Commentary. Hippocrates in his ‘Prognostics’ has stated the danger of an erysipelas being translated to an internal part. He also states that gangrene supervening upon erysipelas is dangerous. He has not, however, given any very particular account of the disease. In one of his aphorisms he states that cold is useful in erysipelas when not ulcerated, but prejudicial when it is ulcerated. His commentators, Theophilus and Damascius, confirm this statement. (Scholia in Hip. et Galen, ii, 456).
Celsus recommends bleeding if the strength permit, and then repellent and refrigerant applications, especially ceruse with the juice of solanum (nightshade), or Cimolian earth with river water, and the like. When refrigerants fail to produce the effect, sulphur, ceruse, and saffron are to be pounded with wine and applied. If the part become putrid he directs us to use corrosive applications or the actual cautery. Afterwards the sore is to be cleansed with honey and rosin, and treated upon general principles.
We have stated in [the preceding Section] that the ignis sacer of Scribonius Largus is not herpes. That it was erysipelas seems probable from the similarity between his applications for it and those which Celsus and the other authorities recommend for erysipelas. Thus for ignis sacer he recommends Cimolian chalk, diluted with the juice of solanum, or the solanum by itself, or with bread; or a mixture of sulphur vivum, ceruse, and litharge.
We may remark further in this place that the ignis sacer, or St. Anthony’s fire of the middle ages, would appear to have been some variety of erysipelas.
Galen’s account of erysipelas is particularly deserving of attention. In the 14th Book of his ‘Meth. Med.,’ he is at pains to state the nature of the disease, and the difference between it and phlegmon. The common symptoms of both are heat and swelling. But they differ, first and principally in colour, which is red in phlegmon, but pale or yellow, or a compound of both, in erysipelas. Throbbing is also a characteristic symptom of a great phlegmon, for it is deep-seated, whereas erysipelas is rather in the skin. Erysipelas, he pointedly inculcates, is occasioned by a bilious humour. This humour being thin, readily passes the fleshy and rare parts, and flows to the skin, where, unless it be particularly watery, it is unable to pass the pores, and, consequently, is retained. When things, indeed, are in their natural state, this bitter bile passes through the pores of the skin by the insensible perspiration, but when it is either too abundant or thicker than usual, it is retained by the skin, which it inflames and causes to swell: hence the reason why erysipelas chiefly affects the skin or the prolongation of it which lines the internal cavities. He states that the great indication of cure is refrigeration or cooling, but that there is danger of carrying this plan too far, lest the humour should be driven to some vital part: wherefore cooling applications are to be used until the part change its colour, but are not to be continued until it become black or livid. It is necessary, therefore, as soon as a change of colour in the affected part is remarked, to exchange them for those of a contrary nature. His cooling applications consist of strychnos (solanum?) and the other articles mentioned by our author. When the part becomes livid, he directs us to make incisions, and afterwards to apply cataplasms and fomentations with hot water, to which salt or vinegar may sometimes be added. It is only at this time that quicklime may safely be added to the applications; for it would prove highly prejudicial at first. With respect to the general treatment, he approves strongly of cholagogues, but does not think bleeding necessary in ordinary cases. When erysipelas arises from ulcers or any obvious causes, he recommends scarifications and cataplasms of barley flour. He recommends much the same plan of treatment in his ‘Therapeut. ad Glauc.’ ii. He speaks highly of early incisions.
Aëtius, as he professes, merely copies from Galen.
Oribasius recommends, at first, such things as are cooling without astringency; namely, henbane, nightshade, &c. When the inflammation subsides, he directs us, before the part becomes livid, to apply a cataplasm of barley flour; but when it does become livid, he recommends free incisions, and afterwards cataplasms and fomentations with fresh water, or water with salt and brine.
Actuarius states the danger of carrying refrigerant and repellent applications too far, and recommends something discutient to be added to them.
Octavius Horatianus approves of bleeding (unless contra-indicated by the want of strength), and of cholagogues, with free incisions and fomentations.
Avicenna states that bleeding in general does no good, unless the humour be seated between the two skins. He approves most of cholagogues and of applications strongly refrigerant; only he cautions us not to carry this plan too far, lest the disease be determined to an internal part, or terminate in gangrene.