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DOMESTIC MEDICINE

CHAP. XXV.

OF THE ERYSIPELAS, OR ST. ANTHONY'S FIRE.

THIS disease, which in some parts of Britain is called the rose, attacks persons at any period of life, but is most common between the age of thirty and forty. Persons of a sanguine or plethoric habit are most liable to it. It often attacks young people, and pregnant women; and such as have once been afflicted with it are very liable to have it again. Sometimes it is a primary disease, and at other times only a symptom of some other malady. Every part of the body is liable to be attacked by an erysipelas, but it most frequently seizes the legs or face, especially the latter. It is most common in autumn, or when hot weather is succeeded by cold and wet.

The country prople in many parts of Britain call this disease a blast, and imagine it proceeds from foul air, or ill wind, as they term it. The truth is, they often lie down to rest them, when warm and fatigued, upon the damp ground, where they fall asleep, and lie so long as to catch cold; which occasions the erysipelas. This disease may indeed proceed from other causes, but we may venture to say, that nine times out of ten it is occasioned by cold caught after the body has been greatly heated or fatigued.

CAUSES. - The erysipelas may be occasioned by violent passions or affections of the mind; as fear, anger, &c. When the body has been heated to a great degree, and is immediately exposed to the cold air, so that the perspiration is suddenly checked, an erysipelas will often ensue. It may also be occasioned by drinking to excess, by continuing too long in a warm bath or by any thing that overheats the blood. If any of the natural evacuations be obstructed, or in too small quantity, it may cause an erysipelas. The same effect will follow from the stoppage of artificial evacuations; as issues, setons, or the like.

SYMPTOMS.-The erysipelas attacks with shivering, thirst, loss of strength, pain in the head and back, heat, restlessness, and a quick pulse; to which may be added vomiting, and sometimes a delirium. On the second, third, or fourth day, the part swells, becomes red, and small pustules appear; at which time the fever generally abates.

WHEN the erysipelas seizes the foot, the parts contiguous swell, the skin shines; and, if the pain be violent, it will ascend to the leg, and will not bear to be touched.

WHEN it attacks the face, it swells, appears red, and the skin is covered with small pustules filled with clear water. One or both eyes are generally closed with the swelling; and there is a difficulty of breathing. If the mouth and nostrils be very dry, and the patient drowsy, there is reason to suspect an inflammation of the brain.

IF the erysipelas affects the breast, it swells and becomes exceedingly hard, with great pain, and is apt to suppurate. There is a violent pain in the arm-pit on the side affected, where an abscess is often formed.

IF in a day or two the swelling subsides, the heat and pain abate, the colour of the part turns yellow, and the cuticle breaks and falls off in scales, the danger is over.

WHEN the erysipelas is large, deep, and affects a very sensible part of the body, the danger is great. If the red colour changes into livid or black, it will end in a mortification. Sometimes the inflammation cannot be discussed, but comes to a suppuration, in which case fistulas, a gangrene, or mortification, often ensue.

SUCH as die of this disease are commonly carried off by the fever, which is attended with difficulty of breathing, and sometimes with a delirium and great drowsiness. They generally die about the seventh or eighth day.

REGIMEN. In the erysipelas, the patient must neither be kept too hot nor too cold, as either of these extremes will tend to make it retreat, which is always to be guarded against. When the disease is mild, it will be sufficient to keep the patient within doors, without confining him to his bed, and to promote the perspiration by diluting liquors, &c.

THE diet ought to be slender, and of a moderately cooling and moistening quality, as groat-gruel, panado, chicken or barley-broth, with cooling herbs and fruits, &c. avoiding flesh, fish, strong drink, spices, pickles, and all other things that may heat and inflame the blood; the drink may be a barley-water, an infusion of elder flowers, common whey, and such like.

BUT if the pulse be low and the spirits sunk, the patient must be supported with negus, and other things of a cordial nature. His food may be sago gruel with a little wine, and nourishing broths taken in small quantities, and often repeated. Great care however must be taken not to overheat him.

MEDICINE. - In this disease much mischief is often done by medicine, especially by external applications. People, when they see an inflammation, immediately think that something ought to be applied to it. This indeed is necessary in large phlegmons; but in an erysipelas the safer course is to apply nothing. Almost all ointments, salves, and plasters, being of a greasy nature, tend rather to obstruct and repel, than promote any discharge from the part. At the beginning of this disease, it is neither safe to promote a suppuration, nor to repel the matter too quickly.

THE erysipelas in many respects resembles the gout, and is to be treated with the greatest caution. Fine wool, or very soft flannel, are the safest applications to the part. These not only defend it from the external air, but likewise promote the perspiration; which has a great tendency to carry off the disease. In Scotland the common people generally apply a mealy cloth to the parts affected, which is far from being improper.

IT is common to bleed in the erysipelas; but this likewise requires caution. If however the fever be high, the pulse hard and strong, and the patient vigorous, it will be proper to bleed; but the quantity must be regulated by these circumstances, and the operation repeated as the symptoms may require. If the patient has been accustomed to strong liquors, and the disease attacks his head, bleeding is absolutely necessary.

BATHING the feet and legs frequently in lukewarm water, when the disease attacks the face or brain, has an excellent effect. It tends to make a derivation from the head, and seldom fails to relieve the patient. When bathing proves ineffectual, poultices, or sharp sinapisms may be applied to the soles of the feet for the same purpose.

IN cases where bleeding is requisite it is likewise necessary to keep the body open. This may be effected by emollient clysters, or small doses of nitre and rhubarb. Some indeed recommend very large doses of nitre in the erysipelas; but nitre seldom sits easy on the stomach when taken in large doses. It is however one of the best medicines when the fever and inflammation run high. Half a drachm of it, with four or five grains of rhubarb, may be taken in the patient's ordinary drink, four times a-day.

WHEN the erysipelas leaves the extremities, and seizes the head so as to occasion a delirium or stupor, it is absolutely necessary to open the body. If clysters and mild purgatives fail to have this effect, stronger ones must be given. Blistering-plasters must likewise be applied to the neck, or behind the ears, and sharp cataplasms laid to the soles of the feet.

WHEN the inflammation cannot be discussed, and the part has a tendency to ulcerate, it will then be proper to promote suppuration, which may be done by the application of ripening poultices with saffron, warm fomentations, and such like.

WHEN the black, livid, or bIue colour of the part shews a tendency to mortification, the Peruvian bark must be administered. It may be taken along with acids, as recommended in the small-pox, or in any other form more agreeable to the patient. It must not however be trifled with, as the patient's life is at stake. A drachm may be given every two hours, if the symptoms be threatening, and clothes dipped in warm camphorated spirits of wine, or the tincture of myrrh and aloes, may be applied to the part, and frequently renewed. It may likewise be proper in this case to apply poultices of the bark, or to foment the part affected with a strong decoction of it.

IN what is commonly caIled scorbutic erysipelas, which continues for a considerable time, it will only be necessary to give gentle laxatives, and such things as purify the blood, and promote the perspiration. Thus, after the inflammation has been checked by opening medicines, the decoction of woods may be drank, after which a course of bitters will be proper. See Appendix, Decoction of woods.

SUCH as are liable to frequent attacks of the erysipelas ought carefully to guard against all violent passions; to abstain from strong liquors, and all fat, viscid, and highly nourishing food. They should likewise take sufficient exercise, carefully avoiding the extremes of heat or cold. Their food should consist chiefly of milk, and such fruits, herbs and roots as are of a cooling quality; and their drink ought to be small-beer, whey, butter-milk, and such like. They should never suffer themselves to be long costive. If that cannot be prevented by suitable diet, it will be proper to take frequently a gentle dose of rhubarb, cream of tartar, the lenitive electuary, or some other purgative.

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