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Summary Classification is probably more important and certainly more difficult in dermatology than in any other branch of medicine. I have attempted to apply what seems to me an excellent classification, proposed by an outstanding dermatologist, to an actual group of children with eczematoid eruptions in order to determine the relative frequency and criteria for differentiation of the various forms and in order to call the attention of pediatricians to the desirability of classification before attempting etiologic treatment.

T HE antigenic power of casein is not diminished by heat.‘> 2 Cow b and goat casein are immunologically identical or almost identical 3, 4, 5 I . The presence or absence of hypersensitivity to casein in milksensitive persons is, therefore, of considerable practical importance, for if it is present, heated cow’s milk or goat’s milk would not be indicated in dietetic treatment, as Anderson, Schloss, and Stuart3 suggested in 1932. It is certain that lactalbumin is immunologically far more important th,an casein. Little attention has been paid to the latter by allergists. Some have even doubted that hypersensitivity to casein exists. Inasmuch as it is originally in colloida,l solution and is then coagulated in the stomach, while most of the laa when the casein

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THE problem of severe reactions to the stings of bees and wasps has presented itself with increasing frequency in the past few years, and although our interest has been turned to these reactions, t...

In 200 consecutive cases of eczema in children from the age of 7 weeks to 14 years, 53 were thought to be caused by outside contact with allergenic or irritating material. The cause was determined in 31 cases, the probable cause in 18, and in 4 it was entirely unknown. The cause was thought to be due to something connected with the clothes (including diapers and shoes) in 40 cases (74%). Contact eczema, as seen in young children, differs from contact eczema in adults in that: it is more likely to be due to the clothes than to anything else, a high degree of sensitization with resulting vesiculation (although it can occur) is not so common as in adults, and primary irritants of relatively low irritating power are more likely to be causes than they are in adults. Too many children are dieted for eczema when the cause is really something which contacts the skin from the outside.

THE following discussion of the literature of the past four years concerns several aspects of eczema in infancy and childhood: pathogenesis, general considerations, antihistaminic drugs, milk-free ...

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WHAT is called "eczema" in infants is, just as in adults, a group of various dermatoses which sometimes closely resemble one another. Infants have atopic, contact, seborrheic, and infectious eczematoid dermatitis, eczema-like fungous infections, nummular eczema, and eczematoid eruptions which do not fit into any of these categories and are impossible to classify. CLASSIFICATION AND NOMENCLATURE It has been said that 75% of "eczema" in infancy is atopic dermatitis. A few weeks ago records from my files of 100 patients under 2 years of age were tabulated, and it was found that the diagnosis of atopic dermatitis had been made for 69, and that of contact dermatitis for 13, while the remaining 18% of the group had other dermatoses. I will confine my remarks almost entirely to atopic dermatitis. About 7% of the population differ from the rest in their immunological response to natural exposure by ingestion or inhalation of

THERE is no doubt that cortisone or adrenocorticotrophin (ACTH) often causes spectacular temporary improvement in infantile eczema.1 2 3 4 5 It is my opinion, however, that these agents when given parenterally and in a hospital, in spite of their great theoretical interest and undoubted temporary favorable action, have little place in the practical over-all management of the disease, for the eczema returns as soon as the treatment is discontinued, and the difficulties of keeping it up over a long period are formidable. The course of the disease is merely interrupted for a short time — it is doubtful if the results are worth . . .

THIS by no means purports to be a complete review of the recent literature concerning allergy in childhood. I have concentrated on a few broad subjects only, some of them highly controversial, that...

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THAT food can cause asthma in children is a fact beyond dispute. The frequency of this sensitivity, as well as its relative importance to recurrent respiratory infection, sensitization to pollens and other environmental allergens, is an entirely different question, concerning which there is considerable difference of opinion. An example of the way allergy is not infrequently treated is provided by the history of an asthmatic child of five years who was recently seen. She had previously been treated in another city and brought with her a typed list, bound in the form of a small book, of the foods that . . .

In 1922 I wrote that with painstaking and intelligent care most cases of infantile eczema can be cured entirely. In 1934 I said that the treatment of eczema may be summarized in six words: "Find the cause and remove it." These statements were due to the optimism of youth. The condition in many cases cannot be cured entirely, and finding the cause does not happen as often as the books tell us. In 1948 I say, "Infantile eczema is a perplexing and exasperating disease to treat, and I wish I understood it better." When one is treating an infant with eczema one is dealing with a patient who is diligently and ingeniously working against him twenty-four hours a day; no skin can heal when it is continually rubbed and scratched. Another difficulty is that atopic dermatitis, which comprises about 75 per cent of "eczema" in the young, has as its

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WHEN I began to treat certain allergic children with cortisone, Dr. Nathan B. Talbot, of the Massachusetts General Hospital, told me that this hormone might retard their growth. Table 1 shows the g...

THERE are many children affected with eczema who are nearly or entirely free from it in summer but in whom it recurs at the onset of cold weather and lasts through winter and spring. As soon as the weather becomes warm their condition begins to improve. It is obvious that something harms them in winter that is absent in summer. Wool deserves consideration as one possible cause. This has been noted by several observers.1 2 3 4 Young children are veritably smothered in wool in the winter. They wear mittens, coarse snow suits, wool hats, sweaters, scarfs and socks; they are continually in . . .

HYDROCORTISONE ointment has been found to be valuable in the treatment of some cases of eczema.1 2 3 4 As far as I know, there are only two reports to date devoted exclusively to its use in infants...

IT IS well known that pollen sensitivity is common in asthmatic children. The full importance of this, however, is not generally appreciated, and in most textbooks and other discussions of asthma i...

It is sometimes necessary to feed infants who are allergic to milk a food containing no milk. The soy bean foods have been and will continue to be of value. Their chief disadvantage is that in some infants they cause large, loose bowel movements and irritated buttocks. While such trouble is not common if the food is cooked in a double boiler for three quarters of an hour, it would be of advantage to have an alternate food for use when necessary. Shohl, Butler, Blackfan and MacLachlan,1using a synthetic protein-free food2in which amino acids prepared from hydrolyzed casein were the chief source of nitrogen, showed that for short periods nitrogen equilibrium and good gains in weight could be maintained. This is of great theoretical interest but of less practical importance unless it can be shown that such a food is adequate for nutrition over relatively long

Most cases of acute nephritis in children follow, or occur coincidentally with, some acute infection elsewhere in the body, tonsillitis being, in our experience, the most frequent one encountered. The question naturally arises whether the kidney condition is produced by bacteria which have gained access to the blood from the throat or from some other locus of infection, and thence invade the kidney, or whether a soluble toxin excreted through the kidney is responsible for the trouble. As far as we know, no systematic study of the question has been made, as regards children, although a number of observations are on record for adults. Inasmuch as the type of case studied in adults by other observers has been, for the most part, widely different from acute nephritis as we see it in children, no conclusions can be drawn by comparing our results with theirs. Therefore, a review of these observations

RENAL FUNCTION TESTS For many years the study of nephritis has attracted a great deal of attention from clinicians. The problems involved are so complicated and so many, the correlation of different anatomic lesions with variations in functional capacity is so difficult, and the stages through which any given case of nephritis may pass are sometimes so varied in the pictures they present, that it is indeed impossible for anyone to feel that he understands nephritis, no matter how much experience he may have had with it. Up to ten or twelve years ago the problem that chiefly interested investigators was a study of the histologic changes produced in the kidney tissue by different types of nephritis, and little attention was paid to changes in the functional capacity of the organ. At present the reverse is true, and studies in kidney function dominate the literature on nephritis in the last

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