Erysipelas, of a contagious and violent character, frequently occurs,
and is apt to spread extensively, in badly aired situations, where
a number of patients with sores are crowded together, without due
attention being paid to cleanliness and proper dressing.
_Hospital Erysipelas_, as this species is termed, is nearly allied to
that dreadful disease, Hospital Gangrene, and the two affections are
often blended. It comes on after operations, or in patients who have
sustained an external injury by accident. In unhealthy hospitals it
not unfrequently appears in previously sound parts, and without any
assignable cause; and, from its following the slightest wound, recourse
cannot be had with safety even to venesection, cupping or leeching.
It is a dreadful scourge in many hospitals, more especially during
particular seasons of the year—during hot, damp weather, and in spring
and autumn, attacking the patients indiscriminately.
Of late years Erysipelas appeared in the Royal Infirmary of Edinburgh,
during the wet and changeable summers which prevailed; some of the
cases were very severe, and a few terminated fatally. It was very
satisfactory, however, to observe that it did not spread as it used
to do formerly, that patients occupying the beds immediately around
those affected, though afflicted with sores and in indifferent health,
remained exempt from the disease; and that many of the most severe
cases did not originate in the house, but were brought from the crowded
and unhealthy parts of the city. The same may be said of the disease as
it has shown itself in the North London Hospital since it was opened
for the reception of patients up to the present time.
Hospital Erysipelas is for the most part preceded by violent
constitutional symptoms, derangement of the chylopoietic viscera,
shivering, brown tongue, and a bitter taste in the mouth; if there
is a sore on the body, it assumes a sloughy aspect; the surrounding
skin becomes of a dark red colour, and there is a feeling of tension,
accompanied with a burning pain. The erysipelas extends rapidly, and
generally terminates in suppuration and sloughing of the cellular
substance, or, if inertly treated, in immediate gangrene of the parts.
The concomitant fever is generally low, and though, in the first
instance, the circulation may be vigorous, symptoms of debility will
speedily appear. It will be more fully dwelt upon, along with Hospital
Gangrene.
In all cases of erysipelas there is more or less concomitant
fever, modified by the extent of the local affection—by the age
of the patient—by the previous habits and state of health—by the
constitution—and by other circumstances. The pulse is accelerated, and
is either of a sthenic or asthenic character, according to the state
of the system and type of the prevailing fever. There is headache,
languor, thirst, restlessness, and even delirium, especially when the
face or scalp is the seat of the disease.
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