A Case of Eczema*

Mrs. C, aged thirty-five years, was sent to me by one of my colleagues. For ten years she has suffered from persistent eczema of the hands, with more severe periodical outbreaks. She has consulted many doctors and has tried various treatments, all of which have proved total failures, the patient never having noted the slightest improvement.1 The stubborn nature of the disease and the knowledge of previous psychical disorders led my colleague to think that possibly these symptoms might have a psychical origin.

The eczema appears on the backs of the hands, on a level with the wrist and the first phalanx. There is no other trace of it on the body. It is a chronic dry eczema; cracked skin; non-suppurating. During the periodical outbreaks it is accompanied by chronic irritation, and the patient cannot refrain from scratching. The outbreak occurs each month before the menses.

The eczema appeared ten years ago after pregnancy. At this time and immediately after confinement Mrs. C. had a puerperal psychosis with delirium, which lasted three months, and of which she remembers nothing. I have had few details about this delirium. I only know that she repeated in the dialect of her own district, “My husband shall not go to war.” She wished to conceal all the keys, and showed anxiety as to the contents of a hand-bag and a silver casket about which she had had a difference of opinion with her mother-in-law. At the time her husband was at the war. On his return she tried to poison herself and was afraid that he would have her put away. At this period the doctors noted slight albuminuria and an increase in the rate of the blood urea. Since then it has been noted that certain outbreaks of eczema corresponded to a slight degree of uremia, but it was only at the end of the puerperal psychosis that attention was paid to the eczema.

Mrs. C. relates that, at the age of two, she had a patch of eczema in the bend of the elbow. During her parents' absence she had been