Erysipelas (Gr. to draw, and neighboring, from its tendency to draw in the neighboring parts; called also St. Anthony's Fire, or in Scotland Rose), an inflammation of the skin characterized by redness, swelling, and burning pain, commonly spreading from a central point, and sometimes affecting the subcutaneous cellular tissue. Idiopathic erysipelas almost invariably attacks the face; frequently it is preceded by loss of appetite, languor, headache, chilliness, and frequency of pulse; a deep red spot now makes its appearance, commonly on one side of the nose, swollen, firm, and shining;, and is the seat of a burning, tingling pain. The disease gradually extends, often until the whole of the face and hairy scalp has been affected, but it is exceedingly rare for it to pass upon the trunk. Often, while it is still advancing in one direction, the part originally affected is restored to its normal condition. Commonly large irregular vesicles (phlyctenoe) filled with serum, precisely similar to those produced by a scald, make their appearance on the inflamed skin. The pulse is frequent, there is total loss of appetite, headache, prostration, restlessness, and sleeplessness, and commonly, particularly at night, more or less delirium.
The complaint runs its course in about a week, and the general symptoms ordinarily abate somewhat before any decline is noticed in the local inflammation. In itself erysipelas of the face is ordinarily unattended with danger; but where it occurs in the course of other and exhausting diseases, it adds much to the gravity of the prognosis. In fatal cases the delirium is apt gradually to lapse into coma. Erysipelas is subject to epidemic influences; in certain seasons it is exceedingly prevalent, while in others it is rarely seen. The attack is favored by overcrowding and deficient ventilation. Hospitals, particularly in spring, are infested with it. Certain unhealthy states of the system predispose strongly to the disease, and an unwholesome diet and the abuse of alcoholic stimulants are commonly cited among its causes. We have seen that simple erysipelas is rarely fatal; consequently recoveries are common under a great variety of treatment. Usually it requires nothing more than to move the bowels by a mild laxative, and afterward to support the system by the administration of nutriment, and if necessary the use of quinine and wine whey. "Where there is great prostration, stimulants may be administered freely.
Systematic writers make a separate variety of the erysipelas of newborn children; it presents no peculiarity, however, except its greater gravity, in common with other diseases, in such delicate organisms. When erysipelas of the abdomen occurs in new-born children, it commonly has its point of origin in the recently divided umbilical cord. In some cases erysipelas, arising generally from some injury or excoriation, shows a tendency to advance in one direction while it passes away in another (erysipelas ambulans); in this manner it may pass over almost every part of the surface. - In phlegmonous erysipelas the precursory symptoms are more constant and severe, the pain more violent, the prostration greater; the redness is most strongly marked along the trunks of the lymphatic vessels, and the lymphatic glands are swollen; the swelling of the skin is more considerable, it soon assumes a pasty consistence, and pits strongly on pressure. As the disease advances, the pain subsides, the redness is diminished, and fluctuation becomes evident; if left to itself, the skin, gradually thinned and distended, sloughs over a larger or smaller space, and pus mingled with shreds of dead cellular tissue is discharged.
The disease indeed seems usually to be in the cellular tissue rather than in the skin, and sometimes the cellular tissue throughout a limb appears to be affected. It is a disease of great severity, and when extensive often proves fatal under the best treatment. In its treatment, the same general principles apply as in simple erysipelas. The patient's strength should be supported by a nutritious diet, and tonics and stimulants must often be freely administered. Early in the disease the skin should be freely divided down into the cellular tissue, to relieve the constriction of the parts and afford an opening to the discharges.