An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.

  • William Williams Keen
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    105/1392 (page 69)
    extend to the glottis, and erysipelatous pneumonia, or imeunionia migrans, is described by some aiitbors. The female genitals and tlie rectum may also be invaded by the disease. The curative influence of erysipelas is shown not only in the effect pro- duced by it on old ulcers, but even by the Avound itself, which, when in the granulating stage, appears to heal more rapidly. Tumors also have sometimes disa]>peared during an attack. Lympho-sarcoma of the neck has been absorbed, tiie cells having uiulergone fatty degeneration. Both lupus and epithelial ulcers of tlie face have been known to break down, healthy granulations su))sequently appearing which healed rapidly. Fehleisen took advantage of this circum- stance to inoculate certain ulcers with cultures of the streptococci of erysipelas, and thus demonstrated the identity of the virus of the disease (p. 207). '^\\Q prognosis of erysipelas is usually favorable, as there is a tendency to self-limitation. The severity of the disease cannot, how^ever, be predicted in any given case, but in small granulating wounds the disease is usually lighter than in large fresh wounds. Danger frequently arises from complications, as oedema of the glottis or secondary hemorrhage. Treatment.—Attempts to restrain the infective process by antiseptic applications have thus for not been very successful. The apparent success of many drugs may be due to the spontaneous arrest of the process which so often occurs. Hot fomentations, containing corrosive sublimate of the strength of 1: 10,000 or 1: 15,000, or carbolic acid may be used ; but care must be taken to avoid increased local irritation or poisoning by absorption of the drugs when a large surface is covered. An ointment of carbolic acid and vaseline, 1 to 100, may be brushed on the face with a soft brush or applied to other surfaces and protected with a thin layer of gutta-percha tissue or oiled paper. Zinc ointment, or an ointment of ichthyol (25 per cent.), is often useful. In phlegmonous erysipelas free incisions are indicated. The slough should be removed, and the pus-cavities must be disinfected as thoroughly as possible. Pressure with plasters or bandages in situations where they can be conveniently applied, has been advised to arrest the spread of the disease. The constitutional treatment should always be supporting, and any deplet- ing measures should be carefully avoided. The presence of delirium does not necessarily contraindicate the use of stitnulants. Tincture of the chloride of iron has been recommended in large and frequent doses on account of its action upon the red blood-corpuscles, which are found crenated, and when placed under the microscope run together readily. This method was at one time received with great favor, but is less used at present. Quinine has also enjoyed a great popularity. Antipyretics as a rule have little effect upon the fever, and should be avoided, owing to the depressing influence upon the heart's action which many of them exert. Opium in some form and hypnotics are indispensable to allay the pain and procure sleep. Food should be carefully and frequently administered. When the blush has disappeared a complete change of bedding and clothing, with careful disinfection, may serve to pro- tect the patient from a relapse due to a reinfection of the system.