Treatment.—The bowels should at first be freely opened and thereafter well regulated. The diet should be carefully scrutinized. It is sometimes necessary to leave one thing out after another in order to discover whether the diet is causing the affection. Nor ought one to overlook the fact that gnats or bugs may be the exciting cause. All external sources of irritation of the skin should be removed, linen or cotton being worn next the skin. The per son should be kept cool and be lightly clad. Cold sponging and sponging with vinegar and water relieve the irritation for a time. It is sometimes a very obstinate affection.
In chronic troublesome cases a nightly bath of tepid water containing 2 ounces of potassa sulphurata, to the full bath of 30 gallons of water, is most useful. The patient should be in it for 10 to 15 minutes. The patient should be dried without friction, and then the skin smeared lightly with vaseline containing 2 per cent salicylic acid, or with menthol oil, 60 grains menthol to 6 ounces olive -oil. This bath blackens lead-painted baths and smells offen sively, and instead of it a bath containing a washhand-basinful of freshly-made starch to the 30 gallons of water, with of vinegar added, may be tried.
Erysipelas (The Rose—St. Anthony's Fire) is an inflammation of the skin, and therefore, for convenience sake, it is discussed here. But it is an infectious disease, due to an organism whose growth and spread in the skin causes the disease. The organism is a micrococcus (p. 495). By its growth it produces poisonous substances, which enter the blood, poisoning the blood and nervous system, and producing the fever and delirium so marked in the dis ease. The organism may enter the body by a wound, in which case the inflammation of the skin begins at the edges of the wound, and thence spreads over the surface, and in such cases it begins on whatever part of the body the wound is situated. But it may begin where there is no obvious wound. In these cases its common seat is on the face and head. But careful search in such cases also will often show that there has been some scratch or abrasion where the disease began as an in flamed spot, or there may be a concealed wound or ulcer, in nose or ear, which has Leen its starting-point. In infants it may begin at a vaccination mark or at the navel.
Symptoms.—The affected piece of skin is red, shiny, swollen, tense and tender, burning or itching. The patch is at first marked off well from the sound skin, but the inflammation spreads rapidly, the eyelids become swollen and cannot be opened, lips swollen, the ears are disfigured, and the whole countenance altered. The inflammation may rapidly spread up and over the scalp, over the neck, causing the glands to be swollen and tender, and down on to the trunk. The inflamed patch, at first bright red, becomes dark, puffy, and boggy, pitting on pressure. In moderately severe cases blebs form, filled with clear fluid which may become yellow. In severe cases the blebs may contain blood. In a few days the inflammation subsides in one place, other parts going through similar stages, and the affected part may resume its normal appearance, the top skin being first shed in flakes. Sometimes, however, pieces of the skin may slough.
The disease is frequently ushered in by chilliness, which rapidly gives place to high fever, with prostration, headache, sleeplessness, and some wandering, or actual delirium. Often the fever and headache exist for a day or two before the nature of the attack is quite clear. There is often sore throat, there is great aver sion to food, thirst, dry-coated brown tongue. Moderately severe cases last about a week, but it may go on for 2 or 3 weeks. Pneumonia may occur as a complication, and evidence of kidney disturbance can usually be found in the urine, in the shape of albumin (p. 406).
Treatment.—The case must be recognized as infectious from the beginning, and the pre cautions proper to all infectious disease fol lowed. The person who attends the patient should be careful not to carry the disease to others, should be specially scrupulous about washing of hands, and should be careful to see that she has herself no sore or scratch on face or hands. The room should be thoroughly aired, and as bare of furniture and hangings as possible.
The patient's diet should consist of milk and bread, soup and bread, and light milk puddings. The bowels should be freely and regularly moved, apenta or fruit saline being excellent for the purpose. For thirst the imperial drink, or lemon squash, may be given.