ECZEMA. 755 



is fresh, soothing and calmative treatment is indicated ; in the 

 middle and pustular stage, tonics and mild astringents are 

 better ; and in the last, stimulants, particularly local ones, are 

 most conducive to favourable results. Thus every case must 

 be treated on its own merits or requirements, directed by the 

 knowledge that individual constitutional states and peculiarities, 

 and such accidental complications as concomitant disturbance 

 of other organs, largely modify the phenomena of the disease. 

 In simple eczema, the conditions being chiefly local, the treat- 

 ment must of necessity partake chiefly of the same character. 

 Here simple applications, as an alkaline wash with a little 

 glycerine and some liquid preparation of opium, or even starch 

 powder or wheaten flour sprinkled over the parts, will do well. 

 Constitutionally, at this stage a mild aperient is indicated, 

 followed by a little acid mixture ; while the terminal process 

 of desiccation and scaling may be expedited b}^ a mild stimulat- 

 ing wash, in which some of the tarry preparations are the 

 active agents. 



In the severer cases, and where there is much exudation, as 

 in eczema rithrum, the treatment is at first essentially that 

 of allaying local irritation by dressing the parts with fine starch, 

 powder mixed with oxide of zinc, or painting the surface with 

 a weak solution of nitrate of silver in glycerine, or a solution 

 of tannic acid and opium to which has been added a httle 

 glycerine. When the exudation is a little dried, a liberal use 

 of the ointment of the oxide or carbonate of zinc or lead may 

 be alternated with either of these lotions. In this form 

 aperients and salines may be less liberally employed, and their 

 place taken by such tonics as sulphuric acid and iron, or cin- 

 chona, gentian, and acid, with a free use of linseed oil in the food. 



When the surface-discharge becomes distinctly lessened, and 

 the swelling and puffiness of the skin gone, and squamation is 

 fairly established, somewhat of the same tonic treatment is to 

 be carried out ; aperients and diuretics may occasionally be 

 used, but with less frequency, and the iron and acid, with 

 vegetable tonics, may be alternated with some preparations and 

 compounds of arsenic, iodine, or mercury. It is in this scaly 

 stage, whether accompanied with much or little itching, that I 

 have found greatest benefit from the use internally of arsenic, 

 and externally of the tarry preparations. 



48—2 



