Eight cases of erysipelas in which a diplococcus thought to he the cause of the disease was found. Cover-glass prep arations made with the pus from the pustules of four cases and from the blood of the affected part in all eight cases, showed the same diplococci in great numbers. Inoculations were made from each case upon glycerin-agar, blood serum, and bouillon. In all the tubes pure cultures of this diplococcus only were found. G. E. Pfahler (Phila. Med. Jour., Jan. 13, 1900).
From cases in which an erysipelatous inflammation was produced by the staphylococcus and experimental facts, the following conclusions are based: (1) that etiologically erysipelas is not a specific disease; (2) that in the rabbit's ear typical erysipelas may he produced not only by the streptococcus, but also by the staphylococcus, pnetunococcus, and bacillus coli; (3) that human ery sipelas is, as a rule, produced by strep tococcus pyogenes, but that it may be excited by staphylococcus aureus; (4) that the question whether the faculta tive pus-producers—such as the pneu mococcus, bacillus coli, and typhoid bacillus—are capable of producing ery sipelas in man is still an open one. Jor Prognosis.—The prognosis of erysipe las is very uncertain. The mortality rate is somewhat above 10 per cent. Much will depend upon the rapidity and intensity of the course of the infection, and upon the organs which may be secondarily invaded by the poison, or possibly a complication by which a septi caemia may exist. Young and otherwise healthy persons would offer a favorable prognosis, while those more depleted, and especially those recovering from a lingering disease, would offer less hope of recovery.
In grave cases of erysipelas in new born infants the prognosis is most un favorable. Under these circumstances serum-therapy may be of great value. Dauchez (La France Med., Nov. 12, '97).
Treatment.—LocAL.—The multiplic ity of remedies advocated for the treat ment of erysipelas is the best proof that no specific exists to arrest this infection. Prevention, therefore, should be sought for. The greatest adherence to aseptic principles and in the subsequent dress ings of the case will insure the impossi bility of the wound's developing erysipe las. Should, however, a contaminated wound present itself with the developing disease, antisepsis must intelligently be applied to the particular case as our sheet-anchor. The various remedies ad
vocated by different authors rest upon this principle, each only claiming his antiseptic to have given the best results. This is probably the case, because the particular author has had most experi ence in that special method. Of all the antiseptics, that which is commonly believed to have the most germicidal power is 1 to 1000 sublimate solution of mercuric chloride, slightly acidified. The antiseptic must come in close prox imity to the invading micro-organisms, in order that it should exert its destruct ive power. Any method which will facilitate this will fulfill the indications. I, therefore, believe, with Kunert, that multiple scarifications and incisions should be performed when possible in order to facilitate the direct absorption of the antiseptic solution, while we also advocate, with Riedel and Classen, the scarification of the advancing margins of the erysipelas, so as to cut the develop ment across before the micro-organisms have had access to them and fill these developments with an antiseptic solu tion, and so destroy them as they ad vance. The parts are kept thoroughly irrigated with the cold solution. If the patient should have some idiosyncrasy against mercuric chloride, a 3- to 5-per cent. solution of carbolic acid may be used with efficiency. In fact, all the antiseptics known to-day have been, in turn, advocated, and, possibly, may be used with benefit.
Quinine should be administered in doses of S to 16 grains, in accordance with the temperature, 4-grain pills being given three or four times daily; so that the patient is kept constantly under the influence of the drug. Over the affected surface is applied an ointment made up of II Bichloride of mercury, 1 grain. Lanolin, Vaselin, of ounce.
Arnozan (Archives de med. et de Marin. Militaires, No. 2, '94).
Combination of camphor and carbolic acid in about equal parts preferred. It is antiseptic, but not escharotic. The skin must be thoroughly cleansed before its application, and it should be used thoroughly and frequently and ahead of the line of demarkation. Regular feed ing at short intervals with highly-nutri tious, but easily-digested, food is of importance. Frank Parsons Norbury (Medical Fortnightly, No. 8, p. 223, '98).