Definition

This is said to be an acute contagious disease, characterized by an inflammatory condition of the skin, caused by a specific germ. My definition for this disease is: an inflammatory disease of the skin, characterized by septic poisoning.

Etiology

Erysipelas is a disease that affects all sections of the country more or less. Depressing atmospheric influences prove to be allies joining forces with toxemia to produce the disease called erysipelas. No one will have erysipelas who is not toxemic from intestinal infection. It requires constipation and the eating of too much animal proteid to prepare the system for this particular disease. As a rule, it requires a little wounding of the skin to start the disease. In some cases it does not appear to require an injury of any kind. However, when the disease starts on the face, its initiative point usually is the nose, and there is always catarrhal state of that organ. My experience with erysipelas would lead me to define it as septic herpes. It appears to locate without any special exciting cause. Like septic poisoning from any type of disease, it can be conveyed to others, but the disease is not infectious to unbroken surfaces. By this I mean that the disease cannot be transferred from the patient who initiates it to another unless the virus is brought in contact with a denuded surface; and then it will not establish inflammation except in those who are susceptible to septic inflammation.

Mothers, immediately after childbirth or at childbirth, are susceptible to septic inflammation coming from any other source. Besides, if the uterine drainage is not perfect, septic poisoning will start up without any further infective agency than simply retention of waste products which become septic and infectious.

The specific infection of erysipelas must be septic, and of the same character as the infections of all other diseases developing a septic character. Medical writers declare that people who are susceptible to the disease are those suffering from wounds or abrasions of any sort. A skin wound that does not drain may become septic. If the septic inflammation is confined to the surface, it will be of an erysipelatous character. If the inoculation is deep, the disease will be septic in character. Those most susceptible to the disease are the people who are broken down from disease, work, or worry.

Symptoms

This disease is supposed to have an incubation period of from three to seven days. It starts with a chill, a rapid rise in temperature, and about all the symptoms with which a fever would start--aching back, headache, perhaps a sensitive spot on the end of the nose, or simply puffiness and redness, with no particular point worse than another. From this location it generally spreads to the cheeks. The swelling is usually great enough to cause a very smooth appearance of the skin. There is redness and heat. The elevation of the temperature at the inflamed point is very much greater than that of the surface of the face in the immediate region.

The first feeling the patient will have is one of stiffness, with a gradually growing sensitiveness. If the disease is severe, the swelling will be very rapid, and the part first affected will be the first to lose redness and swelling. When the disease spreads only over the forehead, it marches apparently with an elevated ridge; or the line of demarcation between the surface not affected and that which is affected is very acute and easily distinguished. Where the skin is very tender, small blisters may appear, which break, discharging a serum-like fluid.

The glands of the neck usually take on a little enlargement; but this condition is often heightened by the swelling of the skin and cellular tissue. Where the disease spreads over much of the head, there is a tendency for delirium. Where the ears become involved, there is danger of the disease passing into the membranes of the bone. In people who are much depleted--those who are in the habit of taking alcoholics, or who have broken down their resistance by the use of much coffee or tea, or by sensual habits--there is a liability to develop symptoms of brain and meningeal complications. It is said, however, that post-mortems seldom show a meningeal complication, This being true, death must result from toxic poisoning of the brain. In drunkards and in the aged the mortality is very heavy.

Treatment

Strict cleanliness, and warm bathing morning and night, should be the rule. If the tongue is pallid, thick, and presenting the prints of the teeth on the edges, the local application should be a saturated solution of baking-soda. By a saturated solution I mean all the soda that a given amount of water will dissolve. Wet cotton with this fluid, squeeze out the superfluous portion so that there will not be enough to drain and wet the pillow, and place the compress over the inflamed part. Then put a towel or bandage around the head, in such a manner as to keep the soda dressing on the disease.

Positively no food is to be given. The first and second day it would be well to give a little alkaline drink--about what soda would lie on a nickel, placed dry on the tongue, and washed into the stomach with a glass of water--three or four times a day. After the second or third day, simply give water and cut off the internal administration of the alkali.

Where there is a putrescent odor from the breath, use chlorate of potash for the solution in place of the soda. The soda drink can be used for two or three days, as suggested above.

If the tongue is inclined to be small and red, or long and pointed, cranberries mashed and made into a poultice will make an excellent local application. Mash the berries and run them through a colander. Then put the crushed berries between layers of cheese-cloth and lay them on the inflamed part. If the patient has a desire for lemon in water without sugar, he may have it. The bowels must be cleansed by enema twice a day for the first three days, and then every night until the disease is entirely under control. If there is much nervousness at any time, the spinal rubbing will bring quiet and rest. The patient should not be annoyed by company. The bedroom should be ventilated, but there must be no drafts on the patient. If cranberries are not to be had, use cotton with lemon juice for a poultice. If lemon juice irritates the skin, reduce it with water; and if the cranberries irritate the skin, apply a little olive oil before the berry poultice is put on. If this treatment is carried out faithfully, there will be no mortality, and patients will make a very quick recovery.

In regular practice there is an established habit among physicians, in treating erysipelas, to give tincture of iron in doses of half a dram to a dram every three or four hours. As a rule, the same physicians recommend a diet that is very nutritious. The iron will positively prevent digestion. Then is there any wonder that patients treated in such a way will become extremely restless, nervous, delirious, and that some of them die?