Up to three quarts of water may be taken in this way. The addition of salt to the dietary is also useful. As a rule, you will find that adult sufferers from eczema are decidedly carnivorous in their tastes, eating a good deal of meat with a very scant quota of vegetables and cereals. Many of them are particularly fond of the pleasures of the table, and indulge much more freely than there is any necessity for. As these matters are under the control of the patient himself, no pains should be spared to impress on him the necessity for a change in his habits. It is not well to cut off the supply of meat absolutely, but it should be very decidedly restricted, and a larger proportion of bread, vegetables, and cereals substituted.
Patients often fancy that diet of this sort reduce their strength and incapacitate them for the amount of labor that their daily vocations necessitate. These fears are groundless, and on trial will soon be dissipated.
A very interesting and important question has been raised as to the propriety of healing completely a discharging eczema, and the fear of driving in the disease has often deterred practitioners from affecting a speedy cure.
Hebra and his school laugh at this idea, and no doubt in the majority of cases with good reason.
The question at issue, whether an habitual discharge may be suppressed without danger to a patient, depends upon the patient, and not on the disease.
” I attended a child who had lost two younger brothers from acute tuberculosis. He had a very extensive eczema of the scalp and face, but otherwise appeared in good health. Under appropriate remedies his eczema rapidly got well, but its disappearance was attended with all the signs of acute hydrocephalus, from which he soon died.
With the family disposition to this disease, it is not unlikely that the child might have succumbed to tuberculosis had the eczema not been cured; but I fear my treatment was injudicious, as the child’s disposition to disease of a special and serious kind was not taken into account.” (Simon).
Analogies of the impropriety of rapidly suppressing habitual discharge are common enough. Hemorrhages from the lungs or stomach occur often enough when hemorrhoids, which have been bleeding for years, are suddenly cured, and cases have been recorded in which cerebral hemorrhage has seemed to follow rapid cure of an old ulcer.
Local Treatment
The local treatment consists in first allaying the acute inflammatory symptoms, if any exist, and involves the employment of various lotions, glyceroles, ointments, oils, plasters, powders and soaps. It is not always an easy matter to say what will soothe in any particular case. Bran infusion, or decoction of marsh-mallow or poppy heads, to which a little clarified size has been added, are very good applications to start with as lotions night and morning. The linimentum aquae calcis is sometimes efficacious.
During the first and second stages the solution of the peroxide of hydrogen is of great value. The commercial article usually contains twelve volumes of the peroxide, and is too strong to apply in many cases of eczema, and may require dilution with one or two parts of water or even more. The effect of this solution in many cases appears almost magical, reducing the purulent exudation, and hastening the formation of a new epidermis.
Dilute alkaline preparations, especially a solution of carbonate of soda, are useful for cleansing purposes, and, to a certain extent, for the relief of pruritus.
Strong alkaline preparations, such as liquor potassae, green soap, and its tincture, have a distinct function to perform in the reduction of thickened epidermis, in eczema of the hands and feet and in the removal of infilticularly. If a patch of greatly infiltrated eczema be painted with liquor potassae, in a few moments little droplets of serum will be seen upon the surface. If that be wiped off, fresh serum exudes, and this continues for some minutes. When the tendency to exudation ceases, the parts should be wiped dry and a sedative ointment applied. The application is repeated on the second or third day, according to the degree of irritation produced, and this is continued until several applications have been made. The result will be a notable reduction of the infiltration.
Should the itching prove obstinate, a weak carbolized oil and lime water lotion, or a grindelia robusta lotion, one drachm to the ounce of water may be used.
The following lotion I have found very useful to allay the terrible itching present in some cases, and to soften the texture of the scalp and reduce the inflammation. At the same time give internally Lappa major 2x or 3x tablets.
Rx. Lappa major 3jj
Glycerine, j.
Aqua destillata, q.s.ad., iv.
M. Sig.: Apply to scalp on retiring.
Ointments:- The ointments most in vogue are the unguentum zinci oxidi, ung. hydrargyri ammoniati, ungpicis liquidi, and ointments containing carbolic acid, salicylic acid, and resorcin. Of these the zinc ointment is probably inert so far as any direct medicinal effect is concerned. It is simply a protective, and as such serves an admirable purpose, especially in cases of extensive disease, where it would be neither safe nor prudent to employ the mercurial preparations. The addition of a little belladonna increases its sedative effects.
Unguentum hydrargyri ammoniati, either alone or with the addition of a little stramonium, is much more effective as a curative agent than zinc ointment, but must be used with a certain amount of discretion, and should not be applied to a very extensive surface, lest salivation should occur. In some cases it irritates and should be abandoned, and in a few instances I have known it to excite an intense dermatitis.
Ointments containing from four to ten grains of carbolic acid to the ounce are sometimes of service for the relief of the distressing pruritus.
The following makes an excellent application for the intense itching:
Rx Chloral hydrastis
Camph pulv., dr.ss.
Acidi carbolici, M.x.
Balsam peru, dr. j.
Menthol, gr.xx.
Ung. zinci oxidi, q.s.ad., j.
M.ft. unguent Sig.: Apply morning and night.
The second stage of eczema with exudation and crusting is the period when the above-mentioned ointments are of the most service. After removal of all crusts, and careful drying of the surface, the ointments maybe smeared on the parts, or applied on muslin and bound on. The salve-muslins introduced by Dr. Unna, which consist of a loosely woven fabric thickly impregnated with the ointment, are exceedingly convenient when a fixed dressing is desired. The plaster-muslins of Unna have a firmer consistence, and are more generally useful than the salve-muslins. Similar dressings have been placed on the market and fully meet all requirements.
The frequency of the application or of the dressing will depend in great measure on the amount of discharge. Sometimes the applications will require renewal night and morning, and sometimes but once in twenty-four hours. As a rule the parts should be disturbed as little as possible, and the dressings removed only when necessary.
Unguentum picis liquidi and ointments containing oleum cadinum, oleum rusci, and similar empyreumatic substances, play quite a different part in the treatment of eczema. They should never be used in the first or second stage of the disease, or when acute conditions are present. In the third stage, however, where the skin presents a dry and scaly surface, covered with newly but imperfectly formed epithelium, and especially if the affection is indolent, these preparations are of the greatest service.
In inveterate cases, oil of white birch may be used in the form of an ointment, one-half to two drachms to the ounce of vaseline.
Collodions.-Contractile collodion will sometimes avert a threatened eczema, and prevent extension from one already existing, if applied around the margin of the lesion. Flexible collodion is a protective only, and may be useful when the exudation is slight. Cantharidal collodion is sometimes employed as an application to an old and obstinate local patch which it is desired to stir up to some degree of activity. Occasionally it hastens a cure-more frequently it does more harm than good. Collodion with five percent. of iodine will often prove of service in chronic thickened patches, while collodion containing three or four per cent. of salicylic acid will dissolve and remove thickened epidermis from the hands and feet more quickly, perhaps, than any other substance. Salicylic acid, however, should never be used continuously, or during the second stage, when the epithelium is absent, as it tends to prevent the cornification of the new epithelium.
Traumaticin is the name in common use to designate a ten per cent. solution of gutta-percha in chloroform, and it possesses many advantages over collodion, and may be made use of in connection with oxide of zinc, ammoniated mercury, etc.
Gelatine, mixed with glycerine, and dissolved by heat, has been used as a basis for the incorporation of various drugs applicable to the treatment of eczema. When applied it should be liquefied by heat and painted rather thickly on the parts. It can only be used where patients are confined to the bed, and is not as useful, in my experience, as other applications.
