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

154 THE CHARLOTTB MEDICAL JOURNAL
is very easy from some local injury to light declares that it is due to an undiscovered
it up again. In this form the skin is thick, parasite.
indu.ated, and presents a leathery appear- Pathology.—There is really less known
ance, and about the joints, it cracks at about the pathology of eczema, than there
times, showing that its usual amount of is about the pathology of Syphilis. Suffice
elasticity is interfered with, when the joint it to say that eczema is a catarrhal inflamis
extended. mation of the skin, similar to that of the
Eiiologv-—Very much like its symptoms, mucous membrane, which has its focus
its causes are legion. It often arises from chiefly in the papillary layer of the skin,
purely local causes, but even then, we must and the rete mucosum. The process being
assumethat there is some predisposition to it, superficially located, is the reason why
on the part of the skin. We often see it on the there is so little scar-tissue formed when the
hands of washerwomen, carpenters, and inflammation has subsided. It is generally
ccnstituting what is known as trade EC- conceded that a tropho neurosis is mainly
ZEMA. responsible, when not due to local irrita-
Perhaps for a score of years they washed lion.
with the same soap and water, and used the Diagnosis—A positive and differential
same plane and saw, without any manifes" diagnosis would consume too much space ^',|
tation of eczema. Then under the same for an article of this kind, but if the six car- I
local conditions, but with some unknown dinal symptoms are kept in mind we will :
internal constitutional state an eczema su- not often go astray. Redness, itching, I
pervenes. Generally speaking the external infiltration, or thickening, exudationor, I
irritants that most frequently cause czema, a tendency to weeping, crusting or scaling, i
are the sun, water intense artificial heat, cracking, they will be a great aid in the '
acids, alkalies, traumatism, rubbing of op- diagnosis. Add to them the tendency the
posed surfaces, parasites, in fact anything diease evinces to locate in the folds of the ]
that will produce a dermatitis, but the pro- joints between opposed surfaces, bebind the '
cess does not stop as a simple dermatitis, ears, and the mucilaginaus quality of the I
but goes further, and a catarrhal condition exudate, which stiffens, and stains linen, i
of the skin results. It has been frequently and mate hairs together. Indeed a diagno-
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observed that children with eczema grow sis of eczema will fit one out of every three
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markedly worse as the mercury descends,
showing that cold has an undoubted influsuch
cases.
Treatment.—While some cases arise from
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ence for the worse. Vaccination has acted purely external causes and require only ex- \
as a local cause. Of the internal or predis- ternal treatment, but in the vast majority
posing causes, perhaps the most common of cases the patients general condition is
and active is some disturbance of the gastor- not good, and he needs treatment quite sepintestinal
tract—as indigestion, dyspepsia, arate and distinct from his skin- disease,
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mal-nutrition, or some hepatic, or renal dis- In fact we should regard the bulk of our
order. Diabetes Mellitus, and nephritis are cases as a sick man rather than a sick
both common causative factors. Occasion- skin. If the patient be anemic he should
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ally we will see cases that have a purely have iron, plenty of fresh air, and moderate i
nervous origin, and recover immediately exercise. The metabolic flame cannot burn
when the proper equipoise is established, without proper and sufficient fuel, i. e. nour-
Rheumatism, gouty diathesis, varicose ishing food. This fuel cannot be consumed
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veins, &c., are other predisposing causes, without enough oxygen. Oxygen cannot
I am also quite certain that the anemias are be carried to the bodily fuel without suffic- ;
frequent etiological factors. And with all lent iron-bearing hemaglobin. If he is of :
these probable internal causes, nearly every the strumous type, codliyer oil is indicated, i
case dates its beginning co-incident with To our nervous patient give appropriate •
some exciting external cause. The disease doses of strychnia, hypophosphites, and ;
of course attacks al) ages, races, conditions, other good nerve bracers. Indigestion needs I
both sexes and is the dermatosis we are most the mineral acids, Nux vomica, pepsin, bis-
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frequently called upon to treat. This is muth, soda, &c. Those with internal disthe
incentive for writing this article. It is eases need appropriate treatment. Where
very common in infants and children. In there is rheumatic tendency the acetate or
Buckley's tables, out of .3000 cases, 676 oc- potash, or the phosphate of sodium are incurred
under five years of age, and of these, dicated. Give colchium, or colchine for
520 were in children under three years. Of gout, lithia is also excellent. All the
the remaining cases 1234 were between
emunctoris should be kept functioning prop-
the
r . . J cr. J 1- ., , erlv. There is no specific for eczema, each
ages of twenty and fifty, and were divided
,^^^ should be carefully studied, and treated
about equally in each decade. Nearly one- accordingly. In treating eczema in all its
third of all skin cases are eczema. Unna stages rich gravies, stimulating foods, con-
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