=Definition.=—An acute, infectious, specific disease, characterized
by a peculiar inflammation of the skin, due to the streptococcus
erysipelatis, with a tendency to spread.
=Osteopathic Etiology= and =Pathology=.—Osteopathically, lesions are
found to the vasomotor nerves and lymphatics of the affected area. Dr.
Still gives lesions of the “inferior maxilla, the cervical vertebræ,
the clavicles or the upper ribs” as specially important factors.
These lead to congestion and predispose to infection. It occurs in
epidemic form, especially in the late winter and spring. One attack
predisposes to a second. Family predisposition exercises a slight
influence. Abrasions, lacerated wounds, especially of the scalp, may
be the starting point of an attack. Persons having skin diseases and
wounds, and women who have been recently delivered are liable to be
affected. Chronic Bright’s disease, chronic alcoholism, syphilis,
debility, phthisis, organic heart disease and unhygienic surroundings
are predisposing causes.
The specific virus is the streptococcus erysipelatis, which acts as a
local irritant producing the dermatitis. These are found in the lymph
vessels and cutaneous connective tissue. The fever and constitutional
symptoms are due to toxic agents.
It is an inflammation of the skin, and if uncomplicated, no other
structures are involved. Subcutaneous and mucous tissues may be
involved, but rarely; if so, there is apt to be suppuration. Visceral
complications are of a septic character. Endocarditis, pericarditis,
pleuritis-pneumonia, and nephritis are possible complications.
=Symptoms.=—The incubation period varies from two to seven days. The
onset is generally sudden with chill, followed by fever, 104 or 105
degrees F. There may be nausea, headache, and pain in the back and
limbs. The local inflammation of the skin follows, usually on cheeks
and bridge of nose, or at site of an abraded surface. The area is red,
smooth, and edematous. It spreads rapidly, the patch being elevated
above the surrounding tissue and tense. The swelling may be so great
as to close the eyes and distort the features. The cervical glands are
swollen. The temperature continues high for four or five days and falls
by crisis. The eruption begins to subside and a moderate desquamation
occurs. If the disease takes a fresh start the fever again rises and
continues as long as the disease spreads. There is usually headache
and sometimes delirium. The tongue is furred, and bowels constipated
and the urine scanty. As a result of intense infiltration the part may
become gangrenous. Suppuration frequently occurs in facial erysipelas.
The inflammation may extend to the mucous membrane of the throat and
mouth.
=Diagnosis.=—This is not difficult. The fever, the acuteness of the
disease, the rapidily spreading eruption, and the constitutional
disturbances will serve to distinguish it from all others.
=Prognosis.=—This is usually favorable; healthy persons rarely die.
Convalescence may be slow.
=Treatment.=—Isolate the patient for the disease is contagious, and a
third person may convey the virus. The poison may cling to clothing,
furniture, etc. The physician should not take care of confinement cases.
A number of cases of erysipelas have been cured by correcting disorders
in the region of the second, third, fourth and fifth dorsals. The
lesions are principally subluxations of the ribs and severely
contracted muscles. The disorder at the points named interferes with
the vasomotor nerves to the face, thus predisposing to an attack of
erysipelas by allowing the micro-organism congenial tissue for its
devastations. In many other cases derangements have been found higher
than the upper dorsal, principally through the middle and upper
cervical vertebræ. Lesions in these regions would also interfere with
vasomotor fibres, especially through the fifth nerve directly.
The treatments on the whole are to examine for lesions to the
innervation of the affected region and remove them, besides giving
special attention to the bowels, a nutritious diet, and absolute rest.
In cases where there is much restlessness and insomnia, treat the upper
cervical region, especially the deep posterior muscles[57]. Locally,
use cold water applications; adhesive strips applied near the inflamed
area or tincture of iodine, may prevent the disease spreading.