A CASE OF ECZEMA WITH URTICARIA AS A 
COMPLICATION.1 
By J. Abbott Cantrell, M. D., Philadelphia. 
ADJ. PROF. OF DERMATOLOGY IN THE PHILADELPHIA POLYCLINIC, DERMATOLOGIST 
TO THE PHILADELPHIA AND ST. AGNES HOSPITALS. 
The present case having lately come under my notice, and 
being to me one of great interest, I thought that the report 
of it would be the same to be read before you this evening. 
John S., aet 75 years, resident of the northern part of New 
York State, in a mountainous district, was admitted into the 
private ward of the St. Agnes Hospital, and, through the 
kindness of Prof. H. A. Hare, came under my care on April 
3d, 1892. 
The patient having lost by death a member of his family, 
this being followed by several reverses in business and loss 
of money in a collapsed bank, so preyed upon his mind that 
the natural care demanded for his bodily preservation being 
neglected, he relapsed into that nervous state to which we 
are often obliged to give the credit for the production of 
Eczema. 
These occurrences happening upon the first of the present 
year, dates the onset of the eruption, and the disease not 
being recognized by his then medical' adviser, progressed 
steadily until at his admission into the hospital, when we 
found the conditions herein enumerated. 
The present eruption, which began three months ago, was 
somewhat of sudden onset, and occupied the greater portion 
of the cutaneous surface, being, in the writer's opinion, 
Erythematous in type, but, to-day (April 3d, 1892), the con- 
dition is one of Eczema Rubrum, the disease occupying all 
portions of the skin from the head to the foot, with the 
exception of the palms and soles; the parts are decidedly 
inflamed, the skin being thickened and infiltrated, the 
oedema being more conspicuous about the face and neck, 
with the ears about double the natural size. 
1 Read before the J. M. DaCosta Medical Society, June 17, 1892. The presence of itching was apparent from the number 
and character of the blood crusts, the discharge of watery 
fluid being very great, with crusting here and there over 
the surface. 
Although it would seem that with these conditions pres- 
ent, the temperature of the body would have been above 
the normal, but this was not seen either at this or at any 
other time during the course of the disease. 
I advised that the patient be placed upon an exclusive 
vegetable diet, with the administration of a tonic aperient 
every morning. Owing to the great amount of itching and 
the high inflammatory nature of the disease, he was ordered 
to be bathed with a saturated solution of Boric Acid in 
water, three or four times daily, and to be thoroughly dried 
and the parts dusted with Kaolin. Internally he was given 
twenty grains of Acetate of Potash every three hours. 
In three or four days, the inflammation having subsided 
somewhat and the itching having diminished, he was given 
inunctions as follows: Picis Liquidee, Sulphuris Sublimate, 
aa Ungt Zinci Oxidi, q. s. * j, which was applied twice 
daily, the parts being afterwards covered with paraffine 
paper and bandaged. 
The disease progressed favorably for one week (April 13th, 
1892), with the exception of the parts around the genitals 
and the inner portion of the thighs, for this I advised a 
cucumber ointment; but, by some miscarriage of directions, 
the nurse applied the ointment from head to foot, and, at 
my next visit, I was confronted with an attack of Urticaria, 
and, whether in ignorance or not, I charged the cucumber 
ointment for its production, as I knew that it was one of 
the prolific products of Urticaria in those so disposed. 
The Urticaria, which began with a chill, was situated 
mostly upon the trunk, where it was visible in large num- 
bers, the lesions being about the size of a nickel five cent 
piece, and those that were not visible were plainly discern- 
ible to the touch; the parts were very irritable, and the 
patient in a depressed condition. 
At this time he was given thirty grains of the Sulphate 
of Quinia in repeated doses in the course of twenty-four hours, and also bathed frequently with a 3 per cent. Car- 
bolic Acid wash. On the evening of the second day the 
attack was repeated, the lesions being more numerous and 
the patient more depressed. At this visit I advised that 
ten-grain suppositories of the Quinia be inserted every three 
hours, until forty grains had been given. The following 
day the attack, although diminished in severity, was still 
very irritating, the Quinia was now ordered to be given in 
five-grain doses every two hours and a half. On the next 
day he complained that the Carbolic Wash had no effect, 
and did not remove the itching as well as on previous days. 
A wash containing two drachms of fluid extract of Grindelia 
Robustse to the quart was given, which seemed to give the 
patient more relief; the dose of the Quinia was kept at the 
maximum for the succeeding two or three days, when it was 
gradually diminished ; and, now that the Urticaria was con- 
trolled, the Tar and Sulphur ointment previously ordered 
being again advised, and in two or three days doubled in 
strength. 
The patient left the hospital on the sixth day of May, 
1892, and no word has been received from him since. 
Reprint from New Eng. Med. Monthly, August, 1892.