Sydenham reckons the Essera (which see) among species of erysipelas.

Erysipelas should be distinguished from the plague, and from inflammations of different kinds that appear on the skin.

When erysipelas approaches suddenly, but with little disturbance, and attacks a person with a good habit; and when no important parts are affected, there is little danger. Sometimes a convulsive disease, as an asthma, or colic, hath been relieved by the approach of erysipelas externally. Danger is very considerable when this disorder is deeply seated, fixed on the brain or lungs, and the habit of body weak; in some debilitated constitutions this disorder leaves a swelling in the foot or ankle, both troublesome and difficult to remove. By bad management it is easily and soon rendered fatal; and frequent returns denote a disordered liver or gall bladder: when seated in the face, and drowsiness attends it, there is danger of a phrenitis, or of a lethargy: when it seizes the breast, particularly of women in child bed, or who give suck, an abscess is often the consequence: if the nostrils and mouth are dry, and the patient is drowsy, an inflammation of the brain of a similar kind is to be suspected. It is generally fatal within the seventh day; and to those who are often seized with this disease' it at last proves fatal.

The causes of erysipelas are the same with those of all febrile cutaneous complaints, an acrimonious discharge, stopped by the cuticle, and exciting inflammation on the skin. The matter is, however, in a larger quantity, and seemingly more fluid than the virus of any other exanthema. It flows with considerable vapidity, very copiously between the cuticle and cutis, elevating the former, and occasionally arising in pustules. At the same time, it is not naturally of a kind to excite active inflammation; but is rather the effect r?f diminished power of the vessels, for it is a disease to which persons who have lived long in a warm climate are peculiarly subject. It is owing to the effusion of a fluid similar to that thrown out when the tone of the vessels has been destroyed by violent previous excitements, as in burns, from continued cold, as in chilblains, or from the application of sedative poisons. It sometimes, indeed, in cold regions and inflammatory constitutions, suppurates properly; but more often produces a foul ulcer, with tendency to gangrene. We have four times seen it epidemic; and more than once we have had reason to suspect that it was communicated by infection.

Ir sometimes appears in a more chronical form, and often returns at regular periods in broken constitutions. It does not then appear to be a salutary deposition, though it has not been thought expedient to prevent its recurrence. To support the strength and regulate the of the perspiration, are the best means of at least avoiding considerable danger from it.

In erysipelas the diet should be mild: roasted apples may be eaten freely; the drink may be whey, barley water, small beer, water gruel, or, if the pulse sinks, small negus may be allowed. The patient should keep out of the bed during some hours in the day; and equal care should be taken to guard against the extremes of heat and cold. In the slighter cases, perspiration may be kept up with frequent draughts of camomile or of eider flower tea, acidulated with the spiritus febrifugus of Clutton, or with other cooling diaphoretics. If the face and head be affected, gentle but repeated purging is useful, and it should be continued until all danger seems to be alleviated. But if the pulse is strong and hard, the patient may be bled, and this evacuation repeated as the fever and his strength indicate. Whenever the head is much affected, numerous and repeated blisters must be applied: we have found four large ones scarcely sufficient to deplete the vessels of the brain. The bowels may be kept soluble by means of cream of tartar, whey, tamarinds, etc. Dr. Freind observes, that when the head is affected, purges are the best remedies, and they undoubtedly are so; but it should be added, that sinapisms may be also applied with singular advantage to the soles of the feet.

When the external inflammation recedes, the disease must be treated as an internal inflammation of the part affected, not of the active kind; for when the pulse is low, cordials and the warmer perspiratives are necessary; and wine often an essential remedy.

From the nature of this disease, and from the peculiarities in the skins of different persons, much caution is required in the application of external remedies. When the scarf skin is raised in blisters, and the serum begins to transude, absorbing powders, such as chalk finely powdered, or fine flour, may be sprinkled slightly over the inflamed part. In every period of the disease, some fluid exudes, and these applications are useful. Watery fluids are injurious, and saturnine applications, unless used with prudence and caution, dangerous; yet Goulard's solution has been sometimes, it is said, employed with advantage.

The symptoms of a suppuration will sometimes come-on, but this process should be by no means encouraged. The abscess will be deep, foul, and difficult to heal.

If a gangrene is threatened, besides the inward use of camphor and the bark, spirituous and astringent applications should be employed externally, such as mixtures of lime water with camphorated spirit, or camphorated spirit mixed with tincture of myrrh, or an infusion of the bark.

Erysipelas is sometimes of the nervous or low kind; appearing with a puffy redness in the skin instead of a swelling; the pain is more acute, but the throbbing of, the vessels less; no circumscribed tumours appear, but the parts are more inflamed: at the decline of the disease, the redness of skin becomes of a purple hue;it is very liable to terminate in a mortification; the habit from the first, and throughout, is very irritable, and the strength depressed. It is generally accompanied with cardialgia, itching, inflammation of the skin, painful ulcerations, and small lucid pustules.

In some strong habits, both a phlegmonous and the low erysipelatous inflammation attend together; in which case, a moderate evacuation of blood may be allowed, but should be cautiously attempted. If the patient labours under great depression of strength, irritability, etc. we must support his strength with wine, and the warmest cordials; when blisters arise, the bark may be freely given, from 3 vi. to i. or more if the stomach will bear it, in twenty-four hours. When the eruption is apparently complete and the pustules ripened, snip the blisters, and absorb the fluid with soft rag; then apply the unguent.spermatisceti,orung. lapi-dis calaminaris. See Sydenham; Heister's Institutions of Surgery, p. i. lib. iv. c. vi. p. 290; Cullen's First Lines, edit. 4. vol. ii.; Kirkland's Medical Surgery, vol. i. p. 329, 404; Pearson's Principles of Surgery, vol. i. p. 173; and White's Surgery, p. 12.

Erysipelas bullatum, and inflammatorium. See Oedema erysipelatoides.

Erysipelas curans arbor. See Malleamothe.

Erysipelas infantilis. Erysipelas of infants was first noticed by Dr. Underwood, who calls it anomalous inflammation; though he speaks of infants being liable to erysipelatous inflammation.

It never appears after the month, but most frequently shows itself a few days after birth; and children are sometimes born with it: in a few instances it is preceded by jaundice or a locked jaw. It attacks suddenly the most robust as well as delicate children, and its progress is rapid; the skin turns of a purplish hue, and soon becomes very hard.

The milder species appears often on the fingers and hands, or the feet and ankles, and sometimes upon or near the joints, suppurating quickly. The more violent kind is almost always seated about the pubes, extending; upwards on the belly, and down the thighs and legs; though it sometimes begins in the neck. The swelling is moderate; but after becoming hard, the parts turn purple, and very often sphacelate; especially in boys, when it falls onthe scrotum. The penis then swells, and the prepuce appears emphysematous as in children when a stone sticks in the urethra.

Osiander seems to connect it with the epidemic constitution; and remarks, that when it appeared, puerperal fevers of a bilious or rheumatic kind were common. The danger is less in proportion to the extent of the inflammation.

Various means have been used with little success; though for a time benefit was apparently received from saturnine fomentations and poultices, applied on the very first appearance of the inflammation: but it soon spread, and a gangrene came on. When matter is formed, the tender infant soon sinks under the discharge. The bark, with a small portion of the confcctio aromatica, sometimes succeeds. Dr. Garthshore has recommended the application of linen compresses wrung out of camphorated spirit of wine, in the place of the vegeto-mineral water, which has proved successful in some instances; though the greatest number of infants, attacked with this disorder, still sink under its violence, and many of them in a very few days.

Professor Hufeland recommends evacuating the alimentary canal and stomach, giving afterwards diaphoretics and antispasmodics, particularly valerian and the calx of zinc. Bark and camphor he only advises when mortification threatens; and saturnine applications are, he thinks, dangerous. See Underwood on the Diseases of Children; Bromfield in the Medical Commentaries; Osiander's Essays on Physic and Midwifery; Hufeland's Observations on the Erysipelas of new born Children; and Gertanner's Memoir.

Erysipelas pulmonis Lommii. See Inflammatio Cordis.