ECZEMA. 



469 



petic diathesis is frequently congenital, and, as Veil in Cans tat t has 

 demonstrated, is hereditary in many instances. One would naturally 

 suspect congenital predisposition to eczema in a family in which all the 

 brothers and sisters were afflicted by it, and that it was hereditary 

 if the parents and grandparents also have had it. We need hardly 

 state that a herpetic diathesis is not always transmitted from parent 

 to child, any more than any other hereditary disease. Scrofulous and 

 rachitic children always exhibit a most pronounced tendency to ec- 

 zema, especially to eczema impetiginosum. Sometimes there is a 

 connection between eczema and chronic dyspepsia or derangement of 

 menstruation. In such cases, although we may succeed in healing the 

 eczema by local treatment, yet there will always be relapses of the 

 eruption so long as the other complaint remains uncured. Much more 

 frequently, although there may be a most decided herpetic diathesis, it 

 is not accompanied by general nutritive derangement, nor by disease 

 of any particular organ. The appearance of eczema, unprovoked by 

 any appreciable irritation of the skin, and its frequent recurrence, in 

 spite of the most careful avoidance of all sources of irritation, is often 

 the sole sign of constitutional derangement. 



SYMPTOMS AND COURSE. The subjective signs of eczema consist 

 in itching, accompanied by an irresistible inclination to scratch, symp- 

 toms which are common to all cutaneous diseases, where the papillary 

 layer is affected. The objective signs have already been given above. 

 We have already seen that the cutaneous surface, which is the seat of 

 that atypical, diffuse, superficial dermatitis called eczema, sometimes is 

 studded with vesicles ; at others, with vesicles and pustules intermin- 

 gled, and sometimes again with scales ; that, in other instances, it 

 presents a red, moist surface, denuded of its epidermis, and that, in 

 still others, it is covered with crusts and scabs. 



Besides the four forms of eczema (e. simplex, e. sqamosum, e. ru- 

 brum, e. impetiginosum), it is also customary to recognize a chronic 

 form of the disease. But not only is it illogical to associate one spe- 

 cies, distinguished by the nature of its course, with four others, classi- 

 fied upon an entirely different basis, but in practice this arrangement 

 is found to be attended by many inconveniences. Chronic eczema can 

 only be contrasted with acute eczema ; like the latter, it sometimes 

 assumes the simple form, sometimes the squamous or the impetiginous 

 form, and sometimes again that of eczema rubrum. In cases of very 

 _ong standing, which usually assume the type of eczema rubrum, the 

 disease upon the surface is occasionally accompanied by changes in the 

 structure of the cutis. This generally consists in an inflammatory hy- 

 pertrophy, quite analogous to that which occurs in the mucous mem- 

 branes in chronic, bronchial, and gastric catarrh. Less frequently there 



