GENERAL TREATMENT.—General treat ment will essentially consist in feeding the patient and giving tonics, chief among these will be the tincture of the chloride of iron in doses of 30 drops every two hours. This is supposed to have more of a specific action than any other drug recommended for the pur pose. The value of Marinorek's serum has not as yet been established.
Rabbits may be immunized against the streptococcus by the injection of at tenuated cultures into the peritoneum, and their serum possesses preventive and curative properties against erysipelas induced in the rabbit and natural ery sipelas in man. D. Gornakowsky (An nales de l'Institut Pasteur. July, '95).
An antitoxin of streptococeic infection used in cases of erysipelas with success. The mortality before this was usually 5.12 per cent., while during the period of its use, in which 306 cases occurred, of which 165 were considered severe enough to be injected, the mortality fell to 1.63 per cent. Omitting certain cases with severe complications or associated con ditions, the mortality was but 1.2 per cent. A weaker serum was then em ployed, and the mortality rose 4.82 per cent. When the dose was sufficient, improvement in the local and general symptoms took place in 5 to 12 hours and the temperature rapidly declined, becoming normal in 24 hours. If this did not occur, the dose was repeated. The dose varied from 10 to 20 cubic centi metres, and never exceeded 120 cubic centimetres in 10 days. Marmorek (An nales de I'Inst. Pasteur, Nov. 7, '95).
Treatment of 501 eases of erysipelas by serum prepared by the Pasteur Insti tute, with a mortality of only 2.59 per cent. The ordinary dose of serum varies between 6 and 10 drachms. Chante messe (Med. Press and Circular, Feb. 12, '96).
Of 145 cases treated systematically by the ordinary methods, 5 died; of 409 cases treated by systematic cold baths, 16 died; of 297 cases treated by a Mar morek serum of medium strength, 5 died; and of 107 cases treated by a weak serum, 7 died; of 97 cases treated by a strong serum, but 1 died—the mortality being for cases not treated by serum 3.79 per cent., and for the serum-treat ment, 2.59 per cent. After the injection the symptoms diminish markedly within a few hours, and disappear completely within a few days.
Allnuninuria is never caused by the injections, and if it exists it disappears. Nevertheless, the treatment by aconi tine is superior to that by the serum,— 100 cases without fatal result. Gonion (Lyon M6d., Feb. 23, '96).
Antistreptococcic serum for the treat ment of erysipelas must be prepared from cultures of streptococcus erysipe latosus; and not from cultures of strep tococcus pyogenes, as these two organ isms are specifically different. Paras candolo (Wiener klin. Woch., Nos. 38 and 39, '97).
Two cases of erysipelas in which anti streptococcic serum was successfully used. Points noticeable were: (1) the rapidity with which improvement was obtained; (2) the fact that the disease may be checked in its early stages; (3) the lack of local symptoms caused by the injections. The serum is considered to be of most value iu severe cases of facial erysipelas, and should not be used in the majority of cases of the disease. W. Murrell (Lancet, June 24, '99).
One or two hypodermic injections of Marmorek's antistreptococcic serum is a very effective form of treatment, and will give in erysipelas as good results as have already been obtained by the use of the Behring-Roux antitoxin in diph theria. This conclusion has been reached after an experience of six cases of ery sipelas of the face in which it has been used. A. de .Martigny (Maritime Med. News, Jan., 1900).
Case of traumatic erysipelas cured by two hypodermic injections of 10 cubic centimetres (2 drachms) of antidiph theritic serum after ointments and in ternal treatment had had no effect. Improvement quickly set in and con tinned uninterruptedly until complete recovery. G. K. Chapiro (Semainc xxii, No. 40, 1002).
Hypodermic injection of diphtheria antitoxin employed in two cases of severe erysipelas of the face with favor able results. This non-specific action of the antitoxic serum is explained by its stimulating action on the phagocytic properties of the cells. Zwetacff (Prak. Vratch, No. 22, 1902).
The best diet will be milk, beef, tea, eggs, champagne, and beer.
The bowels should be regulated, and an anodyne given to induce sleep and relieve restlessness.