Erysipelas is a diffusely-spreading inflammation of the skin, caused by the presence and activity of germs, which enter through a wounded surface. It is most frequently due to want of cleanliness in the treatment of wounds. Bright’s disease and gout predispose to this complaint.
Symptoms.—The disease begins with a vivid red blush, usually starting from a wound, and which has a great tendency to spread or to move from one part of the limb to another. The edge of the blush is sharply defined, and slightly raised above the surrounding skin; there is stiffness and heat in the part, with fever 103°-104° F., not varying much; rapid pulse, headache, loss of appetite, furred tongue and constipation.
Treatment.—Isolate the patient and administer a good purgative. Give twenty drops of tincture of steel, with five grains of quinine in two ounces of water. Light diet. Stimulants will be necessary. Local treatment: flour, starch, or zinc oxide may be used to dust over the part, or zinc ointment applied on lint. The healthy skin just beyond the advancing edge may be painted with tincture of iodine.
Cellulitis.—Occasionally the infection of the skin by the germs spreads to the tissue beneath, and is then called cellulitis, or phlegmonous erysipelas. In this condition there is more swelling than in simple erysipelas, and the skin is very boggy or doughy, and retains the imprint of a finger pressed upon it. The red blush is not so vivid, being darker and more purple, and there is no well-defined edge. If left untreated, the skin will break down and die, causing extensive destruction of the part.
Treatment.—General treatment the same as for erysipelas. Locally, several incisions, each at least one inch in length, should be made into the swollen tissue where it is most boggy, and right through the skin, care being taken to avoid the larger blood-vessels; then hot fomentations of boric acid (five grains to the ounce) or other antiseptic should be applied, every two or three hours, till the swelling has subsided. The important point in the treatment of swollen and inflamed parts following wounds, when accompanied by continued or rising high temperature, is to relieve tension by making free incisions. Some knowledge of the anatomy of the parts is essential before using the knife. In any case, incisions in the arm or leg should be made parallel to and not across the limb.
Blood-Poisoning.
If a poisoned wound is left without thorough local treatment, the poisons and germs contained in the tissues are taken up by the blood, and cause blood-poisoning. The symptoms of this condition are high temperature, delirium, headache, loss of appetite, vomiting, and occasionally bronchitis and pneumonia. Severe forms of blood-poisoning may lead to the formation of abscesses all over the body, with fatal result.
Treatment.—The general treatment is the same as that described for erysipelas. The local treatment is to thoroughly open up and disinfect the poisoned part.