Treatment. Careful antisepsis will banish it. Every wound must be disinfected with the most scrupulous care. Every punctured wound is to be incised to its depth and thoroughly cleaned and drained. Large doses of the bromide of potassium, at least sixty grains, should be given every four to six hours. Tetanus antitoxin should be given (5000 units), and repeated in twenty-four hours if no improvement is seen. Recently a saturated solution of magnesium sulphate has been given intraspinally, with very good results. In all suspicious cases, a prophylatic injection of tetanus antitoxin is to be recommended (1000 units).
Erysipelas. Erysipelas is an acute, contagious disease, characterized by a peculiar form of inflammation of the skin. It is caused by the streptococcus of erysipelas, which grows and multiplies in the smaller lymph channels of the skin and its subcutaneous cellular layers, and in serous and mucous membranes.
The disease is a rapid spreading dermatitis, accompanied by a remittent fever, due to the absorption of toxins, having a tendency to recur. It is always due to a wound. The involved area may or may not suppurate.
Symptoms. The onset is sudden, with a high fever, and at the time of febrile onset, spots of redness appear on the skin. These spots run together, and a large extent of surface is found to be red and a little elevated. This combination of redness and swelling extends, and its area is sharply defined from the healthy skin. The color at once fades on pressure and returns immediately the pressure is removed. In the hyperemic area, vesicles or bullae form, containing first serum and later possibly sero-pus. Edema affects the subcutaneous tissues, producing great swelling in the regions where these tissues are lax.
Treatment. Isolate the patient; asepticize the wound; and give a purge. If a person is debilitated, stimulate freely.
Tincture of iron and quinine are usually administered. Nutritious food is important. For sleeplessness or delirium, use the bromides; for light temperature, cold sponging and antipyretics. Locally, strict antiseptic treatment of existing wounds or other lesions; cold compresses to relax the skin; rest; elevation of the limb; and incisions, only if pus forms.
Where the disease is spreading, good results are obtained by spraying the affected surface with a weak solution of corrosive sublimate in ether, or painting the borders of the affected area with contractile collodion. The affected part may also be painted with a 50 per cent. ichthyol and water solution. Alcohol, Burow’s solution, and a great many other liquid applications are recommended. Antistreptococci serum is also to be recommended; an initial dose of 20 c.c. followed by doses of 10 c.c., as often as necessary, being the usual procedure.
Cellulitis. In cellulitis, redness of the skin is not very pronounced and is late in appearing, following swelling, and not preceding it. It is essentially the same condition as a mild form of erysipelas. Its spread is heralded by red lines of lymphangitis, ascending from a wound (infected), swelling of glands, and fever.
In slight cases, the lymphatics may dispose of the poison, and suppuration fails to occur. In severe cases septicema arises. Cellulitis is usually a result of infection not only with streptococci, but also with other pyogenic cocci.
Treatment. Incise and curet the wound and apply one of the wet dressings. (See chapter on same).