ENCEPHALITIS LETHARGICA {Epidemic Encephalitis)

ERYSIPELAS
Erysipelas is a notifiable disease which should, as a general rule, be treated at home. The incubation period is from three to five days.
Curative Treatment.—Sulphonamides.—The use of the sulphonamide group of drugs has so greatly hastened recovery that no other form of treatment is usually required. Any sulphonamide will prove effective. For an adult, 5 g. daily should be administered for a period of seven days; under the age of five years a daily dose of 3 g. will be found satisfactory.
Penicillin.—Penicillin also achieves rapid cure in erysipelas, but in view of the excellent results obtained with the sulphonamides and the ease of their administration, it is not the treatment of first choice. Exceptions to this general rule are : erysipelas of the leg, in which there is a tendency for invasion of the cellular space with abscess formation ; lesions associated with massive oedema ;when the patient is under two years of age ; and if attacks recur. In such cases the intramuscular injection of 500,000 units of benzylpenicillin twice a day for a period of five days will give more satisfactory results.
Complications.—The incidence of complications is exceedingly low if treatment is begun early. Inflammation of the associated lymph glands is frequently present, but will usually subside without any local treatment. Sub­cutaneous abscesses (especially of the eyelids) are not infrequent, and incision should be delayed until the activity of the erysipelatous plaque has subsided.

GLANDULAR FEVER
(Infections Mononnckosis)

Epidemics of this acute infectious disease of virus aetiology occur in schools and institutions, and sporadic cases are common among the general population

Although susceptibility to the disease appears to be almost universal, the degree of infectivity is not high. For example, cases of glandular fever can be treated in a mixed ward with no ill results. Fever accompanied by acute enlargement of the lymph glands, particularly of the neck, is the form of the disease com­monly met with in children. Febrile and anginose types occur in young adults. A mononuclear leucocytosis is characteristic of the disease. The Paul-Bunnell sheep-cell agglutination test has proved a valuable aid to diagnosis ; agglutina­tion in a titre of i : 160 or higher may be regarded as diagnostic. Unfortunately, the test is often negative in cases which otherwise seem typical. The bacterio­logist should be informed if horse serum has been administered, since this causes false positive results.
Glandular fever is not a notifiable disease. The incubation period is usuaUy between five and fifteen days.
Preventive Treatment.—There is no specific method of prophylaxis against glandular fever.
Curative Treatment.—There is no specific treatment: management of the disease is on symptomatic lines. The antibiotics have some value in the anginose forms of infection because of their effect upon the secondarily infecting organ­isms. A period of three to four days' treatment will usually suffice.
General Management.—The patient should be confined to bed until the temperature has been normal for one week and the glandular swelling markedly diminished. The febrile type with high and prolonged pyrexia lasting several weeks requires to be treated on the same lines as a case of enteric fever.
Meningitis, epistaxis, hsematuria and conjunctivitis are rare complications.
Convalescence.—Recrudescences are liable to occur. Even after mild attacks anaemia and slight debility often persist for several months and the patient should return gradually to normal life. When convalescence is unduly prolonged, careful hasmatological examination is desirable, for some cases of reticulosis have an onset similar to infectious mononucleosis.