The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).
- Date:
- 1849-59
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![Some continental surgeons have recommended the application of vesicants and escharotics as local remedies in erysipelas. Dupuytrcn employs blisters to the affected portions of skin in the se- cond stage of phlegmonous erysipelas. M. Larrey reports favourably of the edicacy of slight cauteri- zation of the surface in traumatic erysipelas. Mr. Higginbottom, of Nottingham, more re- cently, has recommended the application of nitrate of silver, with the view of arresting the spreading of erysipelatous inflammation. He conceives that the influence of this remedy (as an external ap- plication) is not confined to the textures consti- tuting the skin, but that it extends to the cellular substance, and even to the parts more deeply seated. This remedy is not to supersede active treatment when necessary. It is to be applied in the following manner. The part is to be first washed with soap and water, to remove any oily substance from the skin, and afterwards wiped dry ; the inflamed and surrounding skin is to be then moistened, taking care that not only every part of the inflamed skin be touched, but the sur- rounding healthy skin, to the extent of an inch or more beyond it. The nitrate of silver is to be passed over these surfaces once, twice, thrice, in common cases, and more frequently if rapid vesi- cation be required. After the application, the part is to be exposed to the air to dry, and is to be kept cool. Mr. Higginbottom has given, in his work, several cases illustrative of the efficacy of this plan of treatment. (See an Essay on the Use of Nitrate of Silver in the Cure of Inflammation, Wounds, and Ulcers, by John Higginbottom.) Compression by a well applied bandage has been employed in the later stages of erysipelas. From what we have witnessed, we are by no means inclined to advise this mode of treatment. If inflammation of the skin and cellular tissue still remain, pressure must prove most injurious; and if there be infiltration of pus in the cellular tissue, it can be of no avail. We have seen more than one case of erysipelas, in which gangrene was in- duced within twelve hours after a bandage was applied. The only form in which it can be at all admissible, is in the suppurative stage of phleg- monous erysipelas, as already recommended, and in the chronic stage of oedematous erysipelas, after the inflammation has disappeared from the skin, when the limb continues enlarged from (Edematous effusion into the cellular tissue. [Mr. Davies (^Practical Remarks on the Use of Iodine locally applied, Amer. Lib. edit. 1839-40) has recommended in the same cases the tincture of iodine diluted with two parts of alcohol to one of the tincture, and applied over the affected parts by means of a camel's-hair pencil. It seems to act like the nitrate of silver, forming a coating over the inflamed surface, and thus protecting it from the air, whilst, at the same time, it acts as an excitant to the over-dilated capillaries. In local erysipelas, the writer has often found it markedly advantageous; and M. Velpeau (Braithwaite's Retrospect, July to Dec. 1842, p. 117, Lond. 1843) has observed a solution of sulphate of iron in the proportion of an ounce to a pint of water, or an ointment of the same, in the proportion of a drachm to an ounce of lard of great service. A few years ago, the application of mercurial Vol. II 14 ointment to the inflamed parts was brought for- ward with high encomiums, and was extensively used, (T. Nunneley, Treatise, Sfc. on Erysipelas, Amer. edit. p. 214, Philad. 1844); but the writer has not been able to notice any better effects from it than from greasy applications in general, whilst it has at times acted as an irritant when the latter might have not. Except, however, in local erysipelas, the writer is not in the habit of employing topical remedies to the inflamed part. He has found decided benefit from carefully excluding the air from it by cover- ing it with carded cotton, as in cases of burns and scalds. The great object would seem to be, to remove the constitutional affection of which the exanthem is only a functional expression, like the eruption of small-pox, measles, or scarlatina. It must be borne in mind, that this is largely neuro- pathic, and that great benefit often results from agents that would be justly esteemed questionable in ordinary inflammation. A recent writer of authority. Dr. Robert Williams, (^Elements of Medicine,) states, that the mode in which he is in the habit of treating idiopathic erysipelas, what- ever may be the part affected, or with whatever symptoms it may be accompanied, is as follows: the patient is put on milk diet; the bowels are gently opened, and from four to six ounces of port-wine, together with sago, are allowed daily. This mode of treatment, he says, it is seldom necessary to vary throughout the whole course of the disease ; for the delirium, if present, is gener- ally tranquillized ; if absent, prevented ; the tongue more rarely becomes brown, or only continues so for a few hours ; while the local disease seldom passes into suppuration or gangrene. In a word, all the symptoms are mitigated, and the course of the disease shortened. I have pursued this sys- tem, he adds, for several years, and I hardly remember a case in which it has not been success- ful. Dr. Williams does not limit the quantity of wine to that above stated. In more severe cases, where the local affection continues to ex- tend, and the delirium to augment, he increases the wine to eight ounces, and adds quinia to it.] A. TWEEDIE. ERYTHEMA, (from the Greek lfi6n)>a, red- ness,) is one of those nosological terms which has been made use of in various significations by dif- ferent writers, and its application is, even at the present moment, in some degree vague and arbi- trary. Hippocrates used it in the general sense of a morbid redness of the skin, of any kind, for which, at a later period, Celsus, and, after him, Galen, substituted the term erysipelas; and hence, per- haps, arose a good part of the confusion which we meet with in the subsequent application of the terms. In the system of Sauvages, erythema is synonymous whh idiopathic erysipelas. Cullen says, when the disease is an affection of the skin alone, and very little of the whole system, or when the affection of the system is only symptomatica) of the external inflammation, it is erythema , but when the external inflammation is an exan thema and symptomatical of an aflection of tho whole system, he calls it erysipelas . and with](https://iiif.wellcomecollection.org/image/b21116817_0107.jp2/full/800%2C/0/default.jpg)
