2. _Erysipelas_, St. Anthony's fire, may be divided into three kinds, which differ in their method of cure, the irritated, the inirritated, and the sensitive erysipelas.
_Erysipelas irritatum_ is attended with increase of irritation besides increase of sensation; that is, with strong, hard, and full pulse, which requires frequent venesection, like other inflammations with arterial strength. It is distinguished from the phlegmonic inflammations of the last genus by its situation on the external habit, and by the redness, heat, and tumour not being distinctly circumscribed; so that the eye or finger cannot exactly trace the extent of them.
When the external skin is the seat of inflammation, and produces sensitive irritated fever, no collection of matter is formed, as when a phlegmon is situated in the cellular membrane beneath the skin; but the cuticle rises as beneath a blister-plaster, and becomes ruptured; and a yellow material oozes out, and becomes inspissated, and lies upon its surface; as is seen in this kind of erysipelas, and in the confluent small-pox; or if the new vessels are reabsorbed the cuticle peels off in scales. This difference of the termination of erysipelatous and phlegmonic inflammation seems to be owing in part to the less distensibility of the cuticle than of the cellular membrane, and in part to the ready exhalation of the thinner parts of the secreted fluids through its pores.
This erysipelas is generally preceded by a fever for two or three days before the eruption, which is liable to appear in some places, as it declines in others; and seems frequently to arise from a previous scratch or injury of the skin; and is attended sometimes with inflammation of the cellular membrane beneath the skin; whence a real phlegmon and collection of matter becomes joined to the erysipelas, and either occasions or increases the irritated fever, which attends it.
There is a greater sympathy between the external skin and the meninges of the brain, than between the cellular membrane and those meninges; whence erysipelas is more liable to be preceded or attended, or succeeded, by delirium than internal phlegmons. 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. If this circumstance should be supported by further evidence, this disease should be removed into Class IV. along with the rheumatism and gout. See Class IV. 1. 2. 17.