f>53 



ERYSIPELAS. 



ERYTHEMA. 



951 



unwholesome articles of diet, as shell-fish, or stale and rancid fish ; 

 rich, oily, fat, or smoked meats ; impure states of the atmosphere ; 

 an impure state of the body, arising from a morbid condition of the 

 blood, in consequence of the suppression of its depurating processes, 

 whence the frequent occurrence of the disease in the advanced stages 

 of fever, greatly complicating the state of fever and exhausting the 

 little remaining strength of the patient. Violent emotion of mind 

 has also been observed to be an exciting cause of erysipelas in those 

 ]x>werfully predisposed to the disease ; in whom also local irritants 

 often induce it, as wounds or punctures in the skin, the bites of leeches, 

 the stings of insects, inoculation with variolous or vaccine matter. 

 Instances are on record in which both variolous and vaccine matter 

 have produced in children of irritable habits, two or three days after 

 inoculation, an erysipelatous inflammation which has proved fatal. 



Erysipelas is a disease capable of being propagated by contagion. 

 Dr. Bateman has noticed that hi several hospitals it has prevailed 

 in certain wards, among patients admitted with different complaints. 

 Dr. \Vell hag collected several examples of the communication of 

 erysipelas by contagion, which occurred in private families. Such 

 cages are rare, and perhaps never happen in well ventilated and 

 cleanly houses. From the Royal Infirmary, at Edinburgh, this disease, 

 like the puerjieral fever, has been banished by ventilation, white- 

 washing, and other means of purification. 



The danger of erysipelas U in proportion to the intensity of the 

 inflammation, and the severity of the affection of the brain. The 

 danger U also imminent when there is great tumefaction of the throat, 

 or when the inflammation spreads to the respiratory passages and the 

 respiratory organs. As long as the inflammation is confined to the 

 external surface, and the fever remains moderate, the brain not much 

 affected, and the heart's action not inordinate, a favourable termination 

 of the malady may be expected. The different varieties or species of 

 the disease are also attended with very different degrees of danger. 

 Authors usually describe four species, namely, the phlegmonous, the 

 (cdematous, the gangrenous, and the erratic. The phlegmonous is that 

 form of the disease in which the inflammatory state of the system is 

 the most distinctly marked. In the ccdematous the fever and inflam- 

 mation are leas intense; but the tumefaction is so great that the 

 appearance of the face resembles that of a bladder distended with 

 water. This form of the malady most commonly affects persons of 

 debilitated constitutions, who have been previously attacked or are 

 simultaneously affected with dropsy, or some other chronic disease, 

 incident to a cachectic state of the system, and induced commonly by 

 habitual intemperance. It is always attended with considerable 

 danger, for the disorder of some internal function increases with the 

 advancement of the external disease. Very frequently delirium and 

 coma come on at the height of the disease, and terminate fatally on the 

 seventh or eighth day ; or, in other coses, the symptoms continue 

 undiminiahed, and death occurs at a later period. When this form 

 of the disease attacks one of the extremities, it is attended with but 

 little danger. 



In the gangrenous form of the disease the colour of the affected part 

 U of a dark red, and scattered vesicles with a livid base appear upon 

 the surface, which frequently terminate in gangrenous ulcerations. 

 Suppuration and gangrene of the muscles, tendons, and cellular tissue 

 often take place, producing little caverns and sinuses, which contain an 

 ill-conditioned pus, together with sloughs of the mortified parts, which 

 arc ultimately evacuated from the ulcers. It is accompanied with 

 symptoms of low fever, in the progress of which delirium comes on, 

 loon followed by coma. It is always a tedious and precarious and 

 often a fatal form of the disease. 



In the erratic species the inflamed patches appear one after another 

 in different parts of the body, thus travelling in succession from the 

 face to the neck and trunk, and from the trunk to the extremities. 

 It often happens that each accession of the complaint is less and less 

 severe as it recedes to a greater distance from the part first affected, 

 and this form of the disease commonly terminates favourably in a week 

 or ten days. 



lu the phleginonous species, characterised by the presence of inflam- 

 matory fever, the method of treatment must be widely different from 

 tint proper to the ccdematous and gangrenous, in which there is the 

 very opposite state of the system. In the young, the plethoric, the 

 nauguine, and the robust, at the commencement of the attack, when 

 there is much pain in the head, when the heat of the skin is intense, 

 and the pulse is full and strong, the remedies proper in any other case of 

 inflammatory fever are required. In such cases there is sometimes danger 

 that the disease will terminate in fatal inflammation of the brain, unless 

 a free abstraction of blood. But it must be borne in mind 

 that erysipelas does not ordinarily occur in the youthful and vigo- 

 rous constitution ; that it is not often accompanied with the signs of 

 acute inflammation ; that blood-letting is required only when acute 

 inflammation in present, and that the extent of the bleeding must be 

 strictly regulated by the degree of the inflammatory action. In an 

 on Unary attack of phlegmonoid erysipelas, general bleeding is not 

 necessary, at least in the constitutions commonly found in a crowded 

 city. Moderate purging, diaphoretic and saline medicines strict con- 

 finement to bed in a cool apartment, with the diet appropriate to 

 febrile rtiiHuntin. are all the remedies required. If local bleeding and 

 blistering appear to be indicated, car* must be taken not to apply the 



leeches or the buster near the inflamed surface. Various applications 

 to the inflamed surface have been recommended, the most common of 

 which is flour, or some other absorbent powder, to imbibe the fluid 

 which oozes from the vesications. The utility of such applications is 

 doubtful. " The application of powdery substances," says Dr. Batemau, 

 " has commonly, according to my own observation, augmented the heat 

 and irritation in the commencement ; and afterwards, when the fluid 

 of the vesications oozes out, such substances produce additional irri- 

 tation, by forming, with the concreting fluid, hard crusts upon the 

 tender surface. In order to allay the irritation produced by the acrid 

 discharge from the broken vesications, Dr. Willan recommends us to 

 foment or wash the parts affected from time to time with milk, bran 

 and water, thin gruel, or a decoction of elder-flowers and poppy-heads. 

 In the early state of the inflammation, when the local heat and redness 

 are great, moderate tepid washing, or the application of a cool but 

 slightly stimulant lotion, such as the diluted liquor ammonia; acetatis, 

 has appeared to me to afford considerable relief." The local application 

 of nitrate of silver is in some cases very beneficial. 



In the oidematous species, when it occurs in broken-down consti- 

 tutions, the result of habitual intemperance, even purgatives must be 

 very cautiously administered ; the strength must be sustained by mild 

 nutritive diet and tonics, as cinchona or quinine, and even stimulants, 

 as camphor, wine, or the beverage to which the patient has been 

 habituated, are required. The aperients employed should be mild 

 alterative mercurials, with equal parts of castor-oil and the spirit of 

 turpentine administered perhaps every alternate morning. 



In the gangrenous species, quinine in considerable doses through the 

 whole course of the disease, opium, camphor, the mineral acids, wine, 

 brandy, and the general regimen adapted to gangrenous affections 

 occurring under other circumstances, must be freely employed. The 

 remedies indispensable in the phlegmonoid species would be fatal hi 

 this form of the disease, while the remedies which afford the only 

 chance of saving life in the latter would produce fatal inflammation of 

 the brain if administered in the former. 



ERYTHEMA, a superficial redness of some portion of the skin, 

 varying in extent and form, attended with disorder of the constitution, 

 without vesications, and uninfectidxis. It is distinguished from erysipelas 

 by the slight degree of constitutional disorder, by the slight degree of 

 local pain, by the more uniformly favourable termination of the disease, 

 and by the absence of tumefaction and vesicatiou. 



Authors describe several species of this affection, namely : 



1. The fugacious (Erythema fugax), consisting of red patches of an 

 irregular form, resembling the redness produced by pressure. Them 

 patches appear successively on the arms, neck, breast, and face. This 

 affection is generally indicative of and produced by some disorder of 

 the digestive organs. 



2. The shining (Erythema, lieve), exhibits a uniformly smooth shining 

 surface, and chiefly appears on the lower extremities iu confluent 

 patches. It is sometimes symptomatic of disorder of the digestive 

 organs; occasionally attends the catamenia in delicate and irritable 

 females, but most commonly accompanies anasarca or ccdematous swel- 

 lings. Under whatever circumstances anasarca occurs, so as greatly to 

 stretch the skin, this Erythema is liable to be produced, and is often 

 chequered with patches and streaks of dark red and purple hue. 

 It -commonly terminates iu extensive desquamation of the skin, 

 and may be considered as merely a modification of ccdematous erysi- 



pel.n. 



3. Margiuated (Erijthcuui Mttri/inatttm), occurs iu patches which are 

 bounded on one side by a hard elevated tortuous red border, iu some 

 places obscurely papulated ; but the redness has no regular boundary 

 on the open side. The patches appear on the extremities and loins in 

 old people, and remain for an uncertain time, without producing any 

 irritation in the skin. They are connected with some internal 

 disorder, and may be considered as indicative of serious and dangerous 

 diseases. 



4. Papulated (Erythema population), appears chiefly on the arms, 

 neck, and breast, in irregular extensive patches, and moat frequently in 

 females and young persons. The patches are of a bright red hue, often 

 slightly elevated ; and for a day or two before the colour becomes vivid 

 they are rough or imperfectly papulated. The redness afterwards con- 

 tinues for several days ; and, as it declines, assumes, in the central parts, 

 a bluish or pale purple tinge. This variety is generally attended by a 

 tingling sensation, passing to soreness as the colour changes ; and 

 sometimes with much constitutional disturbance, with a frequent 

 small pulse, loss of appetite, depression of strength and spirits, watch- 

 fulness, and pains or tenderness of the limbs, but the general disorder 

 is trifling. 



6. Tuberculated (Erythema titbcmdatu,m) , is merely a slight modifica- 

 tion of the advanced stage of the papulated. 



6. Nodose (Erythema iiudosum), consists of large oval patches on the 

 fore part of the legs ; the long diameter of the patch is parallel with 

 the tibia ; these patches slowly rise into hard aud painful protu- 

 berances, and as regularly soften and subside in the course of nine or 

 ten days. The red colour turns bluish on the eighth or ninth day, as 

 if the leg had been bruised. It chiefly affects children, and particularly 

 females, and is very seldom observed in boys. It is preceded by slight 

 febrile symptoms for a week or more, which generally abate when the 

 erythema appears. It is sometimes connected with the approach of the 



