466 DISEASES OF THE 



srete ; at others, they stand so closely together as to coalesce (urti- 

 caria conferta). Sometimes the duration of the individual weals is 

 very brief (u. evanida), then again it may be very persistent (u. per- 

 stans). When the weals are large and hard, the urticaria is called 

 tuberous ; when small, it is said to be papulous (lichen urticariw) ; 

 and, if the epidermis upon them be elevated into the vesicles here and 

 there, it is called urticaria vesiculosa. The rash is always accompa- 

 nied by a most tormenting itching of the part, so that the patient can- 

 not refrain from scratching it. With exception of the febrile urticaria, 

 the itching and the objective signs upon the skin are the only symp- 

 toms of all forms of the disease. It seldom lasts over a few days ; 

 although, in chronic urticaria, the rash recurs at short intervals for 

 weeks, months, and years, one eruption following another, but none 

 of them ever lasting very long. The fever which accompanies and 

 sometimes precedes the febrile urticaria may be so intense as to cause 

 dryness of the tongue, disturbed sleep, and even delirium. If the 

 fever be attended by violent vomiting (and, as often happens, by diar- 

 rhoea, due, no doubt, to an affection of the intestinal mucous mem- 

 brane similar to that upon the skin), the disease may present an as- 

 pect of great gravity. However, the eruption, fever, and gastric dis- 

 turbance subside in a few days, and a rapid convalescence ensues. 



TREATMENT. It would be a great gain, could we only relieve pa- 

 tients from the itching of that form of urticaria which sets in rapidly 

 and subsides spontaneously, and which so torments them as to deprive 

 them of all comfort and sleep. The palliatives recommended for this 

 purpose, however, the chief of which are bathing the skin in very di- 

 lute acids, and rubbing it with slices of lemon, are often ineffectual. 

 Neither do we know of any efficient remedy for chronic urticaria. We 

 must, therefore, confine our treatment to the endeavor to restore the 

 general health of the patient by suitable diet and medicines, to correct 

 digestive derangement, and to forbidding the use of such articles of 

 food as we know to be liable to cause the disease. 



CHAPTEK VII. 



ECZEMA DIFFUSE SUPERFICIAL DERMATITIS, WITH SEROUS EXUDA- 

 TION UPON THE FREE SURFACE, AND WITHOUT TYPICAL COURSE. 



ETIOLOGY. By far the most common form of dermatitis is eczema. 

 As in herpes, the inflammation is limited to the superficial layers of 

 the skin, and is accompanied by a serous exudation upon its free sur- 

 face. But it differs from herpes, on the one hand, in its tendency to 

 spread over the surface a tendency which is quite unmistakable even 



