The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
When once established, the disease is to be treated on lines nearly
similar to those laid down for septicemia, including resort to the
ichthyol or silver ointments, and to intravenous infusion of silver
solution. (See p. 89.) Amputation or extirpation of the part from
which infection has first proceeded may be of avail. Among the most
successful measures for surgical treatment of this disease is to expose
the infected area, open the involved veins, and either excise them or
scrape them out and disinfect them. This treatment has been successful
in cases of cranial infection following middle-ear disease, etc. (See
chapter on Cranial Surgery.)
Disinfection of the infected area and immersion in hot water should
be practised. Metastatic abscesses should be opened and drained, and
every accessible collection of pus evacuated, either by the knife or
aspirator needle--_e. g._, in the liver.
The medicinal treatment is practically the same as in septicemia,
while the surgeon’s mainstays are alcohol and strychnine. These, with
cathartics and intestinal antiseptics, will practically sum up the drug
treatment, the surgeon meantime not neglecting the matter of nutrition,
crowding it in every assimilable form.
ERYSIPELAS.
Erysipelas is an _acute infectious disease characterized by its
tendency to involve the skin and cellular structures, to extend along
the lymphatic vessels, to involve wounds and injuries under certain
conditions, accompanied by more or less fever of septic type, leading
frequently to septic disturbances of profoundest character, yet tending
in the majority of instances to spontaneous recovery_. It has been
observed probably from prehistoric times, but has not found a proper
description nor appreciation until perhaps within the past century. It
occurs in so-called _traumatic_ and _idiopathic_ form--which latter
means that the site of infection is not discovered--and also in a
_virulent_ and _contagious_ type, which leads to the appearance of
a number of cases over a large territory; it often appears in the
_epidemic_ form. On account of the reddening of the skin it goes by the
name of _the rose_ among the German laity. It may assume the type of
an infectious dermatitis, subsiding without suppuration, or a similar
lesion of exposed mucous membrane may be noted, or, occasionally, its
virulence seeming greater, its lesions are met with in more deeply
seated parts, accompanied by suppuration or even gangrene, and it
is then called _phlegmonous_. In a small proportion of cases the
infectious organism appears to be transported from one part of the body
to another, and thus we have _metastatic_ expressions of this disease.
The most common examples of this are seen in erysipelatous meningitis
after erysipelas of the face or scalp, and erysipelatous peritonitis
after the disease has manifested itself on the truncal surface. It is
of a type which makes itself almost interchangeable with puerperal
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