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Yol. IV. 
ST. LOUIS, MO., AUGUST, 1891. 
No. 8. 
Confinement Closely Following Erysipelas.* 
Report op a Case, with Some Remarks on Symptomatology, Etiology and 
Treatment. 
EARNEST JOSErii LUTZ, M.D. 
Gentlemen :—In selecting my theme 
of confinement following an attack of 
erysipelas of the face and skull, I am 
prompted to report to the honorable fra- 
ternity a case which came under my ob- 
servation only four weeks ago, and as 
the time is limited to only twenty min- 
utes, I will relate the case as briefly as 
possible as it came before me. 
Mrs. M., set. 32, German desc., multi- 
para, called me on April 30th, at 10 
o’clock p. m. Upon my arrival I found 
the following condition : Fever 104.5 F., 
pulse 125, accelerated and bounding, res- 
piration increased, tongue moist and cov- 
ered with a white fur. Her face pre- 
sented a peculiar flush, involving the 
upper lip, nose, both cheeks and ears, 
right eye and some of the portions over 
the frontal and temporal bones. The 
oedematous infilitration was especially 
marked about the right eyelid, disfig- 
uring the patient in such a degree as to 
render her unrecognizable. Acute head- 
ache, inflammation of the throat, general 
malaise, accompanied with constipation 
and scanty elimination of urine, were 
some of the subjective symptoms present. 
The swelling of both ears resulted in dif- 
ficult hearing, while the infilitration of 
the nasal cavities brought about oral 
breathing. 
* lie ad before the Wyandotte County Medical 
Society. 312 
CONFINEMENT CLOSELY FOLLOWING ERYSIPELAS. 
Inquiring into the history of the pa- 
tient, I found, besides the above men- 
tioned symptoms, that the lady had re- 
ceived a previous wound in the right 
nostril from her fingernail, at which 
point the disease showed itself first, 
starting as a red, rose-colored spot on 
the right ala over the depressor aim nasi 
and the junction of the lavator labii su- 
perioris alseque nasi muscles, spreading 
very rapidly to above named portions of 
the face and skull. 
About thirty-six hours before the spot 
made its appearance, the patient had 
several chills, quickly followed by py- 
rexia, confusion of intellect and nausea. 
I diagnosed the case erysipelas faciei. 
The lady further stated to me that she 
expected to be confined at any time, which 
latter fact horrified me, having learned 
through experience and statistics that the 
prognosis in such cases would be an un- 
favorable one. It therefore placed me 
on the alert, and I watched the case with 
double interest and utmost care. Being 
a young physician, I felt that my future 
success might be seriously imperiled 
were my apprehensions to be verified. 
But at the same time, having sufficient 
confidence in my teaching, I endeavored 
to do my best, instituting at once vigor- 
ous constitutional and local treatment 
combined with hygienic measures. 
To lower the temperature, to promote 
rapid absorption of the infilitrated tissues 
and to relieve the intense pain, I gave— 
Antikamnia 5 j 
Spirits Frumenti § iv 
M. Sig.:—Tablespoonful every two to 
three hours. 
Fluid Extract Pilocarpi was admin- 
istered in full doses every one, two 
or three hours, to act upon the secre- 
tory and excretory glands. Know- 
ing the emmenagogue properties which 
Tinctura Ferri Chlor. and Quini. Sul- 
phas sometimes possess, those remedies 
were, in my mind, not indicated, and 
so 'Omitted, but I should, under other 
circumstances, have held them in high 
esteem. 
The constipation was relieved by an 
enema consisting of soap-suds, and the 
bowels were kept open by mild aperi- 
ents during the entire course of the der- 
matitis. To support the strength of the 
patient and diminish the febrile move- 
ment, I ordered Spirits Frumenti to be 
taken ad libitum, but not using more 
than one pint daily. 
After washing her thoroughly with 
soap and water, I applied over the whole 
affected surface (except skull), with a 
camel’s hair brush, some of the following 
mixture : 
Collodii 5 xj 
01. Ricini 5 v 
Hydragr. Biclilor. Corros... gr. j 
M. 
This forming a complete protection, 
being also elastic, gave the required sup- 
port to the swollen parts. Not only con- 
sidering it valuable for its already speci- 
fied effects, I added the Bichloride of 
Mercury for its antiseptic properties, and 
was not misled in m}r expectations. Upon 
the affected portions of the skull, a solu- 
tion of Ferrum Sulphas was applied on 
compresses kept constantly wet. (The 
solution consisted of three and one-half 
drachms of the salt to the pint of water.) 
This treatment was highly recommended 
by M. Velpeau, the great French Sur- 
geon, who tried the remedy 
in forty cases, cutting the disease short 
in from thirty-six to forty-eight hours in 
almost every instance. (U. S. Dispensa- 
tory, page 685, fifteenth edition.) CONFINEMENT CLOSELY FOLLOWING ERYSIPELAS. 
313 
Called again May 1st, at 11 a. m.,when 
I found the patient seemingly improved. 
Temperature 101.5 F., pulse 96, respira- 
tion almost normal. The temperature I 
found rising and falling from 100 to 104.5 
F. during the entire course of the disease. 
The above named treatment was con- 
tinued right along until the seventh day, 
when all at once labor set in. The lady 
had a so-called easy time, with only eight 
to ten regular pains, terminating in the 
birth of a healthy-looking baby. 
Once more I insisted on the utmost 
care and cleanliness toward mother and 
child, ordering a linen rag dipped into 
a 1 to 1,000 solution of Hydrarg. Bi-chlor. 
Corros. (using Dr. Bernay’s antiseptic 
tablets), to be applied over the outer sur- 
face of the mother’s genital organs, and 
renewed every hour or two. For the 
child likewise, I directed a compress of 
a somewhat weaker solution, to be ap- 
plied over the umbilicus. 
Mother and child seemingly were doing 
well, although in the former there was a 
rise in temperature and elevated pulse 
for the first and part of the second da}’, 
noticeable. When I called at that time, 
the lady complained of headache and 
uneasiness ; the eyes were sparkling, 
pulse being 108, the thermometer regis- 
tering 103 F., and meteorism being pres- 
ent. Upon digital examination I detected 
great heat and tenderness in both iliac 
fossae, extending upward to the uterus, 
which latter was soft and flabby ; the 
lochia was decided 1}T offensive. 
This condition leading me to the fol- 
lowing treatment: Antikamnia in five 
grain doses every three hours for its 
antipyretic effects, and 
Potassi Chloratis § ss 
Aquae Bullientis § iv 
M. Sig.:—Teaspoonful every two to 
three hours. 
The medical properties of the potash 
in this case I cannot explain fully as yet. 
But it is taught that under the use of 
this drug all the blood of the body be- 
comes florid, as it was long supposed that 
the salt acts upon the as an oxid- 
izing agent. Dr. Moorehead, of Keokuk, 
Iowa, called my attention to this drug 
about two years ago, stating the fact that 
he met with the best of success in simi- 
lar cases, and in all cases of retained 
placenta or puerperal fever, and such 
statement was verified in six of my own 
cases, which happened during my stay 
with Dr. Lambert last summer. The 
latter gentleman has one case on hand at 
present, on which he has used the same 
treatment with excellent results. 
Besides the internal medication, I used 
uterine and vaginal irrigations of a 1 to 
1,000 and 1 to 500 solution of Creoline, 
respectively. The former was executed 
twice daily with an uterine irrigator by 
myself, the latter done every two hours 
by the nurse. 
Visited the patient again the same 
evening, and found her resting well, but 
pulse and temperature the same as in the 
morning. 
The before-mentioned treatment was 
kept up for the next four da}rs following, 
when the patient felt about normal, al- 
though weak, and fearing no more dan- 
ger, I did away with the internal and 
external treatment gradually. The lady 
never complained of any other symptoms 
afterward, and to-day she is up and about 
again. 
Looking over the statistics, I found 
one similar case recorded in Ashhurst’s 
International Encyclopaedia of Surgery, 
Vol. I, page 174. It says : “In 1857, Dr. 
Duncan, of York, Pa., related a case of a 
lady in whom an attack of puerperal fever 314 
CONFINEMENT CLOSELY FOLLOWING ERYSIPELAS. 
occurred simultaneously with erysipelas 
of the face, while her infant suffered from 
erysipelas of the umbilicus.” Regarding 
this statement as incomplete as to the 
result, I thought it a warning in my case, 
and therefore instituted vigorous treat- 
ment on the part of the lady as well as 
on the baby. 
Below I will give a table showing the 
temperature, pulse, respiration, specific 
gravity and condition of urine on the 
different days : 
was low, only traces of albumen were 
found, and as the temperature increased, 
so likewise the quantity of albumen in- 
creased and specific gravity lessened. 
Now the question in my mind arises. 
What was the cause of the erysipelas? 
Certainly in many cases erysipelas of the 
face follows exposure to cold, but how 
far cold maj7 be regarded as an essential 
cause, I cannot say. In the same man- 
ner, cachectic conditions favor the devel- 
opment of the disease, but probably only 
by lessening resistance to the morbid 
poison on which the disease more di- 
rectly depends, and it would seem that 
albuminuria, in a special manner, consti- 
tutes such a predisposition. 
Albuminuria generally occurs in preg- 
nant women ; transient albuminuria of 
pregnant women disappears about the 
eighth month of pregnancy, and is ac- 
companied by no kidney change ; but if 
albumen is persistent in varying quan- 
tity in women who are far advanced in 
pregnancy, it generally constitutes a 
disease. 
Summing up my report with the idea 
that erysipelas in this particular case 
was due to a certain predisposition, which 
latter was facilitated by the persistent 
albuminuria, I leave it to the medical 
profession to settle this fact in their own 
mind. 
I thank you for your kind attention. 
Concordia, Mo. 
Month, 
e+ 
5. 
>> 
a 
fi 
Morning. 
Evening. 
Temperature. 
| Pulse. 
| Respiration. 
Condition of 
Urine. 
Specific 
Gravity. 
April 
30 
E 
104,5 
125 
24 
May 
1 
M 
101,5 
96 
21 
1 
E 
102,3 
104 
22 
Dist. Album. 
1018 
44 
2 
M 
101,5 
100 
21 
Traces of Album. 
1017 
it 
2 
E 
102,7 
106 
24 
Dist. Album. 
1020 
44 
3 
M 
102 
102 
21 
Scant, High Color. 
1019 
44 
3 
E 
102,8 
109 
44 
1017 
44 
4 
M 
102,6 
99 
21 
44 
1016 
44 
4 
E 
103,5 
no 
25 
44 
1020 
44 
5 
M 
100,3 
96 
21 
Traces of Album. 
10.20 
44 
5 
E 
100,5 
96 
22 
No Album. 
1022 
44 
6 
M 
100 
96 
21 
44 
1022 
a 
0 
E 
100.2 
114 
21 
44 
1022 
44 
7 
M 
102 
105 
23 
44 
1022 
44 
7 
E 
102 
110 
24 
Scant, High Color. 
8 
M 
103 
108 
26 
44 
44 
8 
E 
103,5 
108 
25 
44 
44 
9 
M 
103 
no 
23 
44 
44 
10 
M 
102,6 
104 
23 
44 
4k 
12 
M 
100 
94 
20 
Normal. 
44 
14 
E 
98,6 
90 
19 
44 
44 
15 
E 
98,6 
86 
19 
“ 
This constitutes the whole of my case, 
but before closing, I would like to de- 
velop some ideas through the following : 
On my second visit my attention was 
called to the elimination of the urine. 
Noticed particularly, as the temperature