Erysipelas, tent; and it frequently changes its situation, growing gradually well in one side, and extending itself on the other. Sometimes it disappears entirely at one place, and attacks some other. As the disease gets well, the cuticle peels off from the affected part.
Erysipelas may be combined with phlegmon (erysipelas phlegmonoides), in which case the inflammation is of a deeper red colour; the swelling is also greater and deeper, and the pain is more acute. There is also a throbbing in the part, and the pulse is full and hard.
There is also a particular species of erysipelas called St Anthony's fire, in which small vesicles are formed on different parts of the skin. These burst, and discharge a thin fluid which forms a scab, and beneath the scab suppuration sometimes takes place.
The true erysipelatous inflammation seldom suppurates, but generally terminates by resolution; very violent cases sometimes cause gangrene.
When erysipelas is accompanied with inflammation of the cellular membrane, as there are no distinct limits of the disease, the matter which is formed in those cases which advance to suppuration, often extends very far in every direction, and sometimes produces very considerable floughing, not only of the cellular substance, but of the fasciae and tendons beneath the skin. Erysipelas is generally accompanied with all the symptoms of general fever, and these occur in a very considerable degree, even where the external inflammation is extremely slight. Languor, lassitude, weakness in the limbs, headache, loss of appetite, oppression about the stomach, precede the appearance of the local complaint. The most violent form of erysipelas is most frequently seen attacking the face, producing a great deal of general fever, often accompanied with delirium; and in a few cases we have known it to proceed so far as to inflame and suppurate the membranes of the brain. Erysipelas seems to be intimately connected with the state of the general constitution. Persons in the habit of drunkennels and other species of intemperance, and who, when in a state of intoxication meet with local injuries, often have erysipelatous inflammation in consequence of these. In general, erysipelas has its principal source in a disordered state of the chylopoetic vasa, and the wrong state of the bilious secretion. It seems also to be often connected with a suppression of perpiration, for it never recedes until that symptom is relieved.
Of the treatment of Erysipelas.—The mild erysipelas is to be relieved by the exhibition of gentle diaphoretics. A few doses of nitre, in order to promote the ordinary evacuations, and the general attention to the antiphlogistic regimen.
It is also of great importance to attend to the state of the bowels, and to give purgative medicines, both with a view of removing any feculent matter contained in them, and as a general evacuant.
When the case is conjoined with phlegmon, and when there are strong symptoms of inflammatory fever, venesection becomes necessary; and this is particularly the case when the face is the seat of the disease. Copious bleeding, however, is generally hurtful, and no blood ought ever to be taken away when the functions of the abdominal viscera are much disordered.
When the patient has a very foul tongue, a bitter taste in his mouth, and a propensity to vomit; if these symptoms cannot be removed, purgatives and emetics become necessary. Indeed, in almost all severe cases, Erysipelas, an emetic is indicated, and ought even to be repeated, should the symptoms remain severe.
There has been a great variety of opinions with regard to the external treatment of erysipelas; some recommending the part to be kept dry, of a moderate warmth, and excluded from the air: others have used warm or cold moist applications. The practice of Default is perhaps the most judicious. In those cases of erysipelas which were produced from an internal cause, no topical application is to be employed, except, perhaps, dusting the part with flour; but when any species of erysipelas succeeds a contusion, a wound or an ulcer, the regimen and internal medicines are insufficient, if proper topical remedies are not at the same time employed to alleviate the local irritation. In this point of view Default employed poultices, the good effects of which in these sort of cases were confirmed by numerous observations. He considered it, however, as an essential precaution not to extend this topical application further than the bruised part, or the edge of the wound or ulcer. If any application is made to the erysipelatous surface, it ought to consist merely of a weak astringent solution: that which was always employed at the Hotel Dieu, consisted of a scruple of the extract of lead in a pint of water.