THE PRINCIPLES OF ANTISEPSIS IN THE TREATMENT OF ECZEMA. 
407 
formation of crusts by the drying up of the secretions over some 
parts or over the entire denuded surface largely increases the 
danger by giving a certain protection to the growing and multi¬ 
plying microbes against external injuries, and favors the resorp¬ 
tion of poisonous substances. In other cases the contents of the 
vesicles rapidly become purulent, which are formed by the serous 
discharge, yellowish or brown crusts cover the surface particu¬ 
larly where the great thickness of hair favors the undisturbed 
drying of the secretions. It matters not for our purpose 
whether suppuration is considered an essential feature of eczema 
or whether the pustules of impetigenous eczema are included in 
the eczematous process or whether we should consider suppur¬ 
ation as a secondary infection. With our present knowledge 
w e must assume either way that an infection with pus forming 
microbes has taken place, that conditions similar to those of a 
suppurating wound or of a suppurating mucous membrane are 
present. I myself am inclined to believe that suppuration, the 
so-called stage of eczema impetiginosum, makes its appearance 
only when local septic infection complicates the moist stage. 
My experience teaches me that when such an event does not 
take place the vesicular, or moist eczema, passes immediately 
into the squamous stage. When the exudation on the surface 
is not present or in so moderate a degree that no moist surface 
is presented the excoriations resulting from scratching afford an 
equally commodious entrance to all kind of septic material, and 
in their turn often actually become the seat of more or less deep¬ 
ly seated suppuration. Besides in many cases and by closer in¬ 
spection and a slight effort to remove the scales will reveal the 
presence of smaller or more extended surface, the scales often 
preventing the oozing out of the secretions and greatly favoring 
absorption of septic substances into the lymph system. In 
other cases, with more infiltration of the cutis and considerable 
accumulation of horny scales, the formation of cracks will 
represent another condition apt to become the seat of septic and 
other infections and in many cases the formation of ulcers, 
simple or specific. My experience is, as long as suppuration ex- 
