The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis.

  • Wharton, Henry R. (Henry Redwood), 1853-1925
Date:
1902
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis. 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.

    65/1268 (page 51)
    Erysipelatoid Lymphangitis of Rosenbach.—The erysipela- toid disease described by Rosenbach is due to a special micro-organism, growing like the cladothrix, suijposed to be a mycelium-j)rodncing fungus. The disease resembles the light cases of facial erysipelas clinically, although it is almost invariably found upon the hands. It is most often seen in persons engaged in handling meat, and especially iish, in the market or kitchen, and is probably associated with some peculiar form of early decomj)Osition in these substances. The point of infection can generally be found in some slight scratch or abrasion, or a hang-nail. Beginning from this as a centre, the infection spreads slowly over one finger, and over the dorsum or palm of the hand and wrist, but seldom extends for any great distance. It is marked by a rosy flush, with sharply limited edges, although there is little or no cedema. It heals at one side and spreads in the way characteristic of erysip- elas, but exceedingly slowly. There is usually little pain, although in some cases a rather severe burning sensation is felt in the skin, and general dis- turbance is absent, the temperature seldom reaching 100° F. (38° C). The disease seems to be self-limited, and runs its com-se in from ten to fifteen days, gradually fading out, first in the oldest parts, finally at the advancing edge. Treatment.—Isolation.—The first essential in the care of any erysipe- latous inflammation is to isolate even the milder cases from any possibility of infection of infants, parturient women, and persons with wounds or ulcers. Even the mildest cases of facial erysipelas, occurring in individuals who have had the disease so often as to consider it of no importance, may be capable of exciting the most vigorous septic form of the disease in others who are more susceptible to the poison. In these mild cases, occui-ring in families in which there are no such especially disposed persons, an absolute quarantine is not necessary if due care is taken to avoid actual contact with the affected individual, to keep the inflamed part well covered, to disinfect the hands thoroughly after changing the dressings, and to destroy the latter by fire. In the virulent cases, however, no ]precautions can. be too great, and the attendants must guard their own hands with the greatest care (by rubber gloves) in order to avoid infection through some unnoticed lesion. Any one having a wound or an ulcer should abstain from actual handling of the patient, for the infection is one of the inost powerful and insidious known. Local Applications.—The milder cases, especially the erysipelatoid of Rosenbach, appear to be self-limited, and would jDrobably recover without any treatment—a fact which makes it difficult to estimate the value of the various methods of treatment which have been recommended. There ap- pears, however, to be svrfiicieut reason to believe that astringent applica- tions, such as a strong solution of acetate of aluminum or a twenty-five per- cent, ointment of ichthyol, will check the spread of the disease, and even hasten its resolution. Strong antiseptic solutions, such as 1 to 20 carbolic acid or 1 to 1000 bichloride of merciiry, ai^pear to have no greater power over the disease to offset their disadvantages in the way of local irritation and the danger of poisoning. More severe, but uncomplicated, cases are treated upon the general principles of reducing inflammation and by cer- tain special efforts to reach the germs developing in the skin or to limit their spread. The parts may be dressed with strong antiseptic solutions.