472 DISEASES OF THE SKIN. 



TREATMENT. Errors in the treatment of cutaneous diseases in 

 general, and in that of eczema in particular, are liable to assume one 

 of two directions. One class of physicians are possessed by the preju- 

 dice that all local treatment is wrong, because they can never be sure 

 that the suppression of an eruption will not be attended by dangerous 

 consequences. Hence, from the apprehension (which certainly is nearly 

 always groundless) that they may, perhaps, do harm to their patients 

 by treating eruptions locally, they resort to an internal medication, 

 which is injurious beyond all doubt. Another party, blindly following 

 the authority of Hebra, look upon all internal medication as super- 

 fluous, and treat all cutaneous diseases locally, without the exception 

 even of cases where an eruption has been followed by the abatement 

 of serious disease of internal organs. HebrcCs success leaves no doubt 

 that the direct treatment of disease of the skin is the best for many 

 patients. Not only is the disorder itself relieved and cured more 

 surely and quickly by such means, but it often does much less harm to 

 the patient than the old-fashioned practice of giving laxatives, metal- 

 lic preparations, and other noxious medicines. Moreover, with few 

 exceptions, it is a groundless prejudice to suppose that other diseases 

 proceed from the suppression of cutaneous eruptions by means of local 

 applications. On the other hand, it must not be denied that exanthe- 

 mata, when' treated by local means alone, are very apt to relapse ; and 

 that cases really do occur now and then, in which there is reason to 

 fear that their repression, under direct applications, may give rise to 

 disease of internal organs. 



The forms of eczema in which I consider it inadmissible, or at all 

 events hazardous, to employ vigorous local treatment are 



1. The moist form which appears upon the scalp and face of children. 

 It is an unmistakable fact that the sudden disappearance of such erup- 

 tions is often quickly followed by bronchial catarrh, croup, or hydroceph- 

 alus ; and it is equally certain that a tedious catarrh or other affection 

 will often subside as soon as an eruption of this kind makes its appear- 

 ance. However, it does not by any means follow that the internal 

 maladies have arisen in consequence of the cessation of the cutaneous 

 disease, nor, on the other hand, have we any proof that it is because 

 of the outbreak of the eruption that they subside. But we are equally 

 uncertain of the contrary propositions, and even the possibility of the 

 existence of such a cause should contraindicate local treatment of 

 moist eczema upon the heads and faces of children. It is true that a 

 similar belief formerly prevailed regarding the supposed injurious 

 effects of the treatment of itch by local means. Such views are now 

 recognized as prejudices, and exploded ; and I readily admit that here- 

 after my fear of treating facial eczema locally may prove equally 



