§ 120. Erysipelas.

This is a febrile condition, during which a certa part of the body becomes hot, red and swollen, and sometimes covered with blisters (erysipelas bullosum The redness is superficial and shining, disappears un der the pressure of the finger, and returns immediate! after the pressure ceases. The redness is apt to wan der from one place to another. The inflammation i seated in the epidermis. When the inflammation i very violent, the more deep-seated tissues are likewis affected (erysipelas phlegmonodes).

The fever is accompanied with a disposition to sleep, and generally disappears after the breaking ou of the erysipelas. If the fever be very violent, it pre cedes the breaking out of the erysipelas for a few days, accompanied with sopor, and continues even a few days after the appearance of the erysipelas; in such a case, the fever may last until the seventh or ninth day. Erysipelas is generally accompanied with gastric and bilious symptoms.

Erysipelas is generally a mild disease, without danger, except when the face is affected, in which case the inflammation inclines to go to the brain. Erysipelas is likewise dangerous when the fever has a malignant character, or when there is a metastasis to internal noble organs. The terminations are: dispersion, induration, suppression, gangrene.

§ 121. Simple erysipelas affecting the cellular tissue and accompanied with a violent synochal fever, is controlled by Aconite, after which Belladonna may be given, particularly if the erysipelas spreads in rays, and a stinging pain is experienced in the tight swelling, increased by contact, and at night. Belladonna is likewise indicated for erysipelas phlegmonodes. In many cases Belladonna is the specific from the commencement of the disease; it shortens the course of the disease very much, which, when left to itself, lasts from nine to twelve days, and occasions a variety of secondary symptoms.

If the joints and the surrounding parts should be affected, and the pain should increase by motion, Bryonia is frequently indicated, still more frequently Belladonna, but least frequently Pulsatilla, which ought to be used when the erysipelas shifts from one part to another; but is never indicated in pure erysipelas of the face, except when accompanied with stitches, in which case the disease is apt to go to the brain; this can be more effectually prevented by Belladonna than by Pulsatilla.

I had a case of erysipelas where the disease re-appeared frequently, always on one side of the face only, and where every attack was preceded for several days by a violent cardialgia. A single dose of Nux v. 15, effected a permanent cure, showing that the accompanying symptoms often indicate a different remedy from what are generally considered specifies for erysipelas. In such cases Sulphur might likewise be resorted to, particularly when a throbbing-stinging pain is experienced in the swelling.

Erysipelas of the face generally runs its course accompanied with a very violent, generally bilious fever. The affected parts are red, hard and swollen. The vesicles are of different sizes, yellowish, occasion an itching, burning, tension, and incline to flow into each other. If the inflammation extends to the hairy scalp, the cerebral membranes and the brain itself are seized in a similar manner as in scarlatina, though the cerebral affection in erysipelas is different from that in scarlatina, inasmuch as it requires a different kind of treatment.

The principal remedy for this kind of erysipelas is Rhus t., even if the brain should be affected. I have never used any other remedy but Rhus t., though some physicians have likewise employed Belladonna and Hep. s. beside Rhus. This kind of erysipelas is sometimes accompanied with external and internal otitis, which may require Pulsatilla after Rhus. Graphites has been used with great success in erysipelas of the face, if indicated. Carbo animalis and Cantharides have likewise proved useful in single cases of erysipelas. Euphorbium is an excellent remedy in erysipelas of the head and face, with swelling, and boring, gnawing, digging-up pains, with itching and creeping after the pains cease; likewise in erysipelas with pea-sized vesicles filled with a yellow fluid, accompanied with great heat. Solanum mammosum is likewise said to be useful in the last-named erysipelas.

Erysipelas neonatorum generally takes place during the first month in the region of the umbilicus, extending to the abdomen and genital organs; it likewise appears on the upper limbs, chest and back. It gradually spreads from one part to another, the fever being very violent and sometimes assuming a typhoid character. It is most frequently epidemic. In all my practice I have only seen two sporadic cases, which I succeeded in curing with Aconite and Belladonna. In dangerous cases, Bryon., Rhus t., Hepar s. or Sulphur, may prove useful.

The erysipelatous inflammation of the scrotum, which is most frequently met with in chimney-sweeps and inclines to terminate in gangrene, is most effectually controlled by Arsenic, which is likewise the most efficient remedy in the so-called black erysipelas, unless Acid mur., Sec. corn., Sepia, etc., should be more suitable.

Camphor, Arnica, Nitr. ac, Mercur., Lycop., Phosphor., Nux v., are excellent remedies in erysipelas of the feet and knees, or in erysipelas generally; likewise Lachesis and Crotalus.