Erysipelas

“ Erysipelas is an acute specific inflammation of the skin and subcutaneous tissue, commonly of the face, characterized by shining redness, swelling, œdema, heat, and a tendency in some cases to vesicle- and bleb-formation, and accompanied by more or less febrile disturbance.
Describe the symptoms and course of erysipelas.
A decided rigor or a feeling of chilliness followed by febrile action usually ushers in the cutaneous disturbance. The skin at a certain point or part, commonly where there is a lesion of continuity, becomes bright red and swollen ”

“ In erysipelas, however, it is tolerably certain that there are different degrees of virulence to be recognized in different cases, and that the disease at times is transmitted in its different types. Thus, traumatic erysipelas is much more closely related to childbed fever than the varieties of the disease appearing upon the head and face, which cannot be attributed to traumatism, surgical accidents, dental abscesses, or local injuries of the antrum of Highmore. Parturient women frequently escape infection when the erysipelatous disorder is of the so-called medical type. ”

“ It rarely spreads from the face to the chest and body, and but occasionally attacks the throat. During the height of the inflammation the temperature reaches 104° F, or over. After four or five days, in most cases, erysipelas begins to subside, together with the pain and temperature, and recovery occurs with some scaling of the skin. The death rate is said to average about ten per cent in hospitals, four per cent in private practice. Headache, delirium, and stupor are common when erysipelas attacks the scalp. The appearance of the disease in other locations is similar to that described. ”

“ For as a new cuticle is formed under the old one, as under a blister, the serous fluid between them is a defence to the new cuticle, and should dry into a scab by exhalation rather than be reabsorbed. Hence we see how greasy or oily applications, and even how moist ones, are injurious in erysipelas; because they prevent the exhalation of the serous effusion between the old and new cuticle, and thus retard the formation of the latter.
Erysipelas inirritatum differs from the former in its being attended with weak pulse, and other symptoms of sensitive inirritated fever. ”

“ As in many other cases, the discovery of the influence of erysipelas on sarcomatous growths was by investigation founded upon accidental occurrences, to wit: Busch reported a case of multiple sarcoma of the face cured by an attack of facial erysipelas; Durante, a sarcoma of the neck; Biedert, an enormous round-celled sarcoma, including the mouth, nose, and pharynx; Bruns, a melanotic sarcoma of the breast; Gerster and Bull, each a recurrent sarcoma of the neck; all cured or disappeared with no return, after an erysipelatous attack. ”

“ During its progress, erysipelas, first appearing on the face, then extending over the scalp, and often down the shoulders and back, is very apt to occur. Excoriation on the back and hips often form sloughing sores of great malignity and extent, while enlargement, inflammation and suppuration of glands situated in different parts of the body frequently appear. ”

“ Against erysipelas take a goat’s horn and lay it to the fire so that it may burn at the fire; then remove the incrustations to a new vessel; then pound them thoroughly along with sharp acid; apply [them] to the erysipelatous eruptions, till they be whole. ”

“ Within twenty-four hours the disease is fully developed; the skin is tense, smooth, and shiny, scarlet and swollen, and feels hot, and is often covered with small blisters. The pain is more or less intense, burning or itching occurs, and there is a sensation of great tightness or tension. On the face the swelling closes the eye and may interfere with breathing through the nose. The lips, ears, and scalp are swollen, and the person may become unrecognizable in a couple of days. Erysipelas tends to spread like a drop of oil, and the borders of the inflammatory patch are well marked. ”

“ The Swelling of the Face, which usually begins on the eighth Day in the distinct Kind, happens most commonly on the ninth in this Sort; and the greater the Swelling is, the greater Prospect there is of the Patient’s Recovery. This Swelling arises from the inflammatory little Tumours that flow together: It is the Nature of all Inflammations, to cause Prominence in the Parts affected: A Boil, a Phlegmon, an Erysipelas, or St. Anthony's Fire, Anginas, Rheumatisms, or scorbutick Inflammations, are all accompanied with Swellings in the Places where they happen ”

“ The accurate determination of the aetiology of erysipelas has led to the adoption of a scientific method of treatment of the disease. The Streptococcus erysipdatis is found, not speciaUy in the zone in which inflammation has become evident, but in the tissues outside this zone: in fact, the streptococci appear to be most numerous in the lymphatics of the tissues in which there is little change. Before the appearance of any redness there is a dilatation of the lymph spaces with fluid, and the tissues become slightly oedematous. ”

“ Conversely, in an outbreak of contagious pneumonia in a locality heretofore free from strangles, strangles do not develop. Again, no matter how prevalent nor how constant strangles may be in a locality, and how habitually men have their wounded hands covered with the pus of the abscesses, no epidemic of erysipelas is entailed in man. Strangles spreads with remarkable rapidity through a stable, but not to the often more than equally exposed human attendants, nor to any animal apart from the genus equus. ”

“ I except the mumps, or parotitis, described below; which is properly an external gland, as its excretory duct opens into the air. When pain of the head or delirium precedes the cutaneous eruption of the face, there is some reason to believe, that the primary disease is a torpor of the meninges of the brain; and that the succeeding violent action is transferred to the skin of the face by sensitive association; and that a similar sympathy occurs between some internal membranes and the skin over them, when erysipelas appears on other parts of the body. ”

“ In humans E. rhusiopathiae causes erysipeloid, a local skin lesion that occurs chiefly as an occupational disease of persons engaged in handling and processing meat, poultry, and fish as well as of rendering-plant workers, veterinarians, game handlers, leather workers, laboratory workers, and the like. The organism occasionally is isolated from cases of endocarditis in humans and rarely causes acute septicemic disease. ”

“ Heracles signs to the Attendants to take Alcestis away again. She stays veiled and unnoticing in the background.
I was fallen, and in this wise
Thou wilt make me deeper fall.... Meseems, meseems,
There in her face the loved one of my dreams
Looked forth.--My heart is made a turbid thing,
Craving I know not what, and my tears spring
Unbidden.--Grief I knew 'twould be; but how
Fiery a grief I never knew till now.
Leader:
Thy fate I praise not. Yet, what gift soe'er
God giveth, man must steel himself and bear.
Heracles, drawing Admetus on. ”

“ She is fighting tremulously, with all her flagging strength, against the thing she longs for. The whole point of the scene requires that one ray of hope after another should be shown to Electra, and that she should passionately, blindly, reject them all. That is what Euripides wanted the signs for.
But why, it may be asked, did he adopt Aeschylus' signs, and even his peculiar word? Because, whether invented by Aeschylus or not, these signs were a canonical part of the story by the time Euripides wrote. Every one who knew the story of Orestes' return at all, knew of the hair and the footprint. ”

“ Admetus:
With Death thou hast fought! But where?
Heracles:
Among his dead
I lay, and sprang and gripped him as he fled.
Admetus, in an awed whisper, looking towards Alcestis.
Why standeth she so still? No sound, no word!
Heracles:
She hath dwelt with Death. Her voice may not be heard
Ere to the Lords of Them Below she pay
Due cleansing, and awake on the third day.
To the Attendants So; guide her home.
They lead Alcestis to the doorway.
And thou, King, for the rest
Of time, be true; be righteous to thy guest,
As he would have thee be. But now farewell! ”

“ Orestes.
⁠Thy mother stays
Unmoved 'mid all thy wrong?
Electra.
⁠A lover weighs
More than a child in any woman's heart.
Orestes.
But what end seeks Aegisthus, by such art
Of shame?
Electra.
⁠To make mine unborn children low
And weak, even as my husband.
Orestes.
⁠Lest there grow
From thee the avenger?
Electra.
⁠Such his purpose is:
For which may I requite him!
Orestes.
⁠And of this
Thy virgin life—Aegisthus knows it?
Electra.
⁠Nay,
We speak it not. It cometh not his way.
Orestes.
These women hear us. Are they friends to thee?
Electra. ”

“ The door bursts open, and Orestes and Electra come forth in disorder. Attendants bring out the bodies of Clytemnestra and Aegisthus.
Leader.
Lo, yonder, in their mother's new-spilt gore
Red-garmented and ghastly, from the door
They reel. . . . O horrible! Was it agony
Like this, she boded in her last wild cry?
There lives no seed of man calamitous,
Nor hath lived, like this seed of Tantalus.
Orestes.
O Dark of the Earth, O God,
⁠Thou to whom all is plain;
Look on my sin, my blood,
⁠This horror of dead things twain:
Gathered as one they lie
Slain ”

“ Then, if Menelaus, lest his daughter die,⁠1195
Will save thee, seeing Helen fallen in blood,
Yield to her sire's embrace the maiden's form.
But if, controlling not his furious mood,
He seek to slay thee, pierce the maid's neck through.
I ween, though swelling be his port at first,⁠1200
His wrath at last shall cool. Nor brave nor stout
By nature is he. This I find for us
The bulwark of deliverance. I have said.
Orestes.
O thou who hast the spirit of a man,
Albeit in body woman manifest, [36] ⁠1205
How worthier far art thou to live than die!
Such woman, Pylades, shalt thou, alas! ”

“ Where thou art, and prepare our second home.
These ministers in that same cedar sweet
Where thou art laid will lay me, feet to feet,
And head to head, oh, not in death from thee
Divided, who alone art true to me!
Leader:
This life-long sorrow thou hast sworn, I too,
Thy friend, will bear with thee. It is her due.
Alcestis:
Children, ye heard his promise? He will wed
No other woman nor forget the dead.
Admetus:
Again I promise. So it shall be done.
Alcestis, giving the children into his arms one after the other. ”

“ It is the earliest dated play of Euripides which has come down to us. True, he was over forty when he produced it, but it is noticeably different from the works of his old age. The numbers are smoother, the thought less deeply scarred, the language more charming and less passionate. If it be true that poetry is bred out of joy and sorrow, one feels as if more enjoyment and less suffering had gone to the making of the Alcestis than to that of the later plays.
ALCESTIS CHARACTERS OF THE PLAY ADMÊTUS, King of Pherae in Thessaly. ”

“ Their house is full of woe; Electra, alone faithful, is ready to face death if only she may destroy the twin furies. The great and good will purchase glory with life; so may'st thou prevail and gain the name of the best of daughters. {1096}
EPISODE III Enter from Distance-door Orestes, Pylades and Attendants.
Orestes informs the Chorus, and Electra as one of the household, that they bear the urn containing the ashes of Orestes, whose death they had sent forward a messenger to announce. Electra begs to clasp the urn and pours over it a flood of grief ”

“ But whom thou hat'st, Aegisthus: blood for blood,
Bitter requital, on the dead has fall'n. {939}
General exultation (in Lyric measures) succeeds, which increases as Orestes and Pylades re-enter bearing the corpse of Aegisthus. After brief celebration of the deed the face of the corpse is uncovered, and Electra, gazing at it, gives vent to her scorn and hatred: how he had slain a hero, made her an orphan, lived in shame with her mother, enjoying and trusting in her father's wealth: but
Nature is firm, not riches: she remains
For ever, and triumphant lifts her head. ”

“ His wife, Alcestis, though no blood relation, handsomely undertook it and died. But it so happened that Admetus had entertained in his house the demi-god, Heracles; and when Heracles heard what had happened, he went out and wrestled with Death, conquered him, and brought Alcestis home.
Given this form and this story, the next question is: What did Euripides make of them? The general answer is clear: he has applied his usual method. He accepts the story as given in the tradition, and then represents it in his own way. When the tradition in question is really heroic, we know what his way is. ”

“ Through all my realm no lute, nor lyre, nor sound
Of piping, till twelve moons are at an end.
For never shall I lose a closer friend,
Nor braver in my need. And worthy is she
Of honour, who alone hath died for me.
The body of Alcestis is carried into the house by mourners; Admetus follows it.
Chorus:
Daughter of Pelias, fare thee well,
May joy be thine in the Sunless Houses!
For thine is a deed which the Dead shall tell
Where a King black-browed in the gloom carouses ”

“ In murder-bond the while is dwelling!
Chorus.
Of many an ill to Hellas and thine house
Was Helen, sister of thy mother, cause.
Orestes and Pylades approach.
Electra.
Woe's me, friends!—needs must I break off my moan! 215
Lo, yonder strangers ambushed nigh the house
Out of their hiding-place are rising up!
With flying feet—thou down the path, and I
Into the house,—flee we from evil men!
Orestes (intercepting her) .
Tarry, thou hapless one: fear not mine hand. 220
Electra. ”