ERYSIPELAS.
Mild 011111 require olllt Iualltreatment. 'onslihrlional Treatment in severe eases will consist of a diet of the most sustaining and easily digested food, solid meats living forbidden till fever disappears. A allowam e of good soup. Ini•f teal, or chicken jelly, with milk in large quantity is essential. Alcoholic stimulants are often indicated in severe cases, and it is a mistakc to give stimulants alone; when possible, they should he 1111 119H/ril1 (11 will] the food. Thus. whiskey or good brandy In mixed with the milk (one wineglassful to each pint or and port wine (one Ivineglassfill to earl] pint of beef tea) may 1.e freely gketi. The precious 11;11)11S of the patient, the stage at which the disease is found when the case conies under the physician's notice, the «indition of the heart and vessels, the amount of cutaneous surface involved, and the temperature will give valuable aid in arriving at a conclusion about the amount of alcoholic stimulants necessary. As a rule, large amounts are well borne, especially in erysipelas following operations on intemperate or irregularly living subjects. Mild cases will require no stimulants; they do better without them.
A Saline purge should he administered in order to thoroughly empty the intestinal canal at the commencement of the treatment. A Mercurial may be given 8 hours before the saline if the patient he robust, but it should not be repeated.
Of drugs used internally Iron is the most valuable, but it must he given in large doses; the older generation of surgeons believed in the almost specific action of 3o to Go min. doses of the Tincture of the Per chloride, and pushed it even in spite of high fever and furred tongue. It may advantageously be combined with Quinine, or full doses of each may be given alternately with 3-hourly intervals, and the latter drug may be combined with full doses (5j.) Aromatic Spirit of Ammonia when signs of cardiac weakness begin to show themselves. Strychnine hypo dermically may be also necessary, or Digitalis may he given with the iron.
The fever of mild cases is easily controlled by Aconite-1 min. of the tincture given every 15 minutes till io or ? doses are taken. This is a favourite method of treating short fevers, and as the entire amount of the drug used should only be equal to one full B.P. dose there is no danger of weakening the heart. The drug should never he used in erysipelas after the first or second day. as the toxins then begin to poison the cardiac muscle. Pilocarpine hypodermically has been extolled, but its use is certainly contra-indicated after the second or third day.
Salicylates, Sulphocarbolates, Benzoates, and a host of drugs have been administered by the mouth with the idea of destroying the strepto cocci; there is no evidence that any such action can be obtained from them.
Serum Therapy is very uncertain and usually disappointing.
Vaccine Treatment, on the other hand, has given good results, and life can undoubtedly be saved by it in severe cases which would otherwise prove fatal. When time permits, the ideal procedure is to obtain a culture of the specific coccus from the local lesion, and inject away from the seat of the disease 5 to io millions of the sterilised streptococci, with half this dose on the following day or days. The dose should be in inverse proportion to the severity of the case, mild types of the disease requiring 20 millions and severe ones 5 to io millions. Usually a poly valent stock vaccine is employed. Recently the apparently fantastic method of deep muscular injections of 5 c.c. boiled milk has been vaunted, on the theory of the value of non-specific proteins.
The disease is infectious to patients who have open wounds or abrasions of the skin, and the most rigid isolation should be insisted upon in hos pitals, and especially in lying-in institutions, and the physician in attend ance upon an erysipelatous patient should not officiate at an accouche ment unless he has been most rigorously disinfected.