In operation cases, care must be taken that irritating chemicals used to purify the skin do not collect under the patient and remain in contact with the skin of the sacrum and buttocks during the time he is on the operating-table.  There is reason to believe that the so-called “post-operation bed-sore” may be due to such causes.  A similar result has been known to follow soiling of the sheets by the escape of a turpentine enema.

Treatment.—­Once a bed-sore has formed, every effort must be made to prevent its spread.  Alcohol is used to cleanse the broken surface, and dry absorbent dressings are applied and frequently changed.  It is sometimes found necessary to employ moist or oily substances, such as boracic poultices, eucalyptus ointment, or balsam of Peru, to facilitate the separation of sloughs, or to promote the growth of granulations.  In patients who are not extremely debilitated the slough may be excised, the raw surface scraped, and then painted with iodine.

Skin-grafting is sometimes useful in covering in the large raw surface left after separation or removal of sloughs.

CHAPTER VII

BACTERIAL AND OTHER WOUND INFECTIONS

Erysipelas—­Diphtheria—­
;Tetanus—­Hydrophobia—­Anthrax—­
    Glanders—­Actino
mycosis—­Mycetoma—­Delhi
    boil—­Chigoe—­Poisoning by insects—­Snake-bites.

ERYSIPELAS

Erysipelas, popularly known as “rose,” is an acute spreading infective disease of the skin or of a mucous membrane due to the action of a streptococcus.  Infection invariably takes place through an abrasion of the surface, although this may be so slight that it escapes observation even when sought for.  The streptococci are found most abundantly in the lymph spaces just beyond the swollen margin of the inflammatory area, and in the serous blebs which sometimes form on the surface.

#Clinical Features.#—­Facial erysipelas is the commonest clinical variety, infection usually occurring through some slight abrasion in the region of the mouth or nose, or from an operation wound in this area.  From this point of origin the inflammation may spread all over the face and scalp as far back as the nape of the neck.  It stops, however, at the chin, and never extends on to the front of the neck.  There is great oedema of the face, the eyes becoming closed up, and the features unrecognisable.  The inflammation may spread to the meninges, the intracranial venous sinuses, the eye, or the ear.  In some cases the erysipelas invades the mucous membrane of the mouth, and spreads to the fauces and larynx, setting up an oedema of the glottis which may prove dangerous to life.