This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
Several authors concur in stating that the local use of iodine tincture will relieve this inflammation.
Lanyon relates a case of idiopathic erysipelas, affecting the right side of the face and rapidly extending. The tincture was painted over and beyond the inflamed part; within four hours pain was relieved and sleep obtained; the malady did not advance, and, after another application, next day, convalescence set in.
Boinet records two cases of "traumatic" erysipelas - one connected with suppurating wounds in the perineum, and affecting the right thigh, the other starting from a varicose ulcer, and affecting the whole leg. Thorough application of iodine tincture, once daily for three days, rendered the wounds healthy, and controlled the inflammation and swelling. Dr. Davies is another advocate for the same remedy, used rather stronger (40 gr. iodine to 1 oz. alcohol).
Bartholow and others have not been so well satisfied with it, and care must be taken not to cause undue irritation by its use.
A sulphurous lotion will often give great relief to the burning pain of erysipelas, and its constant application is said to cut short the malady. Dr. Hewson records twenty-seven cases of various degrees of severity - seven of them idiopathic, and all treated by the local use of a sulphite lotion (sodae sulphitis gr. x. ad 3 j.) applied on lint covered with oiled silk; it bleaches the skin and "destroys the inflammation" (Philadelphia Medical Times, i., 1868). Mr. Pairman describes great and immediate relief to pain in a severe case of facial erysipelas from a lotion of equal parts of glycerin and sulphurous acid: the patient recovered at the end of a week, but tincture of steel and other remedies were given internally; relief, however, was clearly traceable to the lotion, and it deserves to be more generally used than it is at present.
The relief given by the acid spray in erysipelas by Dr. Hewson and Mr. Pairman has been already noted, but the internal use of the remedy may be well conjoined with the external. In the case of an infant living under unhealthy conditions, and in whom a severe attack of the idiopathic malady affected one arm and leg, the pudenda and head, and when iron had no control over it, the internal use of sulphurous acid seemed the cause of improvement which very quickly followed.
Desault recommended the frequent use of minute doses of antimony in erysipelas, giving 1 gr. dissolved in a quart of water in the course of twenty-four hours. Dr. A. J. Walsh has reported a number of satisfactory results under this treatment (Dublin Quarterly Journal, August, 1850), but I consider other remedies act still better.
The power of the remedy in this disease depends much on the mode of its application; the mere drawing of a line of caustic round the inflamed margin (as sometimes practised) is illusory. The best method is that of Mr. Higginbottom, who advises previous cleansing of the part with soap and water, then with pure water, and afterward the thorough application of a saturated solution (20 gr. in each fluid drachm) two or three times over the whole affected surface, and beyond it on the healthy skin for about two inches. This is effective in the superficial forms of erysipelas, but not, according to my experience, when much oedema or cellulitis are present, and I am reluctant to advise it over an extensive surface, or in the idiopathic form. It causes severe burning pain, and in the latter condition, at least, does not always stay the inflammation, so that I prefer milder applications and appropriate internal medication.
Preparations of iron have been largely used, both externally and internally, in the treatment of this malady. A strong ointment or lotion of the sulphate (about 1 in 4) was recommended by Velpeau after many comparative trials with other remedies; it does not, however, always prevent the extension of the inflammation [Bulletin, 1855). Mr. Hulke recommends a lotion containing 10 gr. in the ounce [British Medical Journal, ii., 1871). The application of equal parts of liq. ferri and spiritus vini rect. would seem still more valuable (Oswald White, British Medical Journal, i., 1876); and Mr. Foster, of Leeds, obtained so much success by painting the ordinary tincture of perchloride over erysipelatous surfaces, that this plan became known as the "Leeds method;" it was applied also to inflamed lymphatics, breasts, etc., and seems to have been especially useful in erysipelas after vaccination (Lodge, Medical Times, i., 1875). Mr. Hamilton Bell was the first to publish cases of remarkable benefit from the internal administration of the same remedy, or rather of the old "tincture of muriate of iron;" he gave 20 to 30 drops every three hours, so that sometimes 2 oz. were taken in eight days (Edinburgh Monthly Journal, 1852). In severe cases of "idiopathic" erysipelas, the spread of inflammation was arrested, the pulse lowered, and the fever relieved, and equally good results were reported by Balfour, Begbie, and other eminent men; and although Lehmann writes more re-cently in praise of the treatment (Lancet, i., 1880), we cannot concede to ferrum the "specific" virtue in erysipelas that has been claimed for it, nor is it the best remedy for every case. Todd curtly denied its efficacy (Medical Times, i., 1860); also H. Bennet and Estlander found it useless in traumatic cases (Medical Times, ii., 1871).
Dr. Marshall (Dover), after relating two acute cases well cured by 20-min. doses (and purging), states that he has found the remedy of less use in the traumatic form (British Medical Journal, i., 1872). The limited experience of Parkes need not weigh with us, because his cases received only 10-min. doses or less, and were therefore not tests of the method in question; but Aran, commenting on ten satisfactory cases recorded by Mathez (These, Paris, 1857), points out that iron is not the best remedy for young, robust subjects with high fever.
It is fair to add that Mr. C. Bell still maintains its very great value in all forms of erysipelas, and attributes the failures of other practitioners to the use of too small doses, or of less excellent preparations; he states that under his own care patients have recovered so soon as the old "tincture of muriate" was substituted for the modern "perchloride." The former, made with sesquioxide and hydrochloric acid, contains more free chlorine and some protochloride of iron, but the present tincture of the B.P. is a more definite preparation; any difference in curative power can be ascertained only by clinical experience, and Mr. C. Bell's observations deserve attention (Edinburgh Medical Journal, August, 1876). Some observers have sought an indication for iron in the locality affected, finding it least useful for erysipelas of the head or trunk; but Pirrie has obtained the best results in such cases. I think that in choosing a remedy for erysipelas we should look rather to the general constitution of the patient, the nature of the tissues affected, and the character of the inflammation; thus, I find iron to be really the best remedy in anaemic, weak patients, or in lymphatic constitutions when there is rapid extension or flitting of the inflammation, when the affected surface is dark-red or bluish, when the pyrexia is slight, and when, owing to debility, the attack tends to linger.
In the erysipelas consequent on surgical operations it is also useful if the subject has been reduced by long-continued suppuration or other causes of exhaustion. I believe it has also some prophylactic power.
In many cases of phlegmonous erysipelas, especially when occurring in strumous subjects, I have found the internal administration of corrosive sublimate distinctly useful.