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.
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