478 DISEASES OF THE SKIN. 



For my part, I consider it to be not only advisable, but impera- 

 tively necessary, that local and general treatment should be combined 

 whenever the disease tends to repeated relapses, in spite of careful 

 protection of the skin from noxious influences. It is of but little ad- 

 vantage to a patient to be discharged from a hospital cured, if his dis- 

 ease is going to be as bad as ever again in a few weeks. We need not 

 search far to find innumerable examples, in which, in spite of the skill 

 of practitioners familiar with the most approved and newest modes of 

 treating diseases of the skin, persons have remained afflicted with eczema 

 for years, now suffering from the eruption, now resorting to treatment, 

 but seldom remaining free from it for any length of time. No general 

 rules can be laid down for the constitutional treatment of those ecze- 

 mas which depend upon a herpetic diathesis ; but in special instances 

 it is not very difficult to ascertain the suitable remedy, since the indi- 

 viduality of the patient, his physical habit, and his mode of life, furnish 

 a clew to the means by which his constitution may be modified effec- 

 tively and at the same time without injury. It would be unfortunate 

 if the conviction, that the effect of Hebrcfs treatment is often merely 

 palliative, were to lead physicians back again to the old routine of 

 systematically purging all forms of this disease ; but I do not hesitate 

 to declare that I regard Hebrdts assertion, that, " in chronic eczema, the 

 mere use of purgatives never does good, and often does harm," as quite 

 inaccurate. When chronic eczema attacks a corpulent patient who 

 eats and drinks more than enough for the requirements of his system, 

 and who is fond of fat food, and of food rich in fat-producing elements, 

 he will recover more quickly, and the cure will last longer, if placed 

 upon a methodical course of laxatives combined with suitable regula- 

 tion of his food, than if his treatment be merely local and no attention 

 be paid to diet. In such cases, where the eruption is very extensive, I 

 often prescribe Zittmarfs decoction in spite of its absurd composi- 

 tion simply because patients follow out the directions for its use with 

 such punctilious and almost superstitious exactness. But there is an- 

 other class of habitual sufferers from eczema, whose idiosyncrasies are 

 exactly the opposite of those described above, and who, without being 

 really sick, are poorly nourished and much emaciated. To purge such 

 patients as these, and to reduce their diet, would be to make the evil 

 worse. On the contrary, they require a treatment calculated to aug- 

 ment the supply of nutriment, and to diminish the wear and tear of 

 the system, such as the exhibition of cod-liver oil and similar medi- 

 cines. These suggestions must suffice. It would take too long were 

 we to attempt to detail all the indications for internal treatment which 

 may accompany the topical applications, and which are deducible from 

 the constitutional peculiarities of the patient. 



