Chro7iic Eczema of the Carpus and Tarsus. 481 



ering for the part, holding the hairs erect and bristlj^ and even 

 lifting them ont of their follicles. Cracks also appear in the 

 depth of the fold, leading to a more abundant exudate, and the 

 disease may extend aroiuid the whole surface of the limb. 



In the more acute cases this may be followed by more or less 

 depilation, dessication and recovery, but too often the condition 

 becomes chronic, the thickened, encrusted or squamous skin 

 continues to exude, crack and cover itself with crusts, under 

 which the decomposing liquids macerate and irritate the ex- 

 posed cuticle, and engorgment of the whole limb with hj-per- 

 plasia of the connective tissue and lymphatic plexus and vessels 

 is the result. This hyperplasia of the skin and connective 

 tissue (elephantiasis) is also a common result of lymphangitis. 



Treatment. As in other skin affections attention must first 

 be given to removal of the causes. Ensure cleanliness, pure 

 air, regular exercise, non-stimulating food, the avoidance of cold 

 water, melting snow, soapy washes and all other .sources of ir- 

 ritation. Deep mud, especially if charged with lime, sharp sand, 

 decomposing organic matter or other irritant, is particularl}- 

 ofFen.sive. 



Hand rubbing (massage) of the limbs and evenly applied light 

 bandages are often of the greatest value in dispersing or obviating 

 swelling. 



The slighter attacks may be met at the out.set by bland oint- 

 ments or du.sting powders and rest from all but necessary exer- 

 cise. Dressing with iodoform may bring about a recovery in a 

 few days. Starch and oxide of zinc, boric acid, magnesia car- 

 bonate, bismuth or lycopodion may give good service. Lotions 

 of lead acetate, tannin, iron sulphate, alum, potassium perman- 

 ganate or pyoktannin may be used as in other forms of eczema. 

 In obstinate cases green soap followed by stimulating ointments 

 or liniments, tar, oil of white birch, Canada balsam, turpentine 

 and glycerine, oil of cade, etc., will often serve an excellent 

 purpose. In these advanced cases an alterative such as arsenic 

 may be employed. 



31 



