Diagnosis

Previous to the attack, gastric symptoms may be present, as well as a general sensation of languor and dullness. The actual attack very frequently commences with distinct shivering. The erysipelatous redness suddenly makes its appearance on different parts of the body, accompanied with swelling, heat and tingling. In severe cases, the parts become very much swollen, the skin presenting a deep red, shining appearance, the patient suffering intensely from a burning heat, tingling, and a painful sensation of tension.

The redness and swelling gradually, and sometimes very rapidly extends, and when it appears on the face, as is most frequently the case, unless checked in its progress, covers the entire head. In these cases delirium is frequently present Sometimes the inflamed surface becomes covered with vesicles or blisters, resembling those occasioned by a scald. In these severe cases, which are often attended with much danger, particularly when it attacks the head, there is a high fever, thirst, pain throughout the body, gastric derangement, sometimes vomiting, severe headache, sleeplessness, great nervous excitability, and a sensitiveness to the slightest noise. The erysipelatous inflammation often wanders, changing from one ear to the other, or from on side of the face to the other, or perhaps confining itself to the nose and eyes. Perhaps there is no disease which produces such a complete change, for the time being, in the appearance of the face as erysipelas. Those who pride themselves on their beauty, would shudder could they see in the closed lids, the swollen cheeks, the inflamed nose, the fearful change which a few hours has wrought in their appearance.

Causes

It maybe occasioned by gastric derangement, or, as is most frequently the case, by sudden suppression of perspiration. It is also very frequently found in females during menstruation. It may also be produced by certain kinds of food at particular seasons of the year, as the different varieties of shell-fish, and also from the abuse of spirituous liquors. We also see it developed in mechanical injuries, and not unfrequently setting in after the operation of the surgeon, with such violence as speedily to destroy life. It sometims seems to prevail as an epidemic to such an extent, that the surgeon hesitates to perform even the most necessary operations. The physician, at these times, is often exceedingly annoyed at finding it set in with great severity in the arm of the child after vaccination.

Treatment

The prominent remedies are, Aconite, Belladonna, and Rhus, also Pulsatilla, Bryonia, Arsenic, Lachesis, Sulphur.

Aconite is indicated by the presence of considerable fever, with dry, hot skin.

Dose

Two drops, or six globules, in a tumbler of water, a table-spoonful every two hours.

Belladonna will be indicated if the redness expands in rays, and severe shooting pains with great heat are felt, aggravated by movement; particularly if the inflammation is in the face, and is accompanied with severe swelling, burning heat, violent headache, delirium, restlessness, thirst, dry and hot skin. It is frequently alternated, with great benefit, with Aconite or Rhus.

Dose

Two drops, or six globules, in a tumbler of water, a table-spoonful once in two hours.

Rhus is particularly indicated, when vesicles or blisters are perceived, or where there is great swelling, a tendency to spread or extend to the brain, and where there is great restlessness and delirium. This remedy is frequently given in alternation with Belladonna or Aconite. The combination of symptoms mentioned under those remedies will be a sufficient guide.

Dose

Two drops, or six globules, in a tumbler of water and a tablespoonful given every one, two, or three hours, according to the severity of the symptoms.

In severe cases, particularly if there is a dryness or pain in the throat, or the swelling or vesicles show a suppurating tendency, a powder, or three globules of Lachesis may be given at intervals of three hours, until four or five doses have been taken, after which the Belladonna and Rhus may be again administered. If at night there should be great restlessness, and no disposition to sleep, two or three doses of Coffea may be alternated with Belladonna, one hour apart.

A constant desire to sleep will be controlled by one or two doses of Opium, prepared the same as Rhus.

Pulsatilla may be given, where the disease affects the ear, where the skin is of bluish red, or the spots wander from one place to another, and also in those cases, which arise from injurious articles of food.

Dose

Dissolve two drops, or six globules, in a glass half full of water. Give a teaspoonful every two or three hours.

Bryonia, will be found useful where the inflammation occurs about the joints.

Dose

Same as Pulsatilla.

Rhus, Sulphur, Arsenic and Lachesis are important remedies, where the disease has terminated in ulceration; the two former or the two latter in alternation, twelve hours apart.

Arsenic is also indicated, where the disease affects the scrotum, or where the vesicles are of a blackish character, and show a tendency to pass into gangrene, where there is great prostration of strength or black diarrhoea sets in. It may be alternated with Carb.-v. or Lachesis, a powder, or three globules every three or four hours.

Where the disease assumes a chronic form, graphites, sulphur or nit. ac. may be consulted.

Diet And Regimen

The diet should be of a simple character, similar to that in fevers. Great pains also should be taken to prevent cold during convalescence, as it often occasions troublesome dropsies.