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skin, fever, disease, inflammation, affection and usually

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ERYSIPELAS (ROSE-RASH).—An inflammatory disease of the skin, accompanied by fever, and caused by the entrance of certain micro organisms (cocci). It always starts from an injured part of the skin or mucous membranes ; either from a more extensive wound or from an insignifi cant abrasion which is apt to be overlooked. The open wounds may be the result of injuries, of childbirth, of infection of the navel in the newborn, or of operations ; or they may be due to scratching or needle-pricks.

The most frequent form of the disease is erysipelas of the face, which usually originates in the injured mucous membrane of the nose. It is not always necessary, however, that an injury precedes the occurrence of erysipelas. The entrance of the bacteria may be favoured by disorders which cause a break in some part of the skin or of a mucous membrane, such as skin eruptions of the nose or ears, fwtid nose (ozena), discharge from the ears, and coryza. Many persons who are periodically affected by erysipelas suffer from such disorders, and escape the erysipelas when the original complaint is cured. Fright and colds are not factors in causing the affection. Epidemics of erysipelas were formerly frequent in the surgical wards in hospitals, hut following the discovery of the cause of the disease, they have become rare.

The first symptom of erysipelas is usually a violent chill, followed by high fever. Soon afterward there appears on the skin a red, painful, elevated spot which rapidly increases in size, advancing either with round contours or in tongue shape. In many patients the onset of the inflammation of the skin occurs simultaneously with the fever. The affected skin is painful to the slightest touch. It is pink to copper-coloured, smooth, glistening, tense, and hot. A striking characteristic is the sharp definition of the inflammation, the affected parts being sharply demarcated from the healthy skin. When the affection spreads over the entire body, or over the greater part of the body, it is spoken of as wandering erysipelas. Erysipelas of the face or head rarely advances further downward than to the nape of the neck. Usually, it is restricted to the face, the ears, and the hairy part of

the head.

The duration of the inflammation is from four to five days, sometimes longer. The outer skin is then cast off in small bran-like scales or in large flakes. Mild infections usually heal in a few days ; cases of medium severity require about a week. In very rare cases the disease may last more than two weeks. An exception to this rule is seen in wandering erysipelas. If the poison of the disease is marked, severe general symptoms develop.

There may be violent headache, delirium, and stupor ; the tongue is dry and covered with crusts ; the appetite is lost. In rare cases complications, such as meningitis, pleurisy, or inflammation of the kidneys, may constitute serious dangers. As a rule, however, the course of the affection is a favour able one. Erysipelas is distinguished from the exanthemata (measles, scarlet fever, etc.) in that recovery from an attack does not make the patient immune to subsequent infections. On the contrary (as is often the case also with articular rheumatism and broncho-pneumonia), a diminution in the power to resist the affection is noted.

As to the treatment, it is in many cases unnecessary to resort to energetic measures. It is sufficient to relieve the painful tension and the suscepti bility to draughts of air by a plentiful application of oil, vaseline, or cold cream to the skin, and by covering the same with a warm dressing. Dusting-powders may be used instead of fats. Cooling drinks (seltzer, lemonade, etc.) may be useful in allaying the fever, and an ice-bag to the head is grateful. Attention must be paid to regular movements of the bowels. The falling-out of the hair does not require any special treatment, as it grows rapidly upon recovery. A marked sensitiveness and irritability of the skin often remains for some time after the disease-process has ceased. It is wise, therefore, to protect the skin on first exposure to the air.

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