OBSERVATIONS ON THE CAUSE AND 
TREATMENT OF INFANTILE ECZEMA 
AND ALLIED ERUPTIONS. 
BY HENRY T. BY FORD, M.D., 
OF CHICAGO. 
Read before the Chicago Medical Society, on August 17, 1885. 
Reprinted from tke Journal of the American MediCal 
Association, September 1 g, 1888- 
CHICAGO: 
Printed at the Office of the Association. 
1885. OBSERVATIONS ON THE CAUSE AND TREATMENT 
OF INFANTILE ECZEMA AND ALLIED 
ERUPTIONS. 
In the winter of 1880, I was called to attend Mrs. 
R., in confinement with her fifth child. Two of her 
other four had been born dead; the other two, born 
apparently healthy, had died in convulsions at the 
ages of three and ten months. Both of the last had, 
before death, suffered from a scabby eruption, and 
become somewhat emaciated, but had not, as far as 
I could determine, been considered syphilitic. The 
child born at this time was, at first, apparently healthy, 
but, in a short time, broke out with an eruption that 
had the appearance of an ordinary eczema pustulo- 
sum, and which affected its scalp and different parts 
of its body. The only other noticeable symptom was 
progressive emaciation. 
A physician seeing the child for the first time at the 
age of three weeks, would have been excusable, with- 
out the family history, in considering this a strumous 
case, and in treating it with cod-liver oil. Minute 
doses of calomel and mercurial inunctions quickly 
transformed the unsightly, emaciated sufferer into a 
healthy, well-nourished infant. 
In the summer of 1876, I was called upon to treat 
a young child, Augustus G., with pustular eczema 
confined to the scalp, excessive nocturnal restless- 
ness and progressive emaciation. This being the 
first child, there being neither copper-colored areolae 
nor other characteristics of a syphilide, but for the 
acknowledgment of the father of a former, but seem- 
ingly perfectly cured attack of syphilis (an acknowl- 
edgment not always made), mercurials would, as a 
rule, have been avoided by an attending physician. 2 
Yet the eczema rapidly disappeared, and the infant 
was soon gaining in flesh upon calomel powders and 
mercurial inunctions. 
To contrast with these syphilitic cases, I' wish to 
relate another in which I know there was no possi- 
bility of a syphilitic taint, as I had been in daily 
communication with the father for three years before 
his marriage, and have often treated his family since. 
The patient, E. H., one year old, was unusually fat 
and well nourished, and had an eczema on the head 
which spread over the body in patches, in spite of 
the prolonged local treatment of one of our most in 
telligent practitioners. I recommended one-fifth of 
a grain of calomel to be given twice a day, and an 
ointment composed of one dram of carbolic acid in 
an ounce of the oxide of zinc ointment. After ten 
powders had been taken the eruption began to give 
up some of its area, and had almost disappeared by the 
time the thirty powders, first prescribed, were gone. 
Soon afterwards the eruption began to spread again, 
but was promptly cured by more of the powders. 
The child, having been overfed, was of course put 
upon a proper diet, by diluting the milk and infant 
food it was already taking, and withdrawing all other. 
The child has since remained well. 
I have notes of a case of eczema, attended in 1880, 
in which the eruption extended to the eyelids, caus- 
ing such conjunctival sensitiveness that the child lay 
motionless in its cradle, with its eyes bandaged by 
day and night. Every attempt to move it or remove 
its bandages elicited either moans or screams. I 
thought the child, which was a little over a year old, 
the most miserable one I had ever seen. I pre- 
scribed quarter-grain doses of calomel twice a day, 
to be given until they produced a laxative effect, 
then once a day only. CarbolizCd oxide of zinc 
ointment (3j to 3j) and a borax eye-water were pre- 
scribed for external use. Improvement did not take 
place until the powders had been taken regularly for 3 
several days, when it commenced, and, in a few days, 
rendered the little patient comfortable, and able to 
endure a moderate light. When, later, the calomel 
treatment was neglected, the case relapsed, in spite 
of external applications; but a return to it soon cured 
the eruption, and improved the condition of the 
patient. 
Many other severe cases of the disease have come 
under my care, and whether the eruption confined 
itself to the head or ran all over the body, whether 
the patient was syphilitic or not, strumous or pletho- 
ric, they were all similarly affected by calomel. When 
treated without this remedy, their recovery has usu- 
ally been very slow, uncertain, and often temporary. 
It is an old popular belief, not utterly unfounded, 
I think, that the rapid drying up of these head erup- 
tions by strong applications does some harm to the 
system, especially the nervous system. With the aid 
of calomel and external applications, I have rapidly 
dried up scores of such head eruptions, without having 
observed any but good results, and consider the coex- 
isting digestive disorders as the causes of any head 
symptoms that may arise. 
The frequency of occurrence of eczema in infants, 
the large size and great activity of the liver in early 
life, and the striking, I might say specific, action of 
calomel, have led me to associate liver-indigestion 
with infantile symptoms of eczematous nature in the 
relation of cause and effect. Even in many syphi- 
litic cases the sallow complexion of the skin, and 
nocturnal restlessness, have seemed to indicate liver 
disorder of syphilitic origin. In these cases, the 
alterative powders often produce an amelioration in 
the skin troubles, sooner than they could through their 
direct action upon the blood poison; and hence the 
mercury should be used so as to affect the liver as 
well as the blood. 
A properly regulated diet is necessary, and in some 
cases is all that need be recommended. But the 4 
negative action of diet alone, and the increased de- 
bility that would, in the meantime, follow with stru- 
mous children, whose disordered and debilitated 
digestive organs would be slow to assume healthy, 
vigorous function, makes it very injudicious to wait 
for such action. Some of my earlier cases were cured 
without any regulation of diet. 
While disordered digestion is usually considered 
an important factor in certain instances, and a regu- 
lated diet, with occasional laxative doses of mercury, 
are often advised, I know of no authority who has 
considered derangement of the liver, and its accom- 
panying digestive disorders, as the chief predisposing 
cause, nor of one who has recommended calomel (or 
its equivalent of blue mass or mercury with chalk) 
as the chief remedy for the vast majority of cases. 
In fact, most authors remind the reader that no one 
remedy can be generally relied upon. 
From the fact that many of my earlier cases got 
well without a regulated diet, that so much calomel 
produced such prompt relief, and that improved di- 
gestive power usually follows, rather than attends, 
the action of the remedy, I am led to believe that 
the cure is brought about, not merely by improvement 
in digestion, but by a removal of waste, irritating 
materials from the system, which are often the main 
exciting cause of the eruption. And from the great 
efficiency of mercurial over other laxatives, I believe 
that the irritating materials are not only in the 
retained faecal matter, but also in the blood-the 
products of imperfect digestive assimilation and ex- 
cretion. There is no doubt that mercurials do much 
to clear up the urine and to restore normal ingredi- 
ents to the faeces. 
Occasional doses of phosphate of sodium, and 
other saline aperients, act in a similar way, but much 
less promptly. And the same maybe said of castor- 
oil, which has proved efficacious in the hands of L. 
Duncan Bulkley (Jour. Am. Med. Assoc., July 25). 5 
The strumous and nervous conditions so often ob- 
served may, I think, be the causes or effects of the 
disordered digestive organs, but are seldom the direct 
causes of the eruptions. Even the beneficial action 
of cod-liver oil is explainable upon dietetic princi- 
ples; for pure oil is a much more proper and natural 
aliment for young children than oatmeal, potatoes, 
fresh bread, state cow's milk, and many other table 
articles of diet that are daily imposed upon their im- 
mature stomachs. This oil helps, like castor-oil, to 
remove faecal accumulations. With infants fat is a 
normal ingredient of the healthy faeces. 
My excuse for ever resorting to such heroic dosing 
with calomel, was that a large proportion of my severe 
cases was traceable to a syphilitic origin; and noticing 
that these cases bore the remedy so well, I began to 
try it where I only suspected syphilis, and finally in 
all cases. I have usually given from a quarter to an 
eighth-grain powder, according to the age, twice a 
day, leaving directions that they should be discon- 
tinued as soon as purgation commenced, and after- 
ward given as often as the bowels would tolerate 
them without much disturbance. Their effect, more 
than the age of the patient, determines their size and 
frequency of administration. 
As children over two and one-half years are very 
liable to be salivated, I usually give them a single 
purgative dose of calomel every six or eight days, 
and trust to diet and other remedies in the meantime. 
For instance, I was called two years ago to see a boy 
four years old suffering with patches of eczema about 
the head and upper part of body, who, although under 
active medical treatment, had been in about the same 
condition for several months, except that he was 
getting worse. While poorly nourished and pale, he 
was a hearty eater, and was fed upon eggs, potatoes, 
oatmeal and other stimulating food, with fruit suffi- 
cient to keep the bowels regular. I ordered two 
grains of calomel to be given at bedtime, and some 6 
powders containing each one gr. of ext. of pancreas 
(F. Bros. & F.), three grs. of bicarb, of sodium, and 
eight grs. of subnitrate of bismuth: one before each 
meal. The diet was restricted to milk, beef extract, 
bread, toast, crackers, rice and fruits. In six days, 
finding some improvement, I ordered the same medi- 
cines and diet. In a week more I found him greatly 
improved in general health and partly rid of the rash. 
Recovery was uninterrupted, rapid and permanent, 
the parents having in the meantime learned how to 
feed him. 
Acute cases may, of course, be greatly benefited 
by protecting the inflamed skin from all external irri- 
tation. This may be done by keeping it constantly 
covered by simple cerate purified by a few grains of 
carbolic or salicylic acid to the ounce, or by vaseline, 
the object being, as already stated, to protect, not to 
medicate, the skin. In chronic cases, I know of 
nothing that will allay the itching and stimulate the 
skin to healthy action as quickly as an ointment com- 
posed of one dram of carbolic acid to the ounce of 
oxide of zinc ointment, constantly applied. I have 
used this formula in nearly all chronic cases, and have 
found the combination soothing instead of irritating. 
That I am somewhat out of fashion with my calo- 
mel I will admit. In one of our latest and best ex- 
ponents of the present state of dermatological science, 
I find the following sentence : " Lastly, patients of 
both classes (of eczema) are to be saved from mercury, 
arsenic and iodide of potassium." I can only offer 
as my excuse, that I have found the treatment under 
consideration almost uniformly successful, and that 
I would like to do what little I can to aid others in 
simplifying the management of this most fickle of all 
diseases, in finding the centre of this Chinese puzzle 
of dermatology. 
Finally, I would like to say that I do not think it 
really best to treat the majority of cases in this heroic 
manner, being usually forced into it by the critical 7 
impatience of parents and friends, or by the impossi- 
bility of securing a prolonged and intelligent attention 
to the diet. I would also like to remind any who 
may chance to thus prescribe calomel, that unless 
they give it with a proper understanding of the con- 
ditions and requirements of the case, they will be 
just as apt to fail with it as druggists and nurses are 
apt to fail in curing malaria with quinine, and much 
more liable to do injury. 
3100 Forest Ave.