Erysipelas of the face usually begins with symptoms of general illness,
the patient feeling languid, drowsy and sick, while frequently there is
a distinct rigor followed with fever. Sore throat is sometimes felt, but
in general the first indication of the local affection is a red and
painful spot at the side of the nose or on one of the cheeks or ears.
Occasionally it would appear that the inflammation begins in the throat,
and reaches the face through the nasal fossae. The redness gradually
spreads over the whole surface of the face, and is accompanied with
swelling, which in the lax tissues of the cheeks and eyelids is so great
that the features soon become obliterated and the countenance wears a
hideous expression. Advancing over the scalp, the disease may invade the
neck and pass on to the trunk, but in general the inflammation remains
confined to the face and head. While the disease progresses, besides the
pain, tenderness and heat of the affected parts, the constitutional
symptoms are very severe. The temperature rises often to 105 deg. or
higher, remains high for four or five days, and then falls by crisis.
Delirium is a frequent accompaniment. The attack in general lasts for a
week or ten days, during which the inflammation subsides in the parts of
the skin first attacked, while it spreads onwards in other directions,
and after it has passed away there is, as already observed, some slight
desquamation of the cuticle.
Although in general the termination is favourable, serious and
occasionally fatal results follow from inflammation of the membranes of
the brain, and in some rare instances sudden death has occurred from
suffocation arising from oedema glottidis, the inflammatory action
having spread into and extensively involved the throat. One attack of
this disease, so far from protecting from, appears rather to predispose
to others. It is sometimes a complication in certain forms of exhausting
disease, such as phthisis or typhoid fever, and is then to be regarded
as of serious import. A very fatal form occasionally attacks new-born
infants, particularly in the first four weeks of their lives. In
epidemics of puerperal fever this form of erysipelas has been specially
found to prevail.
The treatment of erysipelas is best conducted on the expectant system.
The disease in most instances tends to a favourable termination; and
beyond attention to the condition of the stomach and bowels, which may
require the use of some gentle laxative, little is necessary in the way
of medicine. The employment of preparations of iron in large doses is
strongly recommended by many physicians. But the chief point is the
administration of abundant nourishment in a light and digestible form.
Of the many local applications which may be employed, hot fomentations
will be found among the most soothing. Dusting the affected part with
powdered starch, and wrapping it in cotton wadding, is also of use.
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