ON THE MANAGEMENT 
OF 
Infantile Eczema, 
BY 
L. DUNCAN BULKLEY, A.M,M.D, 
a‘~- 
ATTENDING PHYSICIAN FOR SKIN AND VENEREAL DISEASES AT THE NEW YORK HOSPITAL, 
OUT PATIENT DEPARTMENT; LATE PHYSICIAN TO THE SKIN DEPARTMENT, DEMILT 
DISPENSARY, NEW YORK; DERMATOLOGIST TO THE HOSPITAL FOE 
RUPTURED AND CRIPPLED, NEW YORK, ETC. 
Reprinted from Transactions of the Medical Society of the State of New York for 1880, 
NEWYORK: 0. P. Putnam’s Sons, 1880. Management of Infantile Eczema, 
“ To be a successful practitioner in the treatment of eczema, a medical man must be an 
accomplished physician; to manage the local treatment with success, he must also be an 
able surgeon.”— Wilson. 
By infantile eczema is here understood cases of this disease 
occurring in children of five years old or under, although writers 
have not generally been very definite in fixing upon the time of 
life at which it ceases to be properly so called. There are reasons, 
however, for classing all cases of eczema occurring during the first 
five years of age together, and for considering them under one 
designation, whereas no objections can be reasonably raised to such 
a procedure. 
The periods of life are conveniently divided into decades and 
half decades, and if we look at the statistics of a large number of 
cases of eczema, we shall find that the first decade of life presents 
a very much larger proportion of cases than any other; by far the 
larger share of cases in this decade will be found in children of 
five years of age or under. Thus, of two thousand and thirty- 
three cases of eczema, five hundred and twenty-four came within the 
definition of infantile eczema, or 25.7 per cent.; the per centage 
in private practice being sixteen, and the dispensary average being 
thirty per cent. This proportion would be increased very largely 
did not a certain number of patients, with infantile eczema, find 
their way to the children’s department of the dispensary, while, 
of course, multitudes of cases are never treated at all, owing to 
7 7 O 
the impression so prevalent, both among the laity and the pro- 
fession, that it is either dangerous or useless to treat this disorder. 
The layman fears lest some harm may come from the disease being 
“driven in,” which fear the physician sometimes fosters, from 
ignorance, or from carelessness and unwillingness to cope with the 
case. The little sufferer from eczema, therefore, is left to bear his 
trials unaided, with the hope that with each change in its physio- 4 
logical conditions the disease will pass away. Thus, the eruption 
being called “ milk crust” during nursing, the assurance is given 
that it will cease when it cuts its teeth. When this stage is arrived 
at, and the eruption is aggravated with each accession of a tooth, 
the eruption takes the name of “tooth rash,” which will cease 
when certain teeth are through. These come, and yet the disease 
persists, little being done to check or modify it, and so on. I have 
seen multitudes of cases which had lasted one, two, three, four, or 
more years, and in one instance, a characteristic moist eczema, a 
veritable milk crust, which had remained on the head from earliest 
infancy to twelve years of age; and in another case, a gentleman 
of thirty-one years of age, had had the same on the legs since the 
first year of life. 
Now we by no means deny that the eczema of infancy is very 
intimately associated with the milk and with the irruption of the 
teeth, but we do start with the proposition that it is not necessarily 
a result of either the partaking of milk or of the formation and 
breaking through of the teeth, but that it always and invariably 
signifies an error of some kind, which medical thought should 
avert; and, that it is, like any other aberration from health, a con- 
dition of affairs which medical skill should remove. 
Infantile eczema presents certain features different from the 
phases of the disease which are seen in adult life, and these features, 
which are dependent upon the structure and quality of the skin of 
children, are such as almost to render it another disease, and to 
call for quite different management, at least in most cases, from the 
same eruption in adults. 
The expression, “The management of infantile eczema,” was 
chosen as a title instead of “The treatment of infantile eczema,” 
because it was wished to impress the fact that the disease is of such 
protean shape, and the etiological facts so varied, that it is difficult 
to speak of the measures to be employed in its cure as a treatment, 
inasmuch as they are better considered as management of the 
patient in all the relations of life, than as routine treatment to be 
given simply because the eruption eczema is present. 
We will, therefore, begin with the etiology of the disease, as 
we understand it; and in considering this, will rather state practical 
facts from experience than cite authorities. 
Infantile eczema is by no means an hereditary affection, that is, 
in but a small proportion of the cases are the parents, one or both, 5 
the subjects of the same; and conversely, parents may have eczema, 
while their infants escape. It is true, however, that many parents 
with a strong eczema tendency often have children thus affected, 
although they themselves need not have the eruption at any partic- 
ular time when the child happens to have it. It need hardly be 
stated that eczema is never acquired by contagion, although the 
laity will often thus believe. 
The fact cannot be denied that a majority of infants with eczema 
appear to be in perfect health, indeed may be apparently healthier 
than the others in the family who have not the eruption; they are 
not infrequently of a ruddy color, have good appetites, with reg- 
ular action of the bowels, and parents are with difficulty convinced 
that there is some error beyond the simple skin lesion. And yet 
I feel confident in affirming that exceedingly careful medical inves- 
tigation will always discover something to be corrected besides the 
disorder of the skin. 
In nursing-infants with eczema, I very commonly find that the 
mother is in the habit of consuming large quantities of tea, or 
perhaps beer or ale, or takes wine pretty freely, or, perhaps she is 
taking only chocolate or milk, and these disagree with her, causing 
dyspepsia; or she is constipated, or her urine shows disorder, 
indicative of derangement of digestion or assimilation. Now if 
these elements exist, if the mother’s secretions, as from the bowels, 
kidneys, skin, liver, etc., are not healthy, certainly the secretion of 
milk is not healthy, and thus it can provoke disorder in the child. In 
the case of nursing-infants with eczema, therefore, my attention is 
always turned first to the mother, and I believe I can say that in 
an enormously large percentage of cases, if not always, I find 
errors of assimilation and disassimilation in the mother, which 
must first be corrected before we can hope for or expect great and 
permanent benefit to the child. It must never be forgotten that a 
patient may have extensive oxaluria as almost the sole indication of 
mal-assimilation, other than a general tired feeling, etc. I never 
allow mothers nursing eczematous children to take any fermented 
liquors, and generally cut off the quantity of tea drank, especially 
if it is used in excess: milk I conceive to be the best food upon 
which the mother may form milk, and seldom do I fail to have it 
used freely. If it is not well borne at first, the habit of taking it 
can be acquired: frequently it is necessary to add a little alkali, 
and I commonly use the liquor potasses, ten to fifteen drops to the 
tumbler full of milk. 6 
In not a few instances the milk furnished by the mother is abso- 
lutely too weak to sustain the child properly, and we must either 
provide other nourishment or improve the mother’s health, or both. 
I have very frequent occasion to prescribe for the mother, giving 
tonics, alkalies, etc., and it must be borne in mind that the mother 
may require oity matter, as codliver oil, as well as the child. 
Where the nutriment from the mother is weak we may supple- 
ment it with codliver oil, which I continually give, even to very 
small children with eczema: or, where it can be had, I believe that 
cream should certainly be given to the infant with eczema whose 
nurse-mother is in poor health and furnishes milk insufficiently 
rich. Or, again, oil may be administered by inunction, either 
cod-liver, linseed or sweet almond oil being used; for eczema is 
decidedly a disease of mal-nutrition, in every subject from the 
youngest to the oldest. 
I see many infants with eczema who are being fed very errone- 
ously, either in conjunction with nursing or in lieu thereof, and a 
change in diet often assists the management of the case wonder- 
fully. Milk I believe to be the proper nutriment for children 
♦ under one year of age, and yet very few of those which I see are 
thus fed. Most of them arc taking too large quantities of starchy 
food, corn starch, farina, etc., and in many instances far too much 
sugar is given with the food. These elements all require attention 
in the management of infantile eczema, if we really desire to cure 
the patient, that is to effect a permanent removal of the disease. 
I need hardly speak of the grosser errors of diet sometimes 
observed in these patients, other than to mention that I constantly 
find among the poorer classes, children of the most tender years, 
or even months, who are allowed to partake of anything or every- 
thing used by adults which they may crave, and that it is not at all 
uncommon to find children with eczema, even less than a year old, 
of whom the parents say with perfect naivete, that they are “very 
fond of tea.” It would seem as though such evils could not prevail 
among the better classes, but we have only to remember that the 
nurses to whom so much is often committed, all come from these 
lower, ignorant classes, and unless they are watched and directed 
otherwise, they will practice just as they have been brought up 
at home. Moreover, if time permitted, I could give instances 
where very intelligent persons were feeding patients with infantile 
eczema in a most outrageous and inexcusable manner. 7 
Constipation is a very frequent accompaniment of infantile 
eczema, though the reverse state, diarrhoea, is occasionally met 
with; either and both are evidences of mal-assimilation. For the 
constipation of children I use lactopeptine, in doses sufficient to 
produce the desired effect. It is to be given directly after eating, 
and may be repeated once or more after each meal, if necessary. 
It is very conveniently administered in suspension, as in orange- 
flower water, though children often rather like to have it dry on 
the tongue. In the beginning of a case, nothing that I know of 
suits so well to unload the bowels, and make an impression on the 
eczema, as Wilson’s treatment, of calomel, in doses suited to the 
age and condition of the child. Under a year I generally give 
six and a half centigrams (one grain), well rubbed up with sugar, 
or a little bi-carbonate of soda, the dose being increased by about 
three centigrams (half a grain) for each additional year of life. 
This powder may be repeated, if necessary, every other day, and 
I prefer to have it given in the morning, rather than at night, that 
the effects may be better watched, and that any uneasiness occa- 
sioned thereby may not disturb the night’s rest. Often the 
powders need be given but once or twice a week, or even as 
occasion demands. Any irregularity of the bowels, and especially 
any tendency to pulmonary congestion, should at once be treated 
by one of the powders. 
Where the tendency to constipation is not overcome by these 
means, the food must be changed, and even in very small infants, 
I have oat-meal or cracked wheat added to the food, in the 
way of a pulp, made by rubbing thoroughly boiled meal through 
a fine sieve. Other modifications of diet may of course be neces- 
sary, but cannot be entered into here. 
Sometimes in the desire to avoid starchy foods, animal food will 
be given in much too large proportion, and I have seen very young 
children stuffed with beef-tea, beef-juice, or extract of beef, to an 
alarming extent. In one instance I believe the child died from 
this, together with brandy, which was freely given. In the more 
acute forms the diet should be light and unstimulating, and the 
organs of digestion assisted, as will be mentioned later; in every 
case there is more or less inactivity of the processes of assimilation 
and disintegration. 
Coming to the medical treatment of infantile eczema, we find 
that remedies certainly have a very great influence in the disease. 8 
Calomel has already been mentioned, and if rightly used, it is 
capable of very much good. Young children also bear alkalies 
very well, and will improve in general health as well, under them. 
In nursing-infants I generally give the mother acetate of potassa 
one gram (fifteen grains) or so, three times daily after eating, with 
mix vomica and a bitter infusion. I do not know if it passes 
through the milk in any way, but it certainly benefits the child 
very much. Lime water is of good service, though I do not use 
it nearly as much as many. I am very fond of giving the child 
Vichy water with the milk, using it rather freely, and when the 
bowels are constipated I have a syphon of Kissingen water and one 
of Vichy provided, and have them used conjointly, in quantities 
sufficient to relax the bowels a little. Children also do very well 
with a few drops of liquor potassse added to the milk, say from 
two to live drops to the tumblerful, according to the age. 
Where there is a good deal of restlessness at night, and the skin 
rather dry and hard, I give the acetate of potassa, three or four 
times daily, in doses of from six to thirty centigrams (one to five 
grains), in five cubic centimeters (a teaspoonful) of the liquor 
ammouiae acetatis; if there is much arterial excitement this is 
improved by the addition of a drop, or a part of a drop, of the 
tincture of aconite. 
Children bear arsenic remarkably well. Some time ago I 
reported a number of cases of infantile eczema, where the disease 
yielded in a very short time to Fowler’s solution (liquor potassse 
arsenitis), given alone; and since then I have had further proof of 
this. The remedy was given in cinnamon water, and of such a 
strength that each five or ten drops represented one of the 
arsenical solution. They were then given this in such a quantity 
that a child a year old began with a drop three times daily of 
Fowler, and the dose was gradually increased by one-fifth of a 
drop until two, three, or even more drops of the arsenical solution 
were taken thrice daily, or until there was some diarrhoea; the 
dose was then lessened. Under this plan the eruption quickly 
paled, and soon ceased, with little or no local treatment, and with 
few, if any, dietetic or hygienic directions. But I have never felt 
it wise to recommend this plan, or to practice it very largely, for 
fear of possible evil results from the free use of so powerful a 
remedy. It is well to know that arsenic can and will exercise 
such a power, certainly in some cases, for I hardly think this could 9 
be relied on as its uniform effect—the cases were more or less 
selected. 
In combination with other measures, however, arsenic should 
seldom if ever be neglected in the treatment of eczema; after the 
first year of life I make very considerable use of it in combination 
with the wine of iron, much as in the ferro-arsenical mixture of 
Wilson, which he lauds so highly. 
The French arsenical mineral water, the Eau de Bourboule, is 
often of considerable service in infantile eczema; the dose for 
adults is from half to one tumblerful, with the meals; children 
may take a small wineglassful alone or mixed with the milk. 
Besides alkalies, cod-liver oil, and arsenic, iron should never be 
forgotten in infantile eczema; wine of iron, the ammonia-citrate 
and tartrate of iron, and dialyzed iron, are especially applicable. 
Babuteau’s tasteless syrup of iron is also valuable, and very accept- 
able to children. I also make considerable use of the syrup of 
the hypo-phosphites of soda, lime and iron, and am more and more 
pleased with its effects. I do not use the syrup of the iodide of 
iron as much as do some, for I have seen it very often ineffectually 
employed by others. 
In dispensary practice very many children with eczema receive 
the standard rhubarb and soda mixture, which contains about six 
centigrams (a grain or so) each of rhubarb and soda in five 
grams (teaspoonful) of peppermint water, and they are very com- 
monly greatly benefited thereby., I think this well-tried combina- 
tion is too much neglected in private practice, for the substitution 
of more agreeable, but often less serviceable remedies. 
The extract or tincture of viola tricolor has been recently 
revived, as a remedy in infantile eczema. I have no great 
experience to offer on the subject, as I have generally found the 
other measures here recommended to be quite sufficient. The 
older French writers speak very well of it. 
It is a little difficult, to give in a few words, the exact indica- 
tions for the various remedies I have mentioned, and perhaps 
intelligent judgment will best decide, if it is borne in mind that 
it is the patient rather than the disease which we are to treat 
internally. The indications are more those suggested by educated 
thought, directed to restoring the system to perfect health, than 
to special remedies called for by the disease in question. 
There are, however, tolerably clear lines of distinction between 10 
classes of cases which call for an alkaline and depurative treat- 
ment, and those where cod-liver oil and more powerful tonics are 
at once demanded. Thus, in the full, ruddy-faced child, with an 
eczema tending to give a dry, red surface, very itchy, or perhaps 
exuding considerable serum when washed or scratched, a full tonic 
course of treatment would certainly aggravate the complaint, 
especially if the child came of gouty stock. Light purgative and 
alkalies would be followed by amelioration of the itchings, a 
lessening of the cutaneous congestion, and subsidence of the 
disease. On the other hand, the pale, strumous looking child, in 
whom the discharge tends to crust up into yellow masses, will be 
benefited by iron, arsenic, cod-liver oil, etc., at once. But this 
latter child, if care be not taken, may soon have the organs of 
life choked by the sudden influx of material to which it is un- 
accustomed, and will require the cooling treatment of an occasional 
purgative, possibly also alkalies. 
Calomel is the better purgative for the first class of cases; rhu- 
barb, castor-oil, etc., are better suited for occasional use in the 
second. 
But of course no hard and fast lines can be laid down, and there 
will occur many cases which cannot be clearly put in either category. 
Not unfrequently we give tonics and builders-up of tissues with 
one hand, while with the other calomel, grey powder, alkalies, etc., 
are administered. It must also never be forgotten that the full- 
blooded arthritic case first described, will at a later period require 
the tonic course; for eczema is a disease of debility, whether there 
is a temporary and false appearance of hyper-activity of the system 
or not. 
There are those who regard eczema as a purely local disease of 
the skin tissue itself, independent of any systemic relations; but it 
is hardly necessary to argue the untenability of this view, which 
has been abundantly shown elsewhere.* Certain it is that eczema 
in children has many constitutional relations, and while in certain 
cases the eruption may be largely or entirely removed by local 
remedies, its complete extinction must be by dietetic, hygienic, and 
medicinal measures as well. 
It must ever be borne in mind, however, that the skin certainly 
is subject to acute inflammation, from purely local causes, as when 
croton oil is applied, or poison ivy, etc., and that in infants harsh 
* Transactions International Medical Congress, Philadelphia, 1876. 11 
usage may abrade and inflame the skin; all this is quite different 
from true eczema, and reasonable care, judgment, and experience, 
will readily distinguish the cases of each. 
While the general measures advised for eczema infantile have 
not differed so very greatly from those which arc required in other 
conditions, and while emphasis has been laid on the fact that it is 
the patient rather than the disease which is to be borne in mind for 
treatment, on the other hand, in the local management of the 
disease there is need of special experience and knowledge. It is 
in the local treatment of diseases of the skin, and especially of 
eczema, both in infant and in adult life, that wisdom is required 
to make just the right application; for a wrong one will pretty 
certainly not only do no good, but positively do harm. 
The experience, both of the special and general medical profession, 
has undoubtedly given to the oxide of zinc ointment the palm for 
universality of use, and that perhaps rightly. But he is poorly 
able to treat infantile eczema who knows only oxide of zinc oint- 
ment, and that as it is directed to be made in the pharmacopoeia. 
The officinal ointment is prepared with lard, which has twelve and 
a half per cent, of tincture of benzoin and sixteen and two-thirds per 
cent, of oxide of zinc (a drachm of tincture of benzoin to the 
ounce, and eight}" grains of oxide of zinc). Now I have repeatedly 
seen this irritate tender skins, to which, if otherwise prepared, a zinc 
ointment was soothing. In the first place I never use lard in oint- 
ment, if it can possibly be avoided; my preference is for the cold- 
cream, the unguentum aqute rosae, which is made from almond oil, 
spermaceti, andbees-wax. This may possibly become rancid, but has 
but slight tendency to do so; it, as well as other excipients, should be 
watched, as a rancid oily matter is exceedingly irritative to a diseased 
skin. The unguentum petrolci or cosmoliue, or the glycerite of 
starch, is preferable to the lard, but the rose ointment is really the 
best of all. 
The strength of sixteen and two-thirds per cent, of oxide of 
zinc (eighty grains to the ounce) is frequently too great, and I seldom 
employ more than twelve and a half per cent, (sixty grains to the 
ounce), and far more often but six and a quarter per cent, (thirty 
grains) in infantile eczema. Ido not benzoate the ointment, as I 
find this sometimes irritates. 
But there are many other measures suited to different states of 
eczema in children which are far more serviceable than simple zinc 12 
ointment alone. The old fashioned tar ointment is a remedy which 
has fallen into unmerited neglect. As directed in the pharma- 
copoeia, of equal parts of tar and suet, it is much too strong for 
application to a child’s skin, or to any inflamed surface; but when 
diluted with three times its quantity of rose ointment, with six and 
a quarter to twelve and a half per cent, of oxide of zinc (half a 
drachm to a drachm of oxide of zinc in the ounce) it forms one of 
the most valuable anti-pruritics possible in eczema. Made thus 
it can be applied even upon a very young child and with the 
happiest effects. 
Bismuth sub-nitrate forms a very good ointment for infantile 
eczema, used in a strength of six and a quarter to twelve and a 
half per cent, (half a drachm or a drachm to the ounce). Tannin 
also acts very happily when there is a dry, red and somewhat scaly 
surface. Likewise a weak white precipitate ointment. 
In the management of infantile eczema very different results 
are obtained according to the mode in which applications are 
made to the diseased surfaces. In general, ointments should be 
spread upon cloths and laid upon the affected portions, if there is 
any tendency to exudation. More harm is often done by the 
efforts of the attendant to rub on the ointment than gain is had 
from the application itself. If laid on with a cloth all this is 
avoided; the dressing should, of course, be renewed occasionally. 
In the management of infantile eczema, attention should also 
always be paid to the use of water by the attendants, for most 
erroneous methods and ways are constantly practiced, and the 
exciting and continuing cause of eczema in the young, as well as 
the old, will not infrequently be found in the use of water; some- 
times, also possibly, in the soap employed. The child, then, in 
whom eczema is developing, should not be freely washed, as if in 
health; but if washed at all, the water should be properly medi- 
cated. I generally have it only wiped oft', as much as cleanliness 
actually demands. 
If a bath has to be given, I have a mixture of carbonate of 
potash, carbonate of soda, and powdered borax made, of which 
from four to eight parts are used to one thousand (two to four 
teaspoonfuls for each gallon of bath water), together with about 
half that proportion (from two to four teaspoonfuls) of dry starch. 
This is used without soap, and on taking the child from the bath, 
it is immediately dried without friction, and a proper medicament 13 
at once applied. If there is tendency to the development of acute 
papular eczema, the whole surface should be well powdered after 
drying; as, with lycopodium powder. 
The practice of many is to wash the parts directly affected with 
eczema; or as I have known the advice of the physician, it was to 
keep the part well washed and clean. Now this is impossible, at 
least in eczema in children, which is at all acute. As often as the 
surface is washed, the outer, lightly-formed epidermal cells, are 
removed before they have acquired any firmness, and the process 
of repair is hindered thereby. My constant direction is not to 
wash a part until I direct it to be done, and in many cases that is 
very seldom. Occasionally the mass of accumulation becomes so 
great that the ointment does not penetrate it, and a single washing 
is of the greatest value, in allowing the astringent to come down 
directly upon the affected surface. I always direct that the appli- 
cation be made in the quickest time possible after the washing, 
otherwise a new coat of exudate has formed and hardened, and 
the medicament lies on top of it, and fails of its end. 
In children, I seldom have parts which are at all acutely involved 
in the eczematous process, washed more than once or twice a week; 
sometimes not at all for a much longer time, if necessary. Occa- 
sionally, when the crusts are quite thick, as upon the scalp, we 
have a very valuable agent which will penetrate them, viz., cod- 
liver oil, whose value as a local application in eczema, is by no 
means small. 
A word may here be said in reference to the use of poultices in 
eczema, especially in eczema infantile. In the almost five hundred 
and fifty cases of eczema in children under five years of age, of 
which I have notes, I believe I can count on the fingers of the 
hands the number of poultices which have been applied by my 
directions; I almost never use them, and yet it is the commonest 
thing for me to hear of others directing them to be used, and, I 
believe, generally to the detriment of the case. Very rarely, 
when there is a thick crust which refuses to come away with 
ointment or oil, a single poultice may be applied for a night, 
the crusts removed in the morning, and the ointment at once 
reapplied. Sometimes a second poultice may be required, but 
very rarely more, and I never have the scalp or other eczematous 
surface treated continuously with poultices, as is frequently 
advised. 14 
When eczema has lost its very acute elements, and when under 
such treatment as has been mentioned, we find that it refuses to 
yield, we may, as in the adult, resort to stimulation, and this, if 
applied correctly, will often furnish the best results. I not infre- 
quently use the compound tincture of green soap of Hebra, 
composed of equal parts of the oil of cade, green soap, and 
alcohol, and find it of great value. If it is too strong, and gives 
much pain in the application, it can be diluted with a little water at 
the time of using. The surface is to be quickly, but firmly, 
rubbed with a cloth dampened in it; it is then dried off, and the 
appropriate ointment, immediately applied. When this is used it 
is far better always to have the ointment laid on a rag, as the 
extra friction of an application with the finger or otherwise may 
be just too much. 
This compound tincture of soap is a very valuable anti-pruritic, 
and will ofttimes arrest the itching excellently. I have not yet 
mentioned an ointment which is used by many for this purpose, 
and that is zinc ointment, with twelve and a half per cent, of oil of 
cade (a drachm to the ounce), rubbed into it. I formerly employed 
this largely, but for three or four years have used the combination 
of the ointment before described, and much prefer it. The addi- 
tion to the ointment of twelve and a half per cent, of tincture of 
camphor, or a corresponding quantity of powdered camphor (a 
drachm of tincture of camphor, or a lew grains of powdered cam- 
phor in the ounce) often arrests the itching well. 
Stronger ointments are sometimes called for in infantile eczema, 
but the danger is rather in the direction of using too strong appli- 
cations than too weak, for we must ever remember the exceedingly 
tender, delicate organism, with which we have to deal. When 
there is thickening in localized patches, which proves obstinate, 
we may often get absorption from one of the mercurial ointments, 
and I use a good deal the unguentum hydrargyri oxidi rubri, 
diluted with three times its quantity of rose ointment; but even 
this I have repeatedly seen to be too strong, exciting fresh papular 
eruptions. The citrine ointment, diluted three, four, or more 
times, will also be well borne where patches are chronic and infil- 
trated. 
I have by no means exhausted the subject, nor have I given all, 
or even most, of the remedies and measures which are of daily 
service in overcoming infantile eczema. To endeavour to do this, 15 
and to give indications for the use of each remedy which would 
be unfailing, would be far beyond the scope and possibilities of the 
present short paper. The intention was not to exhaust the subject; 
nor to furnish formulae for practice, as these may be found in many 
good text books. 
The desire of the writer was rather to direct attention to what 
he deems wise to call the management of infantile eczema, rather 
than its treatment. The object of the paper is to show that arsenic 
and oxide of zinc ointment are not the only weapons to be 
employed against this very frequent and very distressing disease; 
to show that as it depends upon many causes, the measures for its 
relief must be multiform. Also it is desired to call attention to its 
frequency, and to the neglect with which it is so often regarded by 
the physician, and consequently by the laity; likewise to the fact 
that its cure should be and will be, if properly accomplished, 
followed or accompanied by improvement in the health of the 
patient; and that, therefore, there is absolutely no danger in 
curing infantile eczema. Finally, the object of this paper is rather 
to elicit discussion for a further elaboration of the subject.