Erysipelas

For generations past, the old school has been enunciat­ing learned theories regarding the etiology of this disease. The "status biliosus" and the "status saburralis" each had its day. Clogging of the pores of the skin, and consequent accumulation of acridities, which nature should have elimi­nated; and the theory that some noxious principle from without found entrance in some mysterious manner, each claimed due regard. Simple inflammation on the one hand, and specific inflammation, involving the lymphatics, on the other, have also had their advocates. Thus, most opposite theories have been advanced, have been held for a season, and then have fallen again into disrepute. It appears quite probable that some microgerm may be the abnormal excitant, it serving as the agent through which the perverting force is enabled to act upon the vital dynamis. However, the observations of different investigators are not in harmony.

Erysipelas is an acute febrile disease, characterised by a peculiar inflammation of the skin and enlargement of the neighboring lymph-glands, which is accompanied by more or less severe general symptoms. It is contagious and inoculable, and arises spontaneously under conditions not accurately determined; in the latter case it is called Idio-paihic. When spreading by its own contagion, which diffuses itself through the air or is carried by linen or instruments previously used for dressing patients with erysipelas, or by flies - it is called Traumatic, and is mostly found in the surgical wards of hospitals. As the slightest scratch may be the recipient of the poison, the disease is often communicated to nurses and physicians. DaCosta found that the idiopathic form was almost invariably attended by albuminuria, which in the traumatic form was either absent or present only in a decidedly less marked degree.

Erysipelas affects the skin in its whole thickness and the subcutaneous cellular tissue. All the layers of the corium and of the subcutaneous cellular tissue are edematous, swollen, and penetrated by large, finely granulated, white blood-corpuscles. The most important distinctive feature of erysipelas is its disposition to spread only by creeping uninterruptedly onwards without making jumps; it spreads like water in blotting paper. "When on the scalp or face it is limited mostly to a more or less extensive portion of the skin of the head and face, and seldom des­cends over the neck to the trunk; on other parts of the body it is apt to spread over larger surfaces.

The local symptoms are frequently preceded a day or two by a feeling of general malaise, chilliness and feverishness. Then the part affected begins to feel hot and tense; the skin reddens and swells, and becomes very sensitive to the touch. At the same time the adjacent lymphatic glands commence to swell. This inflamed portion assumes a red, smooth and shiny appearance, which is, however, darker and duller on the scalp than on other parts, and to the touch it gives the impression of a hard, stiff, caked mass. The inflammation gradually creeps on until it reaches from side to side of the scalp, down into the face, and even to the neck and shoulders.


On the second or third day, generally, the redness and swelling reach their height, and, at this stage, in some cases, the epidermis becomes raised and filled with a yellowish, limpid fluid, sometimes tinged with blood, in the shape of large blisters - Erysipelas bullosum - which either dry up, or burst / and become covered with crusts.

During the height of the disease, the patient has high fever, with evening aggravations; his sleep is restless and full of dreams; he sometimes becomes delirious. On the fourth day the redness and swelling gradually subside on the places first attacked; while those parts which were invaded later stand yet in full bloom. By and by, however, they grow paler, softer, and assume a wrinkled appearance, as the swelling leaves; the crusts dry off, and on the whole surface the epidermis peels off in large flakes; the entire process lasting from about eight days to two weeks.

But this is not invariably its course. Just in its very nature to creep on lies its danger. It may, by continuity of tissue, wander to the mucous membrane of the nasal and pharyngeal cavities, cause an oedema of the glottis, and affect the larynx, the bronchial tubes, and even produce pneumonia and pleuro-pericarditis.The tongue usually is covered with a white creamy coat, which dries gradually, becomes dirty yellow and, when the fever is protracted, blackish and crust-like; there is nausea and vomiting; sometimes diarrhoea, and, what seems very remarkable, in rare cases profuse intestinal hemorrhage, in consequence of ulcers in the duodenum, which generally have proved fatal, and remind one of similar symptoms which are occasionally observed after severe burns of the skin. In almost all idiopathic cases there is albuminuria. The fever, accompanying erysipelas, is characterized by a sudden rise of the temperature to even 104° F., or higher often within from eight to twelve hours, still rising, in some cases, to 107.6°F. When recovery approaches, it usually sinks as rapidly as it rose, and may attain its nor­mal standard within a few hours, or in a single night; then desquamation of the epidermis, in the form of large or branny scales, and wrinkling, of the skin terminate the local process. The hair usually falls out, but quickly grows again. The skin, too, recovers its normal state; only upon the eyelids, the scrotum, the prepuce and vulva, where it is natur­ally tender, it may in severe cases undergo a more or less extensive gangrenous destruction, and its duration be pro­longed to several weeks, even months.

Unlike to other infectious fevers, erysipelas leaves a very great susceptibility for renewed attacks. Not a few persons are subject to a periodically returning form - the so-called Habitual erysipelas, which mostly affects the face or lower extremities.

Phlegmonous erysipelas is usually the result of an injury, and deep abscesses form in various parts of the body, discharging a foul, dirty pus. These cases are very serious, and often prove fatal. Dr. H. Landerer relates the history of a case of melancholia of seven months' standing and progressing towards incurable dementia, in which the patient, a young girl, recovered completely from her mental affection simultaneously with the subsidence of an attack of facial erysipelas spreading to the scalp. Two or three years had elapsed when the report was made, and she still maintains perfect health.


Burns lias collected twenty-two cases of tumors which were the seat of idiopathic erysipelas. Three cases of sarcoma were permanently cured. In four cases of lymphona of the neck, some of the glands entirely disappeared, and the others became smaller. In five cases erysipelas was artificially produced. Three of these cases were of carcinoma of the breast. In one of them the disease was not checked; in another the tumour was diminished to one-half its former size, and the third was practically cured, a small induration in the scar, the size of a pea, remaining. A multiple fibroid sarcoma was diminished in size, and an orbital sarcoma was unchanged.

My own observation has been limited to one case, a carcinoma of the breast. Erysipelas was artificially produced, with the result of death in about three weeks. No effect was produced upon the carcinoma.