Erysipelas

Erysipelas is a direct transliteration of the Greek, literally "red skin," referring to its most obvious characteristic. It was usually termed ignis sacer (holy fire) in classical Latin, and the synonym is confirmed by Celsus and Cassius Felix. It is important to note that the erysipelas termed ignis sacer is distinct from ergotism, sometimes also called ignis sacer or St. Anthony's Fire.

Although noted several times by Hippocrates, erysipelas was not given much attention in classical medical writings and is very rare in nonmedical writings (but see Lucretius and possibly Virgil). It was considered to be serious, however, and an epidemic was reported by Hippocrates. Fatalities were reported by Hippocrates and Paul of Aegina. It is clear that the erysipelas of classical texts is not always restricted to the streptococcal infection known by that name today, for apparently sometimes it was confused with gangrene and herpes, as, for example, by Scribonius Largus.

Despite the relatively slight attention paid to the etiology and incidence of erysipelas by classical writers, there are reasons for believing that, in fact, it was far from rare. First, the disproportionately large amount of space devoted to a host of different therapeutic forms by Caelius Aurelianus, Scribonius, Pliny, and Oribasius strongly suggests it was not uncommon. Second, the prevalence of wounds, abra sions, and contusions must have provided easy access to the pathogens. Third, even without therapeutic intervention, many cases of self-limiting erysipelas ran their courses with little lasting trauma to the patient.

The symptoms of erysipelas are so clearly described by the classical medical writers as to leave little doubt about the accuracy of the identification. These include redness and swelling with a spreading painful lesion (Celsus), usually accompanied by fever (Hippocrates). In agreement with modern symptomatology, erysipelas was described on most of the more exposed portions of the body; specifically, it was noted as involving the face and the mucous membranes of the mouth and throat (Hippocrates), thus perhaps as being one of the causes of noninfantile aphthae. Celsus and Hippocrates noted appearance of erysipelas soon after the infliction of a wound, and Celsus made the distinction, though not with complete understanding, between idiopathic and traumatic erysipelas. It is more difficult to understand what is meant by erysipelas of specific, usually internal, organs, for example, uterus and lungs (Hippocrates) and brain (Paul of Aegina). A Hippocratic aphorism suggests that the phrase inward-turning erysipelas (regarded as a dangerous sign) is simply a way of expressing the fact that other, more serious symptoms accompanied the external, reddened areas.

The etiology of erysipelas was not altogether clear but, as was frequently the case with infectious diseases of rapid onset, a humoralistic explanation was advanced by Galen and Paul of Aegina.

Hippocrates noted that "early in the spring" was the season of highest incidence and that "those of about sixty years" were especially prone; however, his detailed case history in Epidemics describes the nonfatal case of an 11-year-old boy.

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