In these types of the disease there is always much brawny infiltration, and the surgeon should not wait for pointing of abscesses, but a number of deep and free incisions into the boggy tissue must be made without delay to save the vitality of the underlying structures, after which warm Boric Acid Compresses should be applied. Poultices are objectionable in all types of erysipelas, but where there is much fcetor or gangrene hot charcoal cataplasms should be applied and renewed frequently. the parts being flushed with an antiseptic solution on each change of poultice.
When the disease attacks the mucous membrane of the nose. mouth, pharynx, or larynx prompt measures must be taken to obviate the dangers caused by interference with the breathing and swallowing. Vaccine treatment is essential, though nose cases usually du well by simply painting the inside of the nostrils with the Ichthyol and Glycerin Cream every hour and occasional syringing with Boric Acid Solution. When the disease attacks the pharynx or larynx, scarification must be resorted to early to avoid suffocation from oedema of the tissues, and the bleeding should be encouraged by spraying warm Boric, Carbolic or Saline solution into the mouth and nostrils. Tracheotomy may be imperatively demanded, especially in children, when the disease causes (edema of the glottis.
The conjunctiva is sometimes involved in facial erysipelas, and usually yields to warm 4 per cent. Boric douching; but the surgeon should always he on the watch for deep-seated inflammation, and this may he silently progressing under the great cedema of the lids without exciting suspicion.
The writer makes a rule of examining the globe from time to time in all cases of facial erysipelas with great cedema of the lids. Orbital cellulitis ending in panophthalmitis and total destruction of the sight has more than once come under his observation as a result of erysipelas of the face. Pus should be evacuated as soon as evidence of its presence is forthcoming.
Toxiemie symptoms are to be treated on general principles. Thus pyrexia, when not yielding to the Quinine and Iron employed as a routine, should he relieved by diaphoretics and tepid sponging. Small doses of .1 ntipyrine relieve the feverishness and also the headache, which is often severe. Ilyperpyrexia must he promptly met by the cold bath, cold pack, or effusion. Delirium will yield also to these last-mentioned agents when it is associated, as it usually is, with a high temperature. Ice should he applied to the scalp and forehead, and a strong saline purge should be given. Insomnia should not he treated by opiates; it is better to remove the condition which is causing it when this is possible. Thus patients often all asleep after the reduction of the temperature by spong ing or after relieving the tension in the (edematous part by punctures or by removing one or more sutures in a throbbing wound; Paraldehyde is the safest of hypnotic's. Rigors are an indication for exploration of the deep-lying tissues, and even when no signs of pus are present a number of deep incisions should lie promptly made when the tension in the part is very high. Heart. failure, as already mentioned, should be met by Strychnine hypodermically.