§ 274. But sometimes this Malady is considerably more severe, beginning with a violent Shivering, which is succeeded by a burning Heat, a vehement Head-ach, a Sickness at Heart, as it is commonly termed, or Reachings to vomit, which continue till the Erisipelas appears, which sometimes does not happen before the second, or even the third Day. The Fever then abates, and the Sickness goes off, though frequently a less Degree of Fever, and of Sickness or Loathing remain, during the whole Time, in which the Disease is in its increasing State. When the Eruption and Inflammation happen in the Face, the Head-ach continues, until the Decline, or going off, of the Disease. The Eyelid swells, the Eye is closed, and the Patient has not the least Ease or Tranquillity. It often passes from one Cheek to the other, and extends successively over the Forehead, the Neck, and the Nape of the Neck; under which Circumstance the Disease is of a more than ordinary Duration. Sometimes also when it exists in a very high Degree, the Fever continues, the Brain is obstructed and oppressed; the Patient raves; his Case becomes extremely dangerous; whence sometimes, if he is not very judiciously assisted, he dies, especially if of an advanced Age. A violent Erisipelas on the Neck brings on a Quinsey, which may prove very grievous, or even fatal.
When it attacks the Leg, the whole Leg swells up; and the Heat and Irritation from it is extended up to the Thigh.
Whenever this Tumour is considerable, the Part it seizes is covered with small Pustules filled with a clear watery Humour, resembling those which appear after a Burn, and drying afterwards and scaling off. I have sometimes observed, especially when this Distemper affected the Face, that the Humour, which issued from these little Pustules, was extremely thick or glewy, and formed a thick Scurf, or Scabs nearly resembling those of sucking Children: they have continued fast on the Face many Days before they fell off.
When the Disease may be termed violent, it sometimes continues eight, ten, twelve Days at the same Height; and is at last terminated by a very plentiful Sweat, that may sometimes be predicted by a Restlessness attended with Shiverings, and a little Anxiety of some Hours Duration. Throughout the Progress of the Disease, the whole Skin is very dry, and even the Inside of the Mouth.
§ 275. An Erisipelas rarely comes to Suppuration, and when it does, the Suppuration is always unkindly, and much disposed to degenerate into an Ulcer. Sometimes a malignant kind of Erisipelas is epidemical, seizing a great Number of Persons, and frequently terminating in Gangrenes.
§ 276. This Distemper often shifts its Situation; it sometimes retires suddenly; but the Patient is uneasy and disordered; he has a Propensity to vomit, with a sensible Anxiety and Heat: the Erisipelas appears again in a different Part, and he feels himself quite relieved from the preceding Symptoms. But if instead of re-appearing on some other Part of the Surface, the Humour is thrown upon the Brain, or the Breast, he dies within a few Hours; and these fatal Changes and Translations sometimes occur, without the least Reason or Colour for ascribing them either to any Error of the Patient, or of his Physician.
If the Humour has been transferred to the Brain, the Patient immediately becomes delirious, with a highly flushed Visage, and very quick sparkling Eyes: very soon after he proves downright frantic, and goes off in a Lethargy.
If the Lungs are attacked, the Oppression, Anxiety, and Heat are inexpressible.
§ 277. There are some Constitutions subject to a very frequent, and, as it were, to an habitual Erisipelas. If it often affects the Face, it is generally repeated on the same Side of it, and that Eye is, at length, considerably weakened by it.
§ 278. This Distemper results from two Causes; the one, an acrid sharp Humour, which is commonly bilious, diffused through the Mass of Blood; the other consists in that Humour's not being sufficiently discharged by Perspiration.