loughs, 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_--_Actinomycosis_--_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.

Erysipelas occasionally attacks an operation wound that has become
septic; and it may accompany septic infection of the genital tract in
puerperal women, or the separation of the umbilical cord in infants
(_erysipelas neonatorum_). After an incubation period, which varies from
fifteen to sixty hours, the patient complains of headache, pains in the
back and limbs, loss of appetite, nausea, and frequently there is
vomiting. He has a chill or slight rigor, initiating a rise of
temperature to 103, 104, or 105 F.; and a full bounding pulse of
about 100 (Fig. 25). The tongue is foul, the breath heavy, and, as a
rule, the bowels are