Zoonomia; Or, the Laws of Organic Life, Vol. II

by Erasmus Darwin

There is a greater sympathy between the external skin and the meninges of the brain, than between the cellular membrane and those meninges; whence erysipelas is more liable to be preceded or attended, or succeeded, by delirium than internal phlegmons. I except the mumps, or parotitis, described below; which is properly an external gland, as its excretory duct opens into the air. When pain of the head or delirium precedes the cutaneous eruption of the face, there is some reason to believe, that the primary disease is a torpor of the meninges of the brain; and that the succeeding violent action is transferred to the skin of the face by sensitive association; and that a similar sympathy occurs between some internal membranes and the skin over them, when erysipelas appears on other parts of the body. If this circumstance should be supported by further evidence, this disease should be removed into Class IV. along with the rheumatism and gout. See Class [IV. 1. 2. 17].

This supposed retropulsion of erysipelas on the brain from the frequent appearance of delirium, has prevented the free use of the lancet early in this disease to the destruction of many; as it has prevented the subduing of the general inflammation, and thus has in the end produced the particular one on the brain. Mr. B——, a delicate gentleman about sixty, had an erysipelas beginning near one ear, and extending by degrees over the whole head, with hard, full, and strong pulse; blood was taken from him four or five times in considerable quantity, with gentle cathartics, with calomel, diluents, and cool air, and he recovered without any signs of delirium, or inflammation of the meninges of the brain. Mr. W——, a strong corpulent man of inferior life, had erysipelas over his whole head, with strong hard pulse: he was not evacuated early in the disease through the timidity of his apothecary, and died delirious. Mrs. F—— had erysipelas on the face, without either strong or weak pulse; that is, with sensitive fever alone, without superabundance or deficiency of irritation; and recovered without any but natural evacuations. From these three cases of erysipelas on the head it appears, that the evacuations by the lancet must be used with courage, where the degree of inflammation requires it; but not where this degree of inflammation is small, nor in the erysipelas attended with inirritation, as described below.

M. M. Venesection repeated according to the degree of inflammation. An emetic. Calomel three grains every other night. Cool air. Diluents, emetic tartar in small doses, as a quarter of a grain every six hours. Tea, weak broth, gruel, lemonade, neutral salts. See Sect. XII. 6.

Such external applications as carry away the heat of the skin may be of service, as cold water, cold flour, snow, ether. Because these applications impede the exertions of the secerning vessels, which are now in too great action; but any applications of the stimulant kind, as solutions of lead, iron, copper, or of alum, used early in the disease, must be injurious; as they stimulate the secerning vessels, as well as the absorbent vessels, into greater action; exactly as occurs when stimulant eye-waters are used too soon in ophthalmy. See Class [II. 1. 2. 2]. But as the cuticle peels off in this case after the inflammation ceases, it differs from ophthalmy; and stimulant applications are not indicated at all, except where symptoms of gangrene appear. For as a new cuticle is formed under the old one, as under a blister, the serous fluid between them is a defence to the new cuticle, and should dry into a scab by exhalation rather than be reabsorbed. Hence we see how greasy or oily applications, and even how moist ones, are injurious in erysipelas; because they prevent the exhalation of the serous effusion between the old and new cuticle, and thus retard the formation of the latter.

Erysipelas inirritatum differs from the former in its being attended with weak pulse, and other symptoms of sensitive inirritated fever. The feet and legs are particularly liable to this erysipelas, which precedes or attends the sphacelus or mortification of those parts. A great and long coldness first affects the limb, and the erysipelas on the skin seems to occur in consequence of the previous torpor of the interior membranes. As this generally attends old age, it becomes more dangerous in proportion to the age, and also to the habitual intemperance of the patient in respect to the use of fermented or spirituous liquor.

When the former kind, or irritated erysipelas, continues long, the patient becomes so weakened as to be liable to all the symptoms of this inirritated erysipelas; especially where the meninges of the brain are primarily affected. As in that case, after two or three efforts have been made to remove the returning periods of torpor of the meninges to the external skin, those meninges become inflamed themselves, and the patient sinks under the disease; in a manner similar to that in old gouty patients, where the torpor of the liver or stomach is relieved by association of the inflammation of the membranes of the feet, and then of other joints, and lastly the power of association ceasing to act, but the excess of sensation continuing, the liver or stomach remains torpid, or become themselves inflamed, and the patient is destroyed.

M. M. Where there exists a beginning gangrene of the extremities, the Peruvian bark, and wine, and opium, are to be given in large quantities; so as to strengthen the patient, but not to intoxicate, or to impede his digestion of aliment, as mentioned in the first species of this genus. Class [II. 1. 2. 1]. But where the brain is inflamed or oppressed, which is known either by delirium, with quick pulse; or by stupor, and slow respiration with slow pulse; other means must be applied. Such as, first, a fomentation on the head with warm water, with or without aromatic herbs, or salt in it, should be continued for an hour or two at a time, and frequently repeated. A blister may also be applied on the head, and the fomentation nevertheless occasionally repeated. Internally very gentle stimulants, as camphor one grain or two in infusion of valerian. Wine and water or small beer, weak broth. An enema. Six grains of rhubarb and one of calomel. Afterwards five drops of tincture of opium, which may be repeated every six hours, if it seems of service. Might the head be bathed for a minute with cold water? or with ether? or vinegar?

Erysipelas sensitivum is a third species, differing only in the kind of fever which attends it, which is simply inflammatory, or sensitive, without either excess of irritation, as in the first variety; or the defect of irritation, as in the second variety: all these kinds of erysipelas are liable to return by periods in some people, who have passed the middle of life, as at periods of a lunation, or two lunations, or at the equinoxes. When these periods of erysipelas happen to women, they seem to supply the place of the receding catamenia; when to men, I have sometimes believed them to be associated with a torpor of the liver; as they generally occur in those who have drank vinous spirit excessively, though not approbriously; and that hence they supply the place of periodical piles, or gout, or gutta rosea.

M. M. As the fever requires no management, the disease takes its progress safely, like a moderate paroxysm of the gout; but in this case, as in some of the former, the erysipelas does not appear to be a primary disease, and should perhaps be removed to the Class of Association.

[3]. Tonsillitis. Inflammation of the tonsils. The uncouth term Cynanche has been used for diseases so dissimilar, that I have divided them into Tonsillitis and Parotitis; and hope to be excused for adding a Greek termination to a Latin word, as one of those languages may justly be considered as a dialect of the other. By tonsillitis the inflammation of the tonsils is principally to be understood; but as all inflammations generally spread further than the part first affected; so, when the summit of the windpipe is also much inflamed, it may be termed tonsillitis trachealis, or croup. See Class [I. 1. 3. 4]. and [II. 1. 2. 4].; and when the summit of the gullet is much inflamed along with the tonsil, it may be called tonsillitis pharyngea, as described in Dr. Cullen's Nosologia, Genus X. p. 92. The inflammation of the tonsils may be divided into three kinds, which require different methods of cure.