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Erysipelas and bone fracture.The occurrence of erysipelas in a wound is usually preceded by a severe chill, followed by high fever. The edges of the wound become swollen and red, and the patient experiences pain in and around the site of the injury. The surface of the skin is often studded with little blisters filled with a clear liquid ; these become somewhat darker in color and increase in size, After a time the blisters dry up into scabs, or open and reveal raw surfaces beneath. If the attack be not very severe, the patient's general condition remains good; he suffers from fever, his tongue is furred, appetite diminished, and bowels constipated. The redness and swelling extend a short distance over the surrounding skin, but fade out at the end of a week or so. If the attack be severe, on the other hand, the swelling and redness spread continually ; the skin becomes soft and has a peculiar boggy or doughy feeling. The wround becoroes at first dry, and there is secreted from it a thin watery fluid, instead of matter; after a time, however, matter forms in large quantities in the inflamed skin. Meanwhile, the patient's condition becomes serious ; he is completely prostrated, often delirious. The temperature is very high, and chills occur repeatedly. In fact the condition resembles very much that of blood-poisoning; this latter affection indeed often results from, or at least follows upon, erysipelas in a wound. Treatment. - If the attack be not severe, but little treatment is required aside from the measures which are commonly employed in all feverish conditions. The patient's bowels should be evacuated by the use of some saline cathartic, such as Rochelle salts, a teaspoonful of which may be taken at night. Locally we may apply to the inflamed skin cloths saturated with a solution of carbolic acid in water (an ounce of the acid to a quart of water); or we may employ for the same purpose the following solution : Sugar of lead, - Two drachms. Tincture of opium, - One ounce. Water, - - - Eight ounces. The patient should also take the tincture of the chloride of iron internally. The following prescription may be given : Quinine, - Half a drachm. Tincture of the chloride of iron, - One ounce. Water, ----- Three ounces. Mix, and take a teaspoonful in water every four hours. In severe cases it becomes necessary to support the patients strength and to give exit to the matter which is formed in the inflamed skin. The latter object can be accomplished only by incisions with the knife, which should be freely made wherever it is evident that matter has formed in the skin. In this affection also, the dressing of a fractured limb should be removed, and the atten tion devoted simply to the removal of the erysipelatous condition. After these incisions are made, the wounds should be frequently syringed with a solution of carbolic acid or listerine, which have been described in the discussion of pyaemia. The inflamed skin may be rubbed with vaseline or pieces of lint upon which this salve has been spread. Internally, the patient should take the prescription given above, containing the tincture of iron and quinine. The dose may be given every two or three hours. In addition, we should administer alcohol in some form, preferably as whisky or brandy. In many cases the patient can secure ease only by immersing the limb in a bath of hot water. Carbolic acid should be added to this in the strength already mentioned. It rarely becomes necessary to administer opiates for the relief of pain. The diet should be carefully attended to. The directions given under the head of pyæmia will apply also to erysipelas. Ventilation should be attended to. It is to be remembered, also, that erysipelas is infectious; if there be any other person afflicted with wounds, or if a woman have been recently confined in the house, it is. very important that the sufferer from erysipelas should be removed to another dwelling; otherwise we may expect, in spite of the most careful attention to ventilation and disinfection, that erysipelas will appear in the one individual or childbed fever in the other. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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