Local Treatment.—Though mentioned last, this is to he undertaken as soon as the disease has manifested itself, and the choice of local applica tions is endless, each surgeon preferring the remedy which his own ex perience has given him confidence and facility in the use thereof. For simple superficial cases the time-honoured plan of freely dusting powdered Starch, Wheaten Flour, Chalk, Zinc Oxide, or other inert powder to cover up the inflamed skin from the air is still followed by many. These agents can he dusted on the skin in a thick layer from a common flour-dredger, and the part covered over by lint, which when the face is involved may he applied as a mask with apertures left for the mouth and eves. White Lead paint and pastes made with Infusorial Clay, Fuller's Earth, &c., are preferred by others, since they are less liable to be brushed off. Watery lotions are less satisfactory, though often used when the swelling is great. Ichthyol is the favourite routine application, notwithstanding its un sightliness; it may be mixed with an equal amount of lanolin and smeared on with the fingers. or dissolved in its own weight of glycerin and painted on the affected region with a feather or soft brush and covered over with lint.
The Green Extract of Belladonna rubbed up with twice or three times its weight of glycerin may be applied in a similar manner where there is much smarting and tension, hut this should not he applied to extensive surfaces owing to the danger of absorption. Small areas may be coated with Carbolic Collodion, Traumaticinc or Carbolic Oil (i in io).
A paste made by mixing equal weights of powdered Chalk and Lard and 6 per cent. Carbolic Acid is used by Duckworth. Antiseptic oint ments in endless variety are recommended. The best of these is Koch's, which consists of Creolin i, Iodoform 4, and Lanolin to: Creosote, Boric Acid, Carbolic Acid and Iodine ointments are favourite applications.
Antiseptic Lotions arc also used, as Perchloride of Mercury (r in ,,000), Permanganate of Potassium in 500), Picric Acid (i in ioo), Nitrate of Silver 0 in Argyrol (t in io), Perehloride of Iron tincture (i in 4), Hydrogen Peroxide (t in 2o), Sulphurous Arid (i in 5), Carbolic Acid (i in 40), Boric Acid (saturated). Tucker treats all cases of facial ery sipelas by a concentrated solution of Sulphate of Magnesia under oiled silk.
Tr. loch Fort. certainly reaches deeper into the tissues than any watery applications.
With the view of limiting the spread of the disease by acting upon its circumferential zone in order to establish an increased protective leuco cytosis or phagocytosis other methods arc employed. The value of
painting the sound skin beyond the thickened margin of the diseased area with a solution of Nitrate of Silver (Go grs. to i oz.) was recognised as an empiric method long before the natural defensive mechanism of the tissues was understood. The solid Nitrate may be used. Strong Iodine Tincture, iodised Phenol, Pure Carbolic Arid, strong Bromine solution, Creosote made into a paste with Kaolin, and many other power ful antiseptics and caustics are employed in this manner to encircle the diseased area, leaving a ring of healthy skin between the site of their application and the circumscribed margin of the diseased action. A further step in advance is to inject by the hypodermic needle weaker solutions of these agents into the skin beyond the diseased margin: Carbolic Acid (io per cent.), Resorcin (5 per cent.), Salicylic Acid (saturated), may be injected, a few minims being inserted with each puncture. This treatment is painful and not free from danger, but the method of limiting the advance of the erysipelatous margin by the application of Collodion, strips of adhesive plaster, or by the pressure of a rubber band, though often futile. may he tried. A more drastic procedure is to incise the skin by making a number of cross hatchings or scarifications with a vaccination lancet at a short distance beyond the margin of the disease. Judd swabs the skin with a 9; per cent. Carbolic Acid over limited areas at a time, extending for 1- inch beyond the margin, and washes the acid off with Alcohol. All these methods are rendered unnecessary by resorting to the vaccine treatment.
When erysipelas sets in after a surgical operation it will be usually necessary to remove some or all of the sutures, and to freely flush the incised surfaces with an antiseptic and to provide for drainage.
Cellulo-cutaneous or phlegmonous erysipelas and diffuse cellulitis or cellular erysipelas are to be treated upon the above lines, and the surgeon should lose no time in resorting to vaccine treatment. In grave cases when a culture of the specific organism is considered necessary, the polyvalent vaccine, or in its absence the antistreptococcic serum, should be at once injected whilst the necessary culture is being prepared. As these types of the disease are usually only met with in alcoholic and debilitated subjects stimulants must be freely given and strong soups administered at short intervals. The urine should he tested for sugar and diabetic dietary resorted to when necessary. Large doses of Iron with Quinine are clearly indicated, and the weakness of the heart remedied by Digitalis and Strychnine.