ERYSIPELAS. 



461 



every erysipelas with an emetic, because the tongue is coated and the 

 breath is foul, and when he attacks the inflammation with all the exter- 

 nal and internal antiphlogistics, and applies irritants to the already in- 

 ^amed skin, in order to prevent the " striking-in " of the disease. How- 

 ever, although in most cases we cannot cut the disease short, and as it 

 almost always terminates favorably, even without treatment, it is bet- 

 ter to let it alone, or, at most, to envelop the inflamed part in cotton ; 

 still accidents may arise, which call for active interference. When the 

 skin is very tense and painful, Skoda strongly recommends the appli- 

 cation of cold in the form of wet or iced compresses. But existing 

 prejudices will oppose insuperable obstacles to applications of this kind, 

 and, as any accident which may occur under such treatment will cer- 

 tainly be attributed by the laity to repression of the disease, I prefer, 

 not so much on my own account, but to save the patient and his rela- 

 tives from useless and erroneous qualms of conscience, to resort to 

 slight compression and to mild scarification instead of cold. The result 

 is the same. The painful tension usually soon subsides under the 

 compression induced by painting the inflamed surface with collodion, 

 similar relief is obtained by making minute superficial punctures with 

 the point of a lancet. One or two pencillings of the inflamed surface 

 and the surrounding parts with lunar-caustic in substance, or painting 

 't with a somewhat strong solution of nitrate of silver (argent, nitr. 

 3iv, acid, nitric, gtt. viij ; aquae dest. ^ ss), seems to have a similar 

 action, although I cannot speak from my own experience. The prac- 

 tice, formerly much in vogue, of drawing a line with lunar-caustic 

 around the area of inflammation, in order to prevent its spreading, has 

 proved useless, and is now generally abandoned. Especial attention 

 should be paid to the fever in treating erysipelas, particularly to that 

 slow form of moderate but very persistent fever which accompanies 

 erysipelas ambulans. Quinia and its preparations are particularly 

 appropriate to such cases, as are also a nutritious diet, wine and 

 strong-beer. 



Wlllarfs indorsement of William's treatment of erysipelas with 

 from four to eight ounces of port-wine daily, and his assertion that 

 the worst case of erysipelas of the head and scalp that he ever saw 

 was cured by Burton ale, should be accepted as meaning merely, 

 that when the fever threatens to consume the patient, alcoholic stimu- 

 lants must be given freely. The complications of the disease, espe- 

 cially the meningitis, are to be treated upon principles already laid 

 down. When the inflammation disappears, it is not advisable to at- 

 tempt to reestablish it upon the surface again by means of vesicants 

 and other cutaneous irritants. Abscesses and gangrene of the skin are 

 to be treated upon surgical principles. 



