Once the diseased surface is freed from all accumulated debris, the important problem must he decided—whether a dry powder, an aqueous lotion, a paste, or a fatty ointment is to be employed. This will to a great extent depend upon the amount of secretion or exudation present. The usual practice is to employ lotions at this stage, and to prohibit greasy or oily applications, but this rule should not be too rigidly followed. Lotions when there is abundant exudation are certainly preferable, but the diffi cult.- must always he kept in mind that as these should not be covered in by oiled silk the lint on which the lotion is applied must be kept continu ously moistened. If this be done by simply pouring the lotion upon the lint the latter filters out the insoluble ingredients and only permits of the aqueous menstruum coming into contact with the diseased skin, unless the raw surface be exposed to the air every time the lotion is reapplied. Another serious objection to their employment is due to the fact that as the lint dries during the night a covering is left in contact with the exuded surface, which firmly adheres to it and which is often removed with difficulty even when thoroughly moistened.
These considerations are frequently lost sight of by those who thought lessly adhere to the hard and fast law that lotions must always he em ployed throughout the acute stages, and it is nut an uncommon experience to find that by persisting in this method the disease is often aggravated by the mechanical irritation caused by the stiffened and dried lint rubbing against the raw surface during the night and by the traction required in the morning to remove the dressing, which often causes pain and some times produces bleeding.
Dusting powders and pastes are not open to the above objections, but they tend to cake into hard masses which are not easily removed, and occasionally the physician will find that he can best obviate this by a combination of both methods, employing alternately a lotion containing in suspension the same powder as has been dusted on previously.
In facial eczema a lotion like the following dabbed on frequently with a small sponge and allowed to dry is not open to the above objections, which only apply when lint and bandaging are resorted to: It . Calamince Prw/aralce 5ss.
spt. Vini Rectificati 5ss. Aqua Rasa ad 5x. Alisce.
Should a lotion he applied upon lint and covered over with oiled silk, the drying difficulty disappears, but the moisture would have the effect of a continually applied poultice, which would keep the diseased skin in a sodden state and retard indefinitely the healing process—a practice which should never be followed.
The objection to ointments is that they make a more or less impervious dressing under which the retained secretion is imprisoned, thus aggravat ing the eczematous condition, hut this can be largely met by prescribing them in a creamy or semi-iiquid form.
In a given case of acute eczema with abundant exudation the writer avoids the above difficulties by using a lotion which contains no insoluble residue, and which therefore can be repeatedly employed for moistening the lint without exposing the eczematous surface. the liquid being fre quently sprinkled on over the dressing. The following combination is suitable; the small quantity of glycerin is insufficient to cause irritation, and prevents the stiffening of the dressings. Some dermatologists employ a i per cent. solution of Picric Acid in the same manner in all acute weep ing eczemas.
R . Liquor. Plumbi Fort. 5ij.
Spt.T'ini Rectif. 3iv.
Glvcerini 3ij.
Aquce Destillatre ad ,7,x. Misce.
When the exuberance of the secretion is checked by the above applica tion soft ointment may he freely smeared lightly over the part, which should be covered with lint coated over also by the ointment, and a light gauze bandage applied to keep it in place without using undue pressure.
There is no limit to the number of such soothing and astringent oint ments. The physician will be wise who selects a simple and well-known substance whose strength may be varied to meet the requirements of each case as experience dictates; the following is suitable in most instances: R . Ungt. Zinci Liq. Plumbi Fort. 5ij.
Olei Oliva 3iv. Misce.
or Cremor. Frigidi Calamin Pr&p. 5ij.
Lassar's Paste is undoubtedly a most valuable application in many cases, and it is not so open to the objection of caking which holds in the case of pastes devoid of a greasy basis, and it is free from the drawbacks of a stifi waxy ointment, since it contains so much absorbent powder. Its com position is Oxide of Zinc 4S, Powdered Starch 4S, Salicylic Acid 4, Vaseline and this may be modified to suit the requirements of each case. With this paste the entire body of an infant suffering from acute eczema may be covered after having previously washed the skin and touched an) bleeding spots with a solution of Caustic. The face, head and joints are smeared over with a 2 per cent. ointment of Salicylic Acid in Vaseline, and muslin bandages are firmly applied. In the very acute stage the salicylic acid had better be omitted, and sometimes a per cent. of Menthol ma) be added to subdue itching.