Erysipelas: Its Causes and Treatment by F. Fleetwood Taylor

Review and Herald Publishing Association · Takoma Park Station, Washington, D. C. · Oct 12, 1911

Erysipelas: Its Causes and Treatment

By F. Fleetwood Taylor

Symptoms

PICTURE to yourself a bright red swelling, quite distinct from, and raised above, the surrounding skin, with surface smooth and shiny. At first it is small, but, if you watch closely, you will notice a great difference in a few hours; the discoloration seems to spread in all directions.

Now, just supposing you have the opportunity, touch the swelling, and you will find it is hot, tender, or even painful and “puffy,”—not firm like the surrounding tissues,—and if pressed with the finger, a small indentation remains.

Next, ask your imaginary patient how she feels. She will tell you she is very ill, has a headache, is disinclined to work or to eat; in fact, is sick at the sight of food.

The patient will further tell you she has not felt up to the mark for a few days, having had “a shivering fit” forty-eight hours before; or if it be a child who is ill the mother will exclaim, “O, yes; baby was in convulsions yesterday.”

This preliminary occurrence is nature’s warning to us that the patient has probably been exposed to some source of infection; and in a few days’ time, called—

The Period of Incubation

we shall know exactly what is wrong. Turning to our patient again, we must examine her more carefully. Most likely the rash is seen on the face, as this is the part commonly affected. We shall find in nine cases out of ten that the starting-point was a sore, cut, or wound. Or the origin may have been where the skin and mucous membrane join, as at the angle of the eye, nose, or mouth; or from a part of the skin roughened by irritating discharges from the nose or ear. Occasionally, the rash begins in the throat or nose, and shows itself afterward on the skin.

Frequently small blebs appear, which may unite into large blisters containing clear, yellow fluid. These break in time. Their contents dry up and form scabs, or crusts, which drop off as the inflammation dies down. Only if further infected through dirt and carelessness do sores result.

The most noticeable features of the case will be—

The Temperature

which rises rapidly, and continues high as long as the redness keeps on spreading. The pulse, however, is the better guide to the condition of the patient. Death seldom occurs if this disease be promptly treated, especially if it is uncomplicated with pleurisy or pneumonia.

During the attack the tongue becomes dry, foul, and in bad cases cracked and brown, while crusts appear on the lips and teeth. Delirium, or wandering of the brain at night, is not uncommon; and the nearest glands are always enlarged.

When the complaint is at its worst, the features are so swollen as to be unrecognizable; but all these symptoms gradually disappear on the fall of the temperature. Simultaneously the inflammation ceases to spread, the rash fades, the skin peels off, and in some cases there is a temporary loss of hair. If properly managed, the patient should begin to recover in from five to seven days, though with a bad constitution the fever may last two or three weeks or longer, especially if relapses occur.

Causes

Erysipelas is contagious, and is therefore due to what bacteriologists call “specific organisms”—minute cellular bodies arranged in chains like a string of beads. They are duly found in the lymph spaces and lymphatic vessels at the advancing margin of the rash, and have nearly always gained entrance to the skin through a cut or wound. There are, however, special circumstances, known as “predisposing causes,” which render people liable to this disease. Such are chronic alcoholism, diabetes, affections of the liver and kidneys; while personal hygiene plays a most important part, the exciting causes including bad or insufficient food, impure water, and lack of cleanliness.

There is little doubt that the infection is carried, not by the air, but by direct contact, i. e., by unwashed hands and dirty clothes. Insanitary surroundings, and accumulations of decaying vegetable or animal matter, favor the growth of the microbe. An eminent authority writes, “The presence of a dust heap near the window of a ward has been known to cause repeated outbreaks of erysipelas in the nearest bed.” Damp and cold weather seem to be specially associated with epidemics of this disease. Certainly it is most prevalent in spring and autumn, and now that the summer months have passed away all too quickly, it may be useful to us to know how best to deal with the complaint should we come across it.

Treatment

As its infectious nature has been explained, we must first isolate the patient, especially from those having wounds, or who are in delicate health. Keep her warm and comfortable in bed in a room with the window open three to six inches, and keep a little fire burning.

The bowels should be relieved at the beginning of the attack, and thereafter daily (if there be no natural evacuation), with the colon douche, or enema, of two pints of warm water.

The whole body should be sponged with tepid water night and morning—except the affected part, which should be bathed in water as hot as the patient can bear, softly and quickly dried, and dusted with flour from a dredger or through muslin. This protects the sensitive area from variations in temperature, and helps to form a scab, under which the new skin grows. If preferred, a cotton-wool mask may be made to cover the face and head. But poultices and cold applications only make matters worse.

While the fever lasts, the nourishment must be entirely fluid and of the simplest character—half a pint of cool milk and barley-water, with a few grapes or other fresh fruit, or a baked apple, every four hours from 7 A. M. to 7 P. M. Between these hours, if the patient is thirsty, let her sip boiled water, lemon-water, or water in which a piece of toast has been soaked. This regimen should be continued as long as the tongue is furred.

When the severe symptoms have subsided, we can add more milk, brown bread and butter, puddings, gruel, etc. During the period of convalescence, macaroni and stewed fruit may be allowed for dinner, or a vegetable stew nicely flavored and thickened with rice or pearl barley, besides the above-mentioned articles of diet.—F. Fleetwood Taylor, M. D.