfrequently lasts long after the whole crop of milk-teeth has appeared through the gum.

In older children irritants to the skin, such as profuse sweating, etc., may produce the disease ; and at this age excess of fruit and other errors of diet may lead to the disorder. Scrofulous children are very liable to it.

Symptoms.—Eczema usually begins as a bright red patch, on which a. crop of papules very quickly appears, or the surface becomes covered with a number of minute, clear vesicles. There is great itching of the inflamed portion of skin ; and the friction to which the part is subjected very rapidly destroys the normal appearance of the rash. , The papules are torn by the nails, and the vesicles also become ruptured and exude a thin fluid which dries into scales. The parts affected are usually those where the skin is delicate and soft, such as the folds of the joints, the genitals, the peri num, the lips and cheeks, the inner sides of the thighs, and the backs of the legs, especially just above the ankles. It is, however, also common on the scalp ; but here the disease usually assumes the pustular form, and thick scabs are seen, under which there is a purulent fluid. In some chil dren this variety is often accompanied by pediculi.

The constitutional disturbance is seldom great ; there is rarely noticeable rise of temperature, and the appetite is little impaired. In very acute cases, however, the burning sensation to which the inflamma tion gives rise may produce great distress. The child's sleep is disturbed, and all his functions may be deranged by worry and want of rest.

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