Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+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.
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