ECZEMA 473 



groundless ; but, according to our present knowledge, such apprehen- 

 sion seems well founded, and the fact, that it is safe to cure other 

 exanthemata by external applications, does not prove any thing re- 

 garding the disease in question ; since, in spite of the great external 

 similarity of the exanthemata, they differ essentially in their influence 

 upon nutrition, and in their effect upon the general health of the 

 body. 



%. Local treatment is contraindicated in all forms of eczema 

 of adults that seem to appear vicariously for other diseases, which 

 have subsided upon the outbreak of the eruption. It is true that 

 Hebra expressly affirms that he has suppressed such eczemas without 

 injury to the patient, solely by the employment of local applications ; 

 but, in spite of his authority, I should not dare to resort to an external 

 treatment of a case of eczema, the establishment of which had been 

 followed by the recovery of an ophthalmia of long standing, or of a 

 chronic derangement of digestion, or other serious disease. 



3. Local treatment, or, at all events, an exclusively local treat- 

 ment, is unadvisable in an eczema, the cause of which is evidently 

 constitutional. The number of cases suitable for external treatment 

 would then be a very small one, however, in the eyes of the class of 

 physicians who ascribe all exanthemata, whose origin they do not 

 know, to a dyscrasia. One of the important steps recently made in 

 the therapeutics of cutaneous disorders, however, consists in our no 

 longer ascribing an eczema to a constitutional origin, and subjecting 

 it to " anti-dyscratic " treatment, unless we have better evidence of 

 the genuineness of such origin than is afforded by the mere existence 

 of an eruption. The impropriety of treating the syphilitic exanthemata 

 locally is universally admitted, but even in the eczema which afflicts 

 scrofulous and rachitic subjects, as well as in that which attacks chlo- 

 rotic females, and in that which accompanies disorders of the sexual or- 

 gans, an exclusively local system of treatment is unwise ; not that direct 

 remedies are hurtful in themselves, but they should only be employed 

 as corroborants to general treatment, directed against the fundamental 

 disease. At the same time, we should mention that eruptions which 

 are undoubtedly of constitutional origin often continue, as it were, 

 independently, after the original disease has subsided, and require a 

 vigorous local treatment for their eradication. This is sometimes the 

 case even in syphilitic exanthemata. I knew a merchant in Magde- 

 burg, who, in addition to other signs of syphilis, had a very unsightly 

 eruption upon his face and head, which had lasted for years after all 

 the other syphilitic symptoms had disappeared. This man, after con- 

 sulting the most eminent physicians, and after undergoing all sorts of 

 anti-syphilitic treatment without benefit, was completely and per- 



