Definition And Description

Erysipelas * is an inflammatory affection of the skin, more frequent on the face than elsewhere, characterized by heat, intense redness and swelling, and a tendency to the formation of vesicles and bullae, and usually accompanied with more or less febrile disturbance. The affection having once appeared, spreads rapidly and may involve a large extent of surface, the entire face for instance, in two or three days. It usually reaches its height in about a week, after which, if everything goes favorably, it begins to decline, and by the end of the second week or sooner, the swelling and redness will have disappeared, and the horny layer of the epidermis be in a desquamating condition. The disease almost invariably runs an acute course, and terminates in, at the most, three weeks. I have, however, seen one case in which a typical facial erysipelas did not undergo complete resolution, but continued as a subacute inflammation, with infiltration for many months. It deserved the name of chronic erysipelas,+ Erysipelas sometimes attacks the same patient a number of times.

Diagnosis

The features presented by erysipelas are so characteristic that there is little difficulty in diagnosticating the affection.

Prognosis

The disease, in the great majority of cases, terminates favorably, in a few cases fatally.

Etiology

Although erysipelas is a very common disease, its etiology is by no means clear. In the majority of cases careful observation has shown that it follows some lesion of continuity and, it is supposed by many, that this is always the case. In some instances, however, this previous lesion cannot be demonstrated.

Treatment

Of the various drugs that from time to time have been advocated in erysipelas we believe that the following are the ones on which the greatest dependence can be placed.

The chloride of iron, especially in the form of an ethereal tincture,++ has enjoyed an extended and deserved reputation, and, in the opinion of some, is the nearest approach to a specific in this affection that we possess. Its best effects appear to follow full doses.

Quinine, in doses of from three to five grains every two or three hours, is given with the view to paralyze the leucocytes and prevent their dia-pedesis. Thus used it certainly abates the fever, and in many cases appears to shorten the duration of the affection.

These are the two drugs on which the most confidence is placed by the majority of physicians at the present time, and their employment is of comparatively recent date. An older method, first brought into vogue by Mr. Liston, should not be forgotten. This consists in the use of aconite and belladonna,* either singly or together. In spite, however, of Liston's high encomiums, their use in this connection did not become very general, a few writers only appearing to have given them a trial. These, however, confirm Liston's statements. Fleming (94, 76) says of aconite: "I have employed it with marked benefit in several cases. ... In one case of simple erysipelas affecting the leg, the inflammation, which was very severe and of six days' standing, was entirely subdued in two days; the pain having abated somewhat soon after the first dose and entirely in seven hours. In another case, also of considerable severity, the pain was entirely removed in ten hours, by which time the swelling was much duced. Every symptom of inflammation had disappeared in thirty-six hours. . . . The treatment of the simple form of the disease may be trusted Aconite alone, the bowels, of course, being at the same time attended to."

* I here refer to the simple superficial variety, not to the phlegmonous form, nor to the erysipelato-cellnlitis of surgeons.

+ This must not be confounded with a chronic eczema often spoken of by patients as "erygipelas."

++ Tinctura Ferri Chlorati AEtherea of the German Pharmacopaeia.

Thompson (83, 96) recommends both aconite and belladonna. He administered the former, however, in a mixture with hyoscyamus, acetate of ammonia, and camphor.

Trousseau + refers to the good effects observed by others with aconite in erysipelas and adds: "These results, without being entirely decisive, seem to us such as to encourage new trials; especially in traumatic ery-sipelas, which is always such a dangerous complication of wounds and operations."

Phillips (2, 59), Bartholow (4, 285), and Kohler (17, 1009), recommend belladonna in erysipelas, the author first mentioned saying: "The forms in which belladonna may be employed to advantage are, such as are marked by superficial inflammation - inflammation, that is to say, which does not much affect the subcutaneous areolar tissue, and in which the surface is free from vesicles, When these are the conditions, belladonna will rapidly quell the disorder."

My own experience confirms that expressed by the authors above mentioned. For several years I have given up the quinine and iron methods of treatment in favor of that by aconite and belladonna, rarely finding it necessary to employ other means. I do not believe that aconite possesses any specific value in this disease, its usefulness being in relation simply to the pyrexia, and its employment should be guided by the thermeter, he appearances presented by the skin. Belladonna, on the other hand, does exert a specific influence on the skin, and my own practice has been to use it externally, keeping the parts covered with a piece of fine linen moistened with a solution composed of one part of tincture of bells-donna, one part of glycerine, and eight parts of water.

In addition to the four drugs mentioned the following have been re-commended:

For Internal Use

Digitalis, 50; Rhus Tox., 99; Stachys Ertecta, 107; and Xanth. Strunar., 116.

For External Use

Ammon. Chlarid., 15; Amman, Iodid., 15; Aralia Nudicaulis, 20; Argent. Nitras, 21; Bismuthi Subnit., 33; Collodium, 46; Plumbi Nitras, 89; Plumbi Subacetas, 89; Potassii Silicus, 95; and Terebinthina, 110.

* Lancet. April 10. 1886. Mr. Liston stated that be obtained the idea of using these drugs from the homoeopaths. + Therapeutics, Am. Ed., 2: 971.