1911 Encyclopædia Britannica/Erysipelas

ERYSIPELAS (a Greek word, probably derived from ἐρυθρός, red, and πέλλα, skin)—synonyms, the Rose, St Anthony’s Fire—an acute contagious disease, characterized by a special inflammation of the skin, caused by a streptococcus. Erysipelas is endemic in most countries, and epidemic at certain seasons, particularly the spring of the year. The poison is not very virulent, but it certainly can be conveyed by bedding and the clothes of a third person. Two varieties are occasionally described, a traumatic and an idiopathic, but the disease seems to depend in all cases upon the existence of a wound or abrasion. In the so-called idiopathic variety, of which facial erysipelas is the best known, the point of entry is probably an abrasion by the lachrymal duct.

When the erysipelas is of moderate character there is simply a redness of the integument, which feels somewhat hard and thickened, and upon which there often appear small vesications. This redness, though at first circumscribed, tends to spread and affect the neighbouring sound skin, until an entire limb or a large area of the body may become involved in the inflammatory process. There is usually considerable pain, with heat and tingling in the affected part. As the disease advances the portions of skin first attacked become less inflamed, and exhibit a yellowish appearance, which is followed by slight desquamation of the cuticle. The inflammation in general gradually disappears. Sometimes, however, it breaks out again, and passes over the area originally affected the second time. But besides the skin, the subjacent tissues may become involved in the inflammation, and give rise to the formation of pus. This is termed phlegmonous erysipelas, and is much more apt to occur in connexion with the traumatic variety of the disease. Occasionally the affected parts become gangrenous. Certain complications are apt to arise in erysipelas affecting the surface of the body, particularly inflammation of serous membranes, such as the pericardium or pleura.

Erysipelas of the face usually begins with symptoms of general illness, the patient feeling languid, drowsy and sick, while frequently there is a distinct rigor followed with fever. Sore throat is sometimes felt, but in general the first indication of the local affection is a red and painful spot at the side of the nose or on one of the cheeks or ears. Occasionally it would appear that the inflammation begins in the throat, and reaches the face through the nasal fossae. The redness gradually spreads over the whole surface of the face, and is accompanied with swelling, which in the lax tissues of the cheeks and eyelids is so great that the features soon become obliterated and the countenance wears a hideous expression. Advancing over the scalp, the disease may invade the neck and pass on to the trunk, but in general the inflammation remains confined to the face and head. While the disease progresses, besides the pain, tenderness and heat of the affected parts, the constitutional symptoms are very severe. The temperature rises often to 105° or higher, remains high for four or five days, and then falls by crisis. Delirium is a frequent accompaniment. The attack in general lasts for a week or ten days, during which the inflammation subsides in the parts of the skin first attacked, while it spreads onwards in other directions, and after it has passed away there is, as already observed, some slight desquamation of the cuticle.

Although in general the termination is favourable, serious and occasionally fatal results follow from inflammation of the membranes of the brain, and in some rare instances sudden death has occurred from suffocation arising from oedema glottidis, the inflammatory action having spread into and extensively involved the throat. One attack of this disease, so far from protecting from, appears rather to predispose to others. It is sometimes a complication in certain forms of exhausting disease, such as phthisis or typhoid fever, and is then to be regarded as of serious import. A very fatal form occasionally attacks new-born infants, particularly in the first four weeks of their lives. In epidemics of puerperal fever this form of erysipelas has been specially found to prevail.

The treatment of erysipelas is best conducted on the expectant system. The disease in most instances tends to a favourable termination; and beyond attention to the condition of the stomach and bowels, which may require the use of some gentle laxative, little is necessary in the way of medicine. The employment of preparations of iron in large doses is strongly recommended by many physicians. But the chief point is the administration of abundant nourishment in a light and digestible form. Of the many local applications which may be employed, hot fomentations will be found among the most soothing. Dusting the affected part with powdered starch, and wrapping it in cotton wadding, is also of use.

In the case of phlegmonous erysipelas complicating wounds, free incisions into the part are necessary.