In obstinate cases arsenic may be usefully combined with the iron, and as children bear arsenic well the drug can usually be given in the same doses as are found beneficial in the adult. There is, however, no advan tage in cases of arsenic in pushing the dose to the utmost limits of toler ation. It is seldom necessary to exceed five drops of Fowler's solution three times a day.
If any tendency to acidity and flatulence is noticed, the alkalies are some times of service, and the quantity of fermentable matter allowed in the diet should be restricted. Too much importance, however, need not be attached to the subject of diet in the treatment of eczema. If a case is obstinate and resists ordinary remedies, I have not found the prohibition of sweets and fruit of much value in promoting a cure. Other observers, however, seem to have met with more success. In cases of flabby (not plethoric) children, Mr. B. Squire advocates an almost total deprivation of the fat-forming elements of food. He allows milk diluted with twice its bulk of water ; dry toast, or dry biscuits ; lean beef or mutton with all the fat carefully removed ; white fish broiled ; green vegetables (but not potatoes, turnips, carrots, or other vegetable roots); and cooked fruit un sweetened. Mr. Squire states that great improvement is seen in these cases within ten days of beginning this diet.
In all cases the digestive organs should be attended to, and any de rangement remedied as quickly as possible. Constipation must be re lieved, looseness of the bowels arrested, and it should be our care to see that the animal functions generally are in good order.
In cases of acute eczema tonic treatment is not always the best suited to cause the disappearance of the eruption. The disease sometimes attacks sturdy, florid children, with a good colour and plethoric habit. These cases should be treated with a mercurial purge, followed by saline laxa tives to keep up a gentle action upon the bowels for several days. The child should take no meat, but should be put upon milk, broth, light pud dings, and bread-and-butter. Again, in cases where there is an evident tendency to rheumatism, or a strong gouty element in the family history, guaiacum often has a very marked influence in curing the disease. The simple tincture is the best preparation ; it should be given in doses of twenty minims three times a day (to a child of ten years old).
The local treatment is of great importance in the treatment of eczema. When the eruption is very acute, stimulating ointments should not be used, but the part should be kept moist with a simple water-dressing, or be bathed frequently with bran-water made by pouring boiling water upon bran and allowing it to cool. Dr. R. Liveing recommends the applica tion to the affected surface of a powder composed of three drachms each of oxide of zinc and starch, and thirty grains of camphor. Over this is to be placed a warm linseed-meal poultice.
In a later stage alkaline warm baths are useful. Dr. Buckley recom mends that for this purpose the carbonates of soda and potash and the biborate of soda be used ; two to four teaspoonfuls of each to the gallon of water. To these two to four teaspoonfuls of dry starch are added. This bath should be used without soap, the child being merely soaked and bathed in the medicated water. After ten minutes or so he is removed, dried without friction, and then well dusted over the body with lycopo diem powder. Much washing is to be forbidden in cases of acute eczema, as it is said to injure the process of repair. Dr. Buckley only allows it when the accumulation of exuded matter prevents the ointments from reaching the diseased surface.
A useful form of bath is made by medicating the water with Wright's liq. carbonis deturgens in the proportion of two drachms to the gallon. This can be given at first every night for half an hour ; afterwards on alternate nights. Local patches of eczema are often benefited and in many cases quickly cured by keeping the part constantly moist with a lotion composed of two drachms of the liq. carbonis deturgens to ten ounces of water. To be effectual, however, the moistened rags in contact with the affected surface should never be allowed to get dry.
Zinc and lead are two of the most valued applications for eczematous patches. In the moist variety a salve composed of oxide of zinc and the solution of the subacetate of lead—a drachm of each to the ounce of vaseline —is very useful. In the dry, scaly form of the rash this ointment is made more efficacious by the addition of twenty to thirty grains of the ammonio chloride of mercury and a drachm of the liq. carbonis deturgens. If itching be very distressing, the following application, taken from the pharmacopceia of University College Hospital, is of great service:— In eczema capitis the crusts must be first carefully removed. This is best done by covering them at night with a thick layer of lard and placing over this a large linseed-meal poultice. In the morning the softened crusts can be picked off with forceps or bathed away with warm water. When completely cleansed the scalp must be anointed with ammonio chloride of mercury ointment diluted with an equal proportion of lard ; or we may use the salve composed of oxide of zinc and subacetate of lead already referred to. Children who have this form of impetiginous eczema in a severe degree are usually of strumous constitution and require tonic treatment. In obstinate cases of eczema of the scalp the disease can often be cured by tarry applications. Half an ounce of common tar, oil of cade, or oil of birch (olei rusci) may be added to two ounces of glycerine of starch. This can be painted over the head twice a day. In very chronic cases one thorough application of undiluted liquid tar will sometimes pro duce a complete cure of the disease.