Erysipelas from Tnu to draw and adjoining, termed in common language rose, or St. Anthony's fire, when it occurs after blood-letting at the bend of the arm, begins in the contiguity of the wound, and soon spreads both upwards and downwards, frequently involving the whole arm, which becomes swollen, the skin assumes a delicate rosy tinge, and is clear and shining, and when pressed gently with the finger, a white mark remains for a little. A yellowish hue is frequently observable, and there are occasionally serous vesicles which either dry up, or burst and desquamate, or ulcerate, or slough and ulcerate. The patient feels a hot burning pain in the part, and when the constitution becomes affected, which is early in the disease, there is inflammatory fever with considerable nausea. By some it is stated, that the wound of the vein often heals before the erysipelatous affection takes place, and continues so, while on other occasions it breaks out. The treatment is the same as that recom mended for inflammation of the vein; for bleeding, blisters, poultices, and anodyne fomentations, are as proper remedies for the one affection as the other; but if there be any tension, incisions should be made as in erysipelas phlegmonodes. The reader is also referred to the treatment of inflammatory fever, and the Article MEDICINE, Vol. XIV. Page 4.
In this disease, a vein opened in the opposite arm never assumes the erysipelatous type; nor do leechbites, according to the common opinion, mor tify; blisters often arrest the extension of the in flammation, and the blistered surface never assumes the erysipelatous action, but, on the contrary, limits it. Warm poultices are as beneficial in erysipelas as in phlegmon. Flour is a common but most inert application. A solution of the sulphate of magnesia, with tartrate of antimony, is found to be an excellent aperient. Emetics are pernicious remedies, particularly when the head is the seat of the disease, as they propel the blood to that organ. When erysipelas attacks the face or scalp, it ought to be treated with great promptitude, in consequence of the vicinity to the brain; and when once either of these parts have been attacked, it is peculiarly liable to return on the slightest ex posure to cold. It is also very apt to move from one place to another, in this manner, extending all over the body, from the head down the back and breast to the arms and even the legs, the one part desquamai.ing as the other makeS its appearance. It is likewise subject to be translated from one part of the body to another like rheumatism, from the leg to the lungs or face, and it has been known to occur periodically. The integuments of the head are particularly prone to erysipelas after all wounds, especially punctured ones; it also often occurs after compound fractures of the leg, and occasionally in the anasarcous leg. It not unfre
quently attacks the umbilical region of new born children, and extends along the umbilical vein, or downwards to the pudenda. Erysipelas is described as being confined to the skin, and when it involves the subcutaneous cellular tissue, it is termed phleg monous erysipelas, or erysipelas phlegmonodes, or diffuse inflammation of the cellular texture. The epidermis, the rete mucosum, the cutis vera, the cellular tissue, and the cellular substance forming the aponeurosis of the muscles, have all individu ally and collectively been supposed by authors to be the seat of erysipelas.
We find erysipelas attacks mucous structures, as the mucous membrane of the fauces, and we feel confident that we have seen it evidenced in other textures, as the serous, namely the pleura and peri toneum, also fibrous textures, as the periosteum, and we can see no reason for its not attacking every tissue. Erysipelas phlegmonodes is dis tinguished from simple erysipelas, by the part af fected presenting a combination of the two colours, the vermilion and purple, and often a yellow tinge, by the (edematous boggy feeling, and by the patient having rigors or shiverings. An oedematous spongy sensation is one of the best criteria of suppuration having taken place. Whenever matter can be dis tinguished, free incisions should be made to eva cuate it, and as it is often diffused over a great extent, these require to be numerous. If much tension is present, or if the disease be severe, it will be advantageous to make these incisions even before suppuration has taken place, as they not only relieve the tension, but moderate the inflam mation by the local abstraction of blood. Instead of short, or moderately sized incisions, as first recommended by Mr. C. Hutchison, Mr. Lawrence makes a long incision, even the length of the leg, which is evidently objectionable. Erysipelas ter minates either in resolution, suppuration, vesica tion, or gangrene. When resolution, or an abate ment of the disease is the termination, the skin assumes a pale yellow colour, and ultimately the cuticle desquamates.
When gangrene supervenes, the parts become first bluish and then black; an inflamed line of demarcation next takes place between the sound and the mortified parts, ulceration succeeds, and the gangrened parts slough or sphacelate, and sometimes leave the principal artery of a limb exposed. In dissection of the more severe cases of erysipelas, the cellular tissue of the arm is uni versally gangrenous, even that forming the basis of the muscles, which texture is also distended with a sanious fluid. There appear no grounds for considering erysipelas infectious, and it is even doubtful how far it is contagious; nevertheless, in this as in all other diseases, every attention should be paid to cleanliness and ventilation. The treat ment will be detailed under mortification.