Vol. 60, 1909 - University of North Carolina at Chapel Hill

152
THE CHARLOTTE MEDICAL JOURNAL-
with irrigation was continued at intervals Eczema.
of six hours for forty-eight hours longer, at By Albert D. Parrott, M. D., Kinston, N. C.
the end of which time there was very slight, Eczema is an inflammatory disease of the
if any, complaint. The temperature had skin, of which we find the acute, subacute,
dropped to normal in the morning with a and chronic forms, depending on the duraslight
afternoon rise. At the end of forty- tion, &c. It is usually attended with some
eight hours more the patient was able to itching, exfoliation, or shedding of the cuvoluntarily
void his urine with but slight tide, and usually with the exudation of
pain. During the second week, pains in serous, or seropurulent fluid which is found
left flank became more prominent. Biman- upon the denuded surface, or beneath the
ual examination painful, and giving an in- cuticle. Vers' often we find in one case,
definite sense of resistance in region of kid- erylheuia papules, vesicles, or pustules, and
ney. Patient was allowed out of bed be- its lesions evince a decided tendency to cocause
there was very little temperature dur- alesce, and thereby form large infiltrated
ing the evening, though urine still very areas.
cloudy. Through the second week, tern- Sy?iiptoi?is.—I should say that eczema is
perature gradually rose and persisted with decidedly a protean disease. I once heard
fluctuations throughout the twenty-four my Professor remark that if a student has
hours, patient steadily growing sicker, thoroughly mastered Syphilis, and Eczema
though pain in left flank not much increas- and their respective treatments, that he
ed. He was greatly troubled by accumu- practically held the key to the rest of Derlations
of gas in the ascending and trans- matology in the palm of his hand. To my
verse colon which caused considerable pain mind this is in a great measure true. Alunder
the margin of the ribs on the left side, though as yet we know only the elementary
Constipation obstinate. All catharsis in- principles of these two diseases, and just a
creased the pain, and purgation was fol- smattering of their Symptomatology and
lowed by marked prostration; there was a treatment. We really know nothing of the
limited area of tenderness below the tip of pathology of either. Every case of eczema
the twelfth rib. will present one or all of the following
At the end of eighteen days, operation prominent symptoms:
advised, though not accepted until eight (I) Redness,
days more. On the 27th day from his chill, (2) Infiltration,
under chloroform anesthesia, incision made (3) Itching,
down to the kidney, revealed a thin lay Jj (4) Tendency to moisture.
of blistered brownish fat surrounding the (5 ) Crusting, or scaling,
kidney and enclosing about a pint of pus. (6) Fissures, or cracks in the skin.
The kidney was greatly enlarged, measur- This disease may, and often does begin
ing six inches in length, by three and one- without any marked constitutional disturbhalf
in thickness; capsules very tense, and ance. We sometimes find accidental fever,
when it was delivered and incised, the en- malaise, anorexia, &c. Commonly the first
tire cortex everywhere was filled with pus, thing that attracts the patient's attention is
as was also the pelvis of the kidney. After itching, and upon inspection we find the skin
several incisions and failing to find healthy slightly reddened, it may be scalv, papules
kidney, it was removed. scattered here and there, or vesicles and]
On his return to bed, the bladder was tules may be present, and sometimes just a
washed out and from that time on no more slight exudation of moisture, or weeping is
pus appeared in the urine. Patient passed found. There is a great tendency for all
thirty-seven ounces of pus during the first forms of eczema to segregate in various size
twenty-four hours; sixty during the second, patches, with more or less infiltration, illand
forty-two during the third; temperature defined, and shade off almost imperceptibly
reached normal on the third day. into the surrounding skin, so that it is ex-
Two years "have passed and ceedingly
patient has
hard at times to say where they
returned to his occupation of traveling sales
^"^' ^^'^^ ^^^ outlying lesions adjacent to
jjjan. them. Their shape is irregular, of many i
A--: ^u i r 11. • • sizes, sometimes very diffuse, and involving
At times there is a trace of albumin in ^^^^^ ^^^ ^^^,-^^ cutaneous surface. Somehealth
""''" '"'°-'' ^ times they are swollen and of a dark red
color, at times they are tinged vellow.
These two cases are fair examples of the Starting with a few leisons, thev multiply
great variation that may exist in the etiol- with more or less rapidity, the individual
ogy, treatment and prognosis of perinephric lesions coalescing and patches are thus
abscess.
formed. It may be quite evanescent clear-
Refere7ices: jng away in a short while, or many weeksi
Gray's Anatomy, Osier. Ransohoff, Tyson, or months may elapse, or it may becom(