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OF ERYSIPELAS, OR ST. ANTHONY'S FIRE.
696. IN 274, I mentioned the distinction which I proposed to make between the diseases to be named the Erythema and the Erysipelas; and from thence it will appear, that Erysipelas, as an Erythema following fever, may have its place here.
697. I suppose the erysipelas to depend on a matter generated within the body, and which, analogous to the other cases of exanthemata, is, in consequence of fever, thrown out upon the sur. face of the body. I own it may be difficult to apply this to every particular case of erysipelas : but I take the case in which it is generally supposed to apply, that of the erysipelas of the face; which I shall therefore consider here.
698. The erysipelas of the face comes on with a cold shivering, and other symptoms of pyrexia. The hot stage of this is frequently attended with a confusion of the head, and some degree of delirium ; and almost always with drowsiness, or perhaps coma. The pulse is always frequent, and commonly full and hard.
699. When these symptoms have continued for one, two, or at most three days, there appears, on some part of the face, a redness, such as that described in 275, as the appearance of Erythema. This redness, at first, is of no great extent; but gradually spreads from the part it first occupied to the other parts of the face, commonly till it has affected the whole; and frequently from the face it spreads over the hairy scalp, or descends on some part of the neck. As the redness spreads, it commonly disappears, or at least decreases, in the parts it had before occupied. All the parts upon which the redness appears are, at the same time, affected with some swelling, which continues for some time after the redness has abated. The whole face becomes considerably turgid; and the eye·lids are often so much swelled, as entirely to shut up the eyes.
700. When the redness and swelling have pro. ceeded for some time, there commonly arise, sooner or later, blisters of a larger or smaller size, on several parts of the face. These contain a thin yellowish or almost colourless liquor, which sooner or later runs out. The surface of the skin, in the blistered places, sometimes becomes livid and blackish: but this livor seldom goes deeper than the surface, or discovers any degree of gangrene affecting the skin. On the parts of the surface not affected with blisters, the cuticle suffers to
wards the end of the disease, a considerable desquamation.
Sometimes the tumour of the eye-lids ends in a suppuration.
701. The inflammation coming upon the face does not produce any remission of the fever, which had before prevailed ; and sometimes the fever increases with the increasing and spreading inflammation.
702. The inflammation usually continues for eight or ten days; and, for the same time, the fever and symptoms attending it also continue.
703. In the progress of the inflammation, the delirium and coma attending it sometimes go on increasing, and the patient dies apoplectic on the seventh, ninth, or eleventh day of the disease. In such cases, it has been commonly supposed that the disease is translated from the external to the internal parts. But I have not seen any instance in which it did not appear to me, that the affection of the brain was merely a communication of the external affection, as this continued increasing at the same time with the internal.
704. When the fatal event does not take place, the inflammation, after having affected a part, commonly the whole of the face, and perhaps the other external parts of the head, ceases. With the inflammation, the fever also ceases; and, without any evident crisis, the patient returns to his ordinary state of health.
705. This disease is not commonly contagious; but as it may arise from an acrid matter externally applied, so it is possible that the disease may sometimes be communicated from one person to another.
Persons who have once laboured under this disease are liable to returns of it.
106. The event of this disease may be foreseen from the state of the symptoms which denote more or less affection of the brain. If neither delirium nor coma come on, the disease is seldom attended with any danger; but when these symptoms appear early in the disease, and are in a considerable de gree, the utmost danger is to be apprehended.
707. As this disease often arises in the part, at the same time with the coming on of the pyrexia ; as I have known it, with all its symptoms, arise from an acrimony applied to the part ; as it is commonly attended with a full, and frequently a hard puse; as the blood drawn in this disease shews the same crust upon its surface, that appears in the phlegmasiæ; and, lastly, as the swelling of the eye-lids, in this disease, frequently ends in a suppuration ; so, from these considerations, it seems doubtful if this disease be properly, in Nosology, separated from the Phlegmasiæ. At any rate, I take the disease I have described to be what physi. . cians have named the Erysipelas Phlegmonodes, and that it partakes a great deal of the nature of the Plegmasiæ.
708. Upon this conclusion, the Erysipelas of the face is to be cured very much in the same man ner as phlegmonic inflammations, by blood-letting, cooling purgatives, and by employing every part of the antiphlogistic regimen; and our experience has confirmed the fitness of this method of cure,
709. The evacuations of blood - letting and purging, are to be employed more or less according to the urgency of symptoms, particularly those of the pyrexia, and of those which mark an affection of the brain. As the pyrexi acontinues, and often increases with the inflammation of the face; so the evacuations mentioned may be employed at any time in the course of the disease.
710. In this, as in other diseases of the head, it is proper to put the patient, as often as he can easily bear it, into somewhat of an erect posture,
711. As in this disease there is always an exter, nal affection, and as in many instances there is no