Search

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.

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 ...

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...

n/a

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

n/a

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...

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...

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

n/a

n/a

n/a

Although innumerable papers on the blood have appeared in the last few years, the proportion of really valuable contributions is small, and a great deal of the literature is unimportant from the reviewer's standpoint. The outstanding advances are an increase in knowledge of the blood chemistry in children, especially in the new-born, and in marasmic and intoxicated infants, and valuable contributions to our understanding of hemorrhagic disease of the new-born, aplastic anemia and alimentary anemia. There have also appeared important articles dealing with the classification of the "hemorrhagic diseases," and many contributions concerned with improved technic for transfusion. THE BLOOD IN NEW-BORN INFANTS Lucas, 1 Dearing, Hobler, Cox, Jones and Smith, in an extensive investigation of the blood of normal new-born infants, report the following: The blood in a large series of infants was studied from a few hours after birth up to the fourteenth day. The hemoglobin and red

At the Children's Hospital we have been for several years especially interested in nephritis. This paper is a brief exposition of our experience with the acute cases. 1 ETIOLOGY It is now generally recognized that the vast majority of cases of acute nephritis are of infectious origin. In the older textbooks, cold and exposure are given as perhaps the more important causes, and it is undoubtedly true that these factors may have something to do with certain cases. In chronic nephritis in older persons, the wear and tear of life, especially on the blood vessels of the kidney, is often of great importance etiologically; but as far as children are concerned, micro-organisms or their toxins may be said to play the main etiologic role. It is well known that in many diseases (pneumonia, typhoid fever, etc.) there is enough irritation of the kidney to cause small amounts of albumin and

In order to discuss treatment intelligently, it is first necessary to indicate briefly what is meant by "infantile eczema." It would be not only futile but presumptuous for a pediatrician to attempt a definition of the word "eczema" when dermatologists have been trying for years to formulate one that would be satisfactory to every one and have not yet succeeded. Suffice it to say that there is in infancy a certain group of dermatoses which is perhaps best called the "eczematoid" group, and that the dermatoses included in it present certain morphologic and clinical characteristics which set them apart from other dermatoses. The component elements of the group are the seborrheic, the atopic, the contact and the mycotic forms of dermatitis.1Added to any one of these may be the elements of traumatic or chemical irritation or of pyogenic infection. Combined forms are frequent, and the morphology is so

It is well known that infants and young children with eczema very frequently give positive skin tests to various proteins and that normal infants do not. What significance have these tests both in a theoretical discussion of the etiology of the disease and in the practical management of it? METHODS OF TESTING Three methods of testing have been employed: (1) the cutaneous, (2) the intracutaneous, and (3) the method of passive transfer, or Prausnitz-Kustner phenomenon. Each has its advantages and disadvantages. The cutaneous test has the advantage of simplicity, and it is not so likely to give false positives as the intracutaneous method. It has been adopted by most allergists for general clinical work. The intracutaneous method is more delicate, but it has the disadvantage of sometimes giving false positives, of occasionally causing general reactions in unusually sensitive subjects and, when a large number of tests with different proteins are

As there are very few metabolism experiments which throw much light on the digestion of sugar and its effect on the digestion and absorption of the other food components, the following investigation was undertaken to increase our knowledge of this phase of the subject. J. P. entered the Massachusetts General Hospital, Sept. 12, 1913, at the age of 5 months. The family history was negative. The baby was born prematurely at seven months, April 11, 1913, weighing 4½ pounds, (2.05 kg.). He was never breast-fed and had been given condensed milk or modified milk with proprietary foods containing maltose and had never thrived. During July he had "cholera infantum." He entered the Boston Floating Hospital, Aug. 14, 1913, where he remained until he was transferred to the Massachusetts General Hospital, one month later (Sept. 12, 1913), at which time he weighed 9 pounds 15 ounces (4.54 kg.). The physical examination

Although in the last fifteen years a certain amount of light has been shed on that perplexing subject infantile eczema, its etiology is still obscure. It is probably true that what is called eczema in reality represents a variety of conditions, with various etiologies. One of the most interesting aspects in the history of dermatology in the last seventy-five years has been the gradual splitting off from the group called "eczema" of conditions that have been found to be specific diseases in their own right. Scabies, impetigo and pityriasis rosea were all originally classed under eczema. In the future, as regards infantile eczema, definite causes will be found for definite types, and the group of cases in which the etiology is uncertain will become smaller and smaller. A good example of this is the realization in the last few years that a good many types of so-called eczema in adults

MALIGNANT TUMORS OF THE KIDNEY Rossi1reviews the literature on this subject and reports three cases. There are only a few instances of operative cures on record, and' recurrence is frequent, but an operation is the only means of possible relief, and the success in one of his cases justifies high hopes with radical intervention. In one of the cases on record, the tumor compressed the ureter from the other kidney, inducing hydronephrosis in this, and the urine from the sound kidney found its outlet through the sarcomatous kidney, the ureter from this being still permeable. Enlargement of the kidney is always the first symptom of the malignant disease in children. Hematuria is not always present, and pain is an unreliable element in the differential diagnosis. His first two cases were in children 2 years of age; one was inoperable, but the other child recovered and seems still in

It is common for infantile eczema to improve with age and to disappear during the second year. This is not always so, however. In a series of 900 cases of eczema in infants and young children, 210 occurred between the ages of 2 and 12 years. In 127 of these the eczema had existed since early infancy; in eightythree it began after the second year. It is the first group that I propose to discuss: chronic eczema in childhood, which had its inception in early infancy.This eczema is characterized by papulation and thickening, but with little vesiculation. The classic case shows involvement of the antecubital and postpopliteal spaces, the wrists and the neck. The skin in these areas is dull red and thick, with a few small papules which are excoriated from scratching. It is often very thick and leathery, without much papulation, but with many furrows, and a

The prevention of infant mortality is one of the most important medical questions of the day. More babies die every year from diarrheal diseases than from any other one cause. These diseases are largely preventable, and in most cases respond to proper treatment, whereas many improperly treated patients die. It is, therefore, essential in any affort to reduce infant mortality that all physicians dealing with children should have as clear an idea as possible of these conditions. Any diarrhea is caused by increased intestinal peristalsis. This increased peristalsis is caused by some irritant acting on the intestinal mucous membrane, and it is best to classify diarrheal conditions according to the type of irritant that is causing the trouble. Broadly speaking, according to this method of classification the diarrheal diseases of infancy may be divided into three groups: (1) mechanical diarrhea, due to mechanical irritation; (2) fermentative diarrhea, due to chemical

There are many factors in the etiology of what is ordinarily somewhat loosely called "infantile eczema," and there can be no clear understanding of the disease until bit by bit the significance of these factors is determined. In the last few years fungi have assumed great importance in dermatology, and it has been shown for adults that many eruptions previously classed as "eczema" are in reality fungous infections. Certain of these present a characteristic morphology, such as the lesions on the palms and soles and between the toes in what is usually called "epidermophytosis," but it is true that the most varied morphology may be seen, and for this reason it may be impossible to diagnose many fungous infections without obtaining scrapings or cultures from the lesions. The fungi that have most often been found in eczema-like eruptions are of two groups: the "yeast-like" forms (cryptococci and monilias) and the

During the period Jan. 1 to April 15, 1943, 68 patients with meningococcic infection were admitted to the Station Hospital at Camp Edwards, Massachusetts. Note that we do not say "meningitis," for many of these patients were admitted before the stage of meningitis had been reached. It is essential to bear in mind that infection with the meningococcus is divided into three stages: Nasopharyngeal infection, or sometimes even tonsillitis, clinically differing in no way from such conditions produced by other organisms. The stage of septicemia. The patient may die in this stage after a few hours, the infection may be overcome by proper treatment before meningitis has developed or in mild infections may be overcome by the patient himself without treatment, or the septicemia may progress in a few hours or in a day or two to meningitis. The last mentioned is the most common sequence of events.

In an infant, dermatitis due to hypersensitivity to "protein" substances is called eczema by most dermatologists, pediatricians and allergists, be they European or American. If the condition becomes chronic, in later childhood or adult life it may take many names, commonly, neurodermatitis, or it may still be called eczema by some physicians. If one limits the term eczema to an acute vesicular dermatitis, as some dermatologists do, the chronic condition that is seen in children and adults is certainly not eczema; but if one considers the etiology and evolution rather than the clinical appearance it is in some cases eczema. Confusion has arisen on account of these variations of nomenclature. While the clinical picture of eczema in infants is different from that of neurodermatitis in later childhood and in adult life, it seems to us, and we wish particularly to stress it, that the fundamental basis of atopic