This is an inflammatory affection of the skin, but frequently affecting the constitution generally, the inflammation extending to the cellular membrane beneath the skin. Every part of the body is liable to be attacked, but it more frequently shows itself on the face, legs and feet than elsewhere, when seated externally. Erysipelas does not usually attack persons before the age of puberty: it is a disease of more advanced life, and is met with more frequently in women than men, particularly those of an irritable, sanguine habit. In many people there appears to be a peculiar predisposition to the disease; and in some it will return once or twice a year, and occasionally much oftener.

It may be brought on by several different causes, as injuries of various kinds, the external application of irritating matters to the skin, exposure to cold, or sudden changes from heat to cold, or from cold to heat, obstructed perspiration, suppressed evacuations, or the presence of irritating matter in the stomach or bowels.

In slight cases, where it attacks the extremities, it appears with a roughness, heat, pain, and redness of the skin, which loses its colour when the finger is pressed upon it, and again becomes red when the finger is removed. There is usually a certain degree of fever, and the patient feels hot and thirsty. If the attack is mild these symptoms will continue for a few days, when the parts affected will lose their redness, the cuticle or scarf-skin will fall off in scales, and the patient will regain his usual health; but if the attack has been severe, and the inflammatory symptoms run high, there will be pains in the back and head, great heat, thirst and restlessness, with swelling of the part affected; the pulse will be small and frequent, and about the fourth day little blisters will frequently show themselves on the inflamed surface. In unfavourable cases these blisters sometimes degenerate into obstinate ulcers.

The trunk of the body is sometimes attacked wieh erysipelatous inflammation, but less frequently than the extremities. It is not uncommon for infants to be attacked in this manner a few days after birth; and in these cases it usually makes its appearance about the genitals.

When Erysipelas attacks the face, it comes on with chilliness, succeeded by heat, restlessness, thirst, and other feverish symptoms, with a drowsiness and tendency to delirium, and the pulse is very frequent and full. At the end of two or three days a fiery redness appears on some part of the face, extending to the scalp, and then gradually down the neck, accompanied with swelling. The whole face at length becomes bloated, and the eyelids so much swelled as to deprive the patient of sight. When the redness and swelling have continued for some time blisters arise on different parts of the face. No abatement of the fever takes place on the appearance of the inflammation in the face, but on the contrary the fever keeps pace with the inflammation, and both may continue for eight or ten days. If the inflammation strikes inwardly to the brain the disease may prove fatal, usually between the seventh and eleventh days. When the complaint is mild, and not of a fatal nature, the inflammation and fever gradually subside.

If the person attacked is of a gross habit of body, and there is much inflammation, fever, and delirium, and these occur at an early period of the attack, we may suppose the patient in considerable danger. Death in these cases does not always ensue from the affection of the head, but frequently the patient dies suddenly, suffocated by the swelling of the parts about the windpipe. In other but more rare cases, the patient will gradually sink; the pulse becomes weaker and weaker, the surface of the body becomes cold, and the heart ceases to beat.

The medical profession have been much divided in opinion as to whether Erysipelas was or was not catching; but the bulk of evidence seems to be in favour of the first proposition; many well authenticated cases having occurred. Dr. Elliotson gives an account of having suffered the disease in his own person. It began in him five days after the breath from one of his patients, over whom he was stooping to examine the skin, and who had Erysipelas badly, and died of it, had come upon his face. "I turned away (he says) disgusted, and said, I hope I have not caught it; but five days afterwards, having forgotten the circumstance, I was seized with it."

Treatment

At the commencement of the attack, if there is any nausea or feeling of oppression at the stomach, the patient may take an Emetic, and follow that up in three or four hours with a brisk purgative of Epsom Salts, or Rhubarb and Magnesia. If the attack is slight, the patient may take 30 drops of Antimonial Wine in a small cup of Oatmeal gruel every four hours, and continue this till there is considerable improvement in the symptoms. If the attack is more severe, the most successful treatment has been the administration of Quinine, and also the Tincture of Sesquichloride of Iron, (formerly called Muriated Tincture of Iron); they may be given as follows: Two grains of Quinine dissolved in 40 drops of the Tincture may be taken in a glass of water every four hours.

If the doses here ordered seem to affect the head, a smaller quantity may be given.

The inflamed part may be bathed constantly with a decoction of Poppy heads, or, if the Poppy heads are not to be obtained, with flannels wrung out in hot water; that is, as hot as can be comfortably borne. No cold applications must on any account be applied in Erysipelas of the head. Much relief is said to have been obtained from covering the head and face with flour powdered over it with a dredging box.

The strength of the patient must be kept up by frequent small quantities of Milk or Beef Tea.

Another complaint something resembling Erysipelas, and sometimes mistaken for it is called Erythema Nodosum. This affection occurs much more frequently in young women than in any other persons: sometimes in feeble boys. The eruption is commonly preceded for a few days by indisposition and a slight degree of fever. Then red elevated spots come out on the fore part of the legs, and .occasionally, but very rarely, on the arms. The redness appears in oval patches, an inch and a half long, and about an inch broad. From their appearance you would suppose that abscesses were about to form; but after lasting a few days the red colour changes to a blue, and the swellings gradually subside. This eruption seems sometimes connected with disturbance of the menstrual functions, and sometimes with acute rheumatism.

Treatment

After an aperient, the best treatment appears to be to give the patient rest, and Quinine in one or two grain doses three times a day. The Quinine should be continued for some days after the patient appears recovered, or the complaint is liable to return.