§ 279. When this Disease is of a gentle Nature, such as it is described [§ 273], it will be sufficient to keep up a very free Perspiration, but without heating the Patient; and the best Method to answer this Purpose is putting him upon the Regimen so often already referred to, with a plentiful Use of Nitre in Elder Tea. Flesh, Eggs and Wine are prohibited of Course, allowing the Patient a little Pulse and ripe Fruits. He should drink Elder Flower Tea abundantly, and take half a Drachm of Nitre every three Hours; or, which amounts to the same Thing, let three Drachms of Nitre be dissolved in as much Infusion of Elder Flowers, as he can drink in twenty-four Hours. Nitre may be given too in a Bolus with Conserve of Elder-berries. These Medicines keep the Body open, and increase Urine and Perspiration.
§ 280. When the Distemper prevails in a severer Degree, if the Fever is very high, and the Pulse, at the same Time, strong or hard, it may be necessary to bleed once: but this should never be permitted in a large Quantity at a Time in this Disease; it being more adviseable, if a sufficient Quantity has not been taken at once, to bleed a second Time, and even a third, if the Fever should prove very high, as it often does, and that sometimes in so violent a Degree, as to render it extremely dangerous: and in some such Cases Nature has sometimes saved the Patients by effecting a large Hemorrhage, or Bleeding, to the Quantity of four or five Pounds. This Conduct a very intelligent and prudent Physician may presume to imitate; but I dare not advise the same Conduct to that Class of Physicians, for which only I write: it being safer for them to use repeated Bleedings in such Cases, than one in an excessive Quantity. These erisipelatous Fevers are often excited by a Person's being too long over-heated.
After Bleeding the Patient is to be restrained to his Regimen; Glysters are to be given until there is a sensible Abatement of the Fever; and he should drink the Barley Water freely, [Nº. 3].
When the Fever is somewhat diminished, either the Purge [Nº. 23] should be given, or a few Doses every Morning of Cream of Tartar [Nº. 24]. Purging is absolutely necessary to carry off the stagnant Bile, which is generally the first Cause of the violent Degrees of this Distemper. It may sometimes be really necessary too, if the Disease is very tedious; if the Loathing and Sickness at Stomach is obstinate; the Mouth ill-favoured, and the Tongue foul, (provided there be only a slight Fever, and no Fear of an Inflammation) to give the Medicines [Nº. 34] or [35], which, in Consequence of the Agitation, the Shaking they occasion, remove these Impediments still better than Purges.
It commonly happens that this Disease is more favourable after these Evacuations; nevertheless it is sometimes necessary to repeat them the next Day, or the next but one; especially if the Malady affects the Head. Purging is the true Evacuation for curing it, whenever it attacks this Part. By carrying off the Cause of the Disease, they diminish it, and prevent its worst Effects.
Whenever, even after these Evacuations, the Fever still continues to be very severe, the Patient should take every two Hours, or occasionally, oftner, two Spoonfuls of the Prescription [Nº. 10], added to a Glass of Ptisan.
It will be very useful, when this Disease is seated in the Head or Face, to bathe the Legs frequently in warm Water; and where it is violent there, also to apply Sinapisms to the Soles of the Feet. I have seen this Application, in about four Hours attract, or draw down an Erisipelas to the Legs, which had spread over the Nose, and both the Eyes. When the Distemper once begins to go off by Sweating, this should be promoted by Elder-flower Tea and Nitre (See [§ 279]) and the Sweating may be encouraged to Advantage for some Hours.
§ 281. The best Applications that can be made to the affected Part are 1st, The Herb Robert, a Kind of Geranium, or Crane's-Bill; or Chervil, or Parsley, or Elder Flowers: and if the Complaint be of a very mild Disposition, it may be sufficient to apply a very soft smooth Linen over it, which some People dust over with a little dry Meal.
2, If there is a very considerable Inflammation, and the Patient is so circumstanced as to be very tractable and regularly attended, Flanels wrung out of a strong Decoction of Elder-flowers and applied warm, afford him the speediest Ease and Relief. By this simple Application I have appeased the most violent Pains of a St. Anthony's Fire, which is the most cruel Species of an Erisipelas, and has some peculiar Marks or Symptoms extraordinary.
3, The Plaister of Smalt, and Smalt itself [Nº. 46], are also very successfully employed in this Disease. This Powder, the farinaceous, or mealy ones, or others cried up for it, agree best when a thin watery Humour distills or weeps from the little Vesications attending it, which it is convenient to absorb by such Applications; without which Precaution it might gall, or even ulcerate the Part.