MEDICINE.——In this disease much mischief is often done by medicine, especially by external applications. People, when they see an inflammation, immediately think that something ought to be applied to it. This indeed is necessary in large phlegmons; but in an erysipelas the safer course is to apply nothing. Almost all ointments, salves, and plasters, being of a greasy nature, tend rather to obstruct and repel, than promote any discharge from the part. At the beginning of this disease it is neither safe to promote a suppuration, nor to repel the matter too quickly. The erysipelas in many respects resembles the gout, and is to be treated with the greatest caution. Fine wool, or very soft flannel, are the safest applications to the part. These not only defend it from the external air, but likewise promote the perspiration, which has a great tendency to carry off the disease. In Scotland the common people generally apply a mealy cloth to the parts affected, which is far from being improper.
It is common to bleed in the erysipelas; but this likewise requires caution. If however the fever be high, the pulse hard and strong, and the patient vigorous, it will be proper to bleed; but the quantity must be regulated by these circumstances, and the operation repeated as the symptoms may require. If the patient has been accustomed to strong liquors, and the disease attacks his head, bleeding is absolutely necessary.
Bathing the feet and legs frequently in lukewarm water, when the disease attacks the face or brain, has an excellent effect. It tends to make a derivation from the head, and seldom fails to relieve the patient. When bathing proves ineffectual, poultices, or sharp sinapisms, may be applied to the soles of the feet, for the same purpose.
In cases where bleeding is requisite, it is likewise necessary to keep the body open. This may be effected by emollient clysters, or small doses of nitre and rhubarb. Some indeed recommend very large doses of nitre in the erysipelas; but nitre seldom sits easy on the stomach when taken in large doses. It is however one of the best medicines when the fever and inflammation run high. Half a drachm of it, with four or five grains of rhubarb, may be taken in the patient’s ordinary drink, four times a day.
When the erysipelas leaves the extremities, and seizes the head so as to occasion a delirium or stupor, it is absolutely necessary to open the body. If clysters and mild purgatives fail to have this effect, stronger ones must be given. Blistering plasters must likewise be applied to the neck, or behind the ears, and sharp cataplasms laid to the soles of the feet.
When the inflammation cannot be discussed, and the part has a tendency to ulcerate, it will then be proper to promote suppuration, which may be done by the application of ripening poultices with saffron, warm fomentations, and such like.
When the black, livid, or blue colour of the part shews a tendency to mortification, the Peruvian bark must be administered. It may be taken along with acids, as recommended in the small-pox, or in any other form more agreeable to the patient. It must not however be trifled with, as the patient’s life is at stake. A drachm may be given every two hours, if the symptoms be threatening, and cloths dipped in warm camphorated spirits of wine, or the tincture of myrrh and aloes, may be applied to the part, and frequently renewed. It may likewise be proper in this case to apply poultices of the bark, or to foment the part affected with a strong decoction of it.
In what is commonly called the scorbutic erysipelas, which continues for a considerable time, it will only be necessary to give gentle laxatives, and such things as purify the blood and promote the perspiration. Thus, after the inflammation has been checked by opening medicines, the decoction of woods[[104]] may be drank, after which a course of bitters will be proper.
Such as are liable to frequent attacks of the erysipelas ought carefully to guard against all violent passions; to abstain from strong liquors, and all fat, viscid, and highly nourishing food. They should likewise take sufficient exercise, carefully avoiding the extremes of heat or cold. Their food should consist chiefly of milk, and such fruits, herbs, and roots, as are of a cooling quality; and their drink ought to be small-beer, whey, butter-milk, and such like. They should never suffer themselves to be long costive. If that cannot be prevented by suitable diet, it will be proper to take frequently a gentle dose of rhubarb, cream of tartar, the lenitive electuary, or some other mild purgative.