As Eczema is the most frequent, and frequently one of the most obstinate of all curable cutaneous affections, its treatment certainly merits the most careful and painstaking consideration. At the very beginning all idea of routine treatment must be abandoned. While certain principles of treatment hold good in all cases, each case must be treated on its own merits and in accordance with the peculiar features that it presents, whether these be in respect to age, location, form, stage, special external etiology, etc.

It is not to be denied that a hurried prescription of an ointment or lotion may in some cases dissipate the eruption for the time; but in most instances a well-considered campaign must be undertaken if we desire to do our best for the patient. This campaign will embrace etiological, hygienic, constitutional, and local measures. As regards the local causes whose existence is determined as lice, contact with irritating substances, varicose veins, etc., these must first of all be removed, or their injurious influence negatived. Where there has been no apparent external exciting cause, we proceed at once to hygienic considerations; and these will embrace ques-tions of air, exercise, protection from the elements, clothing, diet, etc. If in any respect these be susceptible of improvement, care should be taken that they are suitably amended. Diet, however, merits special notice, and affects both those who have their diet provided for them, as infants, and those who are old enough to regulate it for themselves. In examining cases of eczema in children at the breast I have long been in the habit of direct-ing special inquiry as to the quality of the milk furnished by the mother or the wet-nurse. This will very commonly be found defective, and the defect that I believe to be most frequent is a diminished proportion of the fatty ingredient (87, 165). When such is the case the fault may be in great measure corrected by giving the child an additional amount of fa' matter in the form of cream or cod-liver oil, either directly, or through the medium of the mother. In the case of bottle-fed children, the basis of whose diet is cow's milk, the cream or oil can be added directly to it, for, as is well known, children do not, as a rule, exhibit the same repugnance to cod-liver oil that most adults do. In these cases the additional fatty food appears to supply a want, and benefit almost always results from it.

The influence of diet on the causation and, in adults, aggravation of eczema, merits investigation. For some time past I have made particular inquiry as to the diet preferred by eczematous patients, making three classes, carnivorous, omnivorous, and herbivorous. To the first class were assigned those who were specially fond of meat, eating it three times a day, and consuming with it but a very small proportion of bread and vegetables. In the second class were placed those who expressed no great fondness for meat, but who ate it in moderation, together with the usual proportion of vegetables; and thirdly, those who disliked meat or ate very little of it and whose diet was, in the main, vegetarian. An examination of the cases of eczema in which I made note, as to the points above mentioned, reveals the fact that fifty-six per cent. were carnivorous, forty per cent. omnivorous, and four per cent. herbivorous.*

The practical bearing of this will be seen when we consider the connection between the rheumic diathesis and the suboxidation of albuminoid food. When, then, a case of eczema, more especially of the chronic form, presents itself, inquiry should be made as to these points, and if the patient be frankly carnivorous, he must be made distinctly to understand that overindulgence in this respect must be promptly curtailed, not necessarily abruptly abandoned. In the omnivora also I am in the habit of restricting the amount of animal food consumed. Many other sufferers from eczema will be found among the class of men who "live to eat" and who are habitually heavy-feeders and who, in addition, attempt to stimulate their digestive functions with a rather liberal use of wine. The dietetic instructions that should be given are self-evident - the difficulty is sometimes to obtain compliance. We find eczema, however, in light eaters, more especially in those who are necessarily so in consequence of dyspepsia, which exacts an immediate penalty in case of over- or even moderate indulgence in the pleasures of the table. The result is that they do not really take food enough, or a certain proportion of it is but imperfectly digested, and the general nutrition suffers. Here again the course is perfectly clear. The dyspepsia must be relieved. In the one case exercise in the open air, in another bitters, tonics, mineral acids, etc., and in a third pepsin or other artificial aids to digestion will prove of service.

The general condition of the skin also requires notice. I do not allude to the diseased parts, but to those which are free from eruption. As a rule, in sufferers from chronic eczema it will be found dry and harsh, and with a tendency to fine epithelial exfoliation. The perspiratory function will be more or less torpid, patients stating that they "do not sweat easily." For the correction of this, I know of nothing superior to the systematic use of the Turkish bath, together with the inunction of some bland oil after the bath. In large cities proper conveniences for this sort of bathing are readily obtainable. Outside of cities, it will be necessary to employ some of the portable arrangements for hot-air bathing, of which there are several in the market. The main advantage derived from these baths is the free induction of perspiration, to which is added, in the regular Turkish bath, thorough manipulation and shampooing of the integument.

Having considered the most obvious features of the etiological and hygienic treatment, we come to the constitutional. By this we mean the use of interna] remedies. At the outset this naturally divides itself into two varieties, the rational and the empirical. By the rational treatment we mean that which would appear from the known action of drugs to best counteract the conditions supposed to underlie the eruption. This is fully discussed in the article on the rheumic diathesis, and need not bo referred to in detail in this place. Many cases of eczema may be made to disappear by these means alone, as I know by abundant experience, and without the aid of local means or the use of the empirical remedies, to be presently noticed. The judicious use of purgatives, diuretics, alkalies, oxidants, and hepatic stimulants, will frequently accomplish all that is desired in the way of ultimate result. Frequently this result is more slowly attained by the use of these agencies, but the cure, I am satisfied, is more thorough and of longer duration.