While internal treatment alone is capable of curing many cases of eczema, there is no doubt as to the advantages to be derived from the use of appropriate external applications in connection with it. Here, too, all idea of routine treatment must be abandoned. As regards the internal treatment it is the patient with all his functional or organic derangements that demands consideration; but in the local treatment it is the condition of the cutaneous lesion that must be studied and cared for.

Although Eczema presents so many phases, varying with the stage, character of the primitive lesion, degree of inflammatory action, etc.; the indications for local treatment are yet so clear that, once rightly appreciated, many of the apparent difficulties disappear.

Every outbreak of acute eczema commences with a prodromal period of local cutaneous congestion, characterized by heat, redness, slight or almost imperceptible swelling, and certain subjective sensations that attract the patient's attention to the part. This period of congestion is rarely presented to the eye of the physician, except when it occurs in patients who are already suffering from more advanced eczematous lesions in other parts of the body, and who have already come under treatment for them.

Under these circumstances we have known the application of the solid nitrate of silver cause a disappearance and abort ion of congestions that we had every reason to believe would have otherwise developed into frank eczemata.

This active congestion, if uninterfered with, usually eventuates in one of the special primary lesions already described. Quite rarely, however, these may not appear, but the active congestion may degenerate into a passive one, more frequently seen on the face than elsewhere,* and usually accompanied with a moderate amount of heat or itching. In these cases the nitrate of silver and other astringents are of service, and in addition we have derived benefit from the application of a solution of bromide of potassium in rose-water and glycerine, varying in strength from ten twenty grains to the ounce. Fluid extract of ergot diluted with glycerine or rose-water ointment is also of service. The pruritus, however, must be attended to. This ceases with the congestion, but as the latter will not always disappear with wished-for rapidity, anti-pruritics are often advisable. Besides hydrocyanic acid, chloroform, and many others that will suggest themselves, a number of useful combinations will be found in the Formulary.

* In these caeca the dingnosis of" chronic erysipelas" is often improperly made.

The early vesicular and pustular condition, though rarely coming under notice, will be greatly benefited by the local application of cooling lotions, as of lead and opium, or still better the "black" or "yellow wash" (mercury and limewater).

The second stage, characterized by exudation and crusting, necessitates ablution, but unfortunately the contact of water proves very irritating in many cases, often causing a decided aggravation of the patient's sufferings and a prolongation of the trouble.* If, however, we bear in mind the condition present, namely, the skin deprived of its horny epidermis, but with the delicate and succulent cells of the rete Malpighii exposed, we can readily understand why the water proves irritating. It is due to endosmosis, producing tumefaction of the cells and pressure on the line nerve-terminations ramifying among them. The remedy is equally apparent. It is only necessary to use, instead of pure water, a solution whose specific gravity approaches that of the serum of the blood. A mixture that we frequently employ for this purpose is rose-water to which a little glycerine and chloride of sodium have been added. Sometimes, when the crusts are very thick or tenacious, it is well to saturate them thoroughly with oil, and afterward apply a poultice for a few hours until they are loosened sufficiently to be easily removed.

The crusts having been removed, the cleansed parts are in a condition to benefit by some medicinal application, usually in the form of ointment. Of ointments the Oxide of Zinc, when nicely made, is perhaps the best where a protective application alone is needed, or when a great extent of surface is involved. It is probably not specially curative, its chief office being to shield the parts from friction and atmospheric influences. The Benzoin which it contains, probably however, exerts a soothing and curative influence. The most effective ointments, however, are those containing some preparation of mercury, as the white precipitate, the nitrate, the mild chloride, and the black oxide. The first two may be employed in ointments of the officinal strength, or somewhat diluted, the third from five to ten per cent., and the last from two to five per cent. Lead comes next to mercury in usefulness, and is generally employed in the form of Ungt. Diachylon,

The pruritus, which is usually present and sometimes severe, invites attention. Unfortunately, it is often very difficult to remove. Decided relief to the itching is sometimes obtained by the addition of Tincture of Conium, Hamamelis, or Stramonium, or of crude Petroleum to one of the ointments above mentioned. In spite of these the itching will often prove obstinate, and disappear only on the cure of the eruption itself.

When an acute eczema has passed through the period of exudation and crusting, and enters the third stage, characterized by redness, dryness, and scaling, the changed conditions demand a change of treatment. The preparations of zinc, lead, and mercury, just alluded to, prove of very little service. Mercurial ointment (Ungt, Hydrarg.), and a two to five per cent. solution of oleate of mercury, are often useful. As a rule, however, dependence is usually placed on some of the preparations of tar. Of these the most important are the Pix Liquida, the Ol. Rusci, and the Ol. Cadini. The last, when genuine (which is seldom the case), is decidedly the best. The tar is mixed with simple ointment in the proportion of half to one drachm to the ounce. A useful preparation belonging to this group is the "Olio di mais guasto," much used of recent years in Italy.