ICHTHYOL 
AS A 
REMEDY FOR FACIAL ERYSIPELAS. 
BY 
S. J. RADCLIFFE, M.D., 
WASHINGTON, D. C. 
REPRINTED FROM THE THERAPEUTIC GAZETTE, MAY ib, 1892. 
DETROIT, MICH. : 
GEORGE S. DAVIS, PUBLISHER. 
1892. ICHTHYOL AS A REMEDY FOR 
FACIAL ERYSIPELAS. 
THERE have been a number of cases of 
facial erysipelas in this city for the past 
month or two, and some deaths, and it is of 
interest to inquire from whence it came and 
how it came, whether it is following in the 
wake of influenza, as one pest follows an- 
other, as typhus follows cholera, or is only ac- 
cidentally endemic or sporadic. Necessarily 
following this inquiry, the mode of treatment 
comes in for a share of attention. 
Erysipelas has never been considered a 
contagious disease in the true sense of the 
term, like the eruptive fevers,-small-pox, 
scarlet fever, or measles; but was believed to 
be propagated by atmospheric or climatic 
influences, or a specific poison, like malarial 
fever from a paludal atmosphere or typhoid 
fever from sewage contamination, was sup- 
posed to be idiopathic, and to bear some 
resemblance to pneumonia, pleurisy, laryn- 
gitis, bronchitis, or angina. At present we 
know it is a contagious disease. 
The old belief was that the condition of 
the blood had in some remarkable way some- 
thing to do with its development, that the 
blood was either too rich or too poor, or " out of order" in some way, and hence " blood 
purifiers" were the only remedy. In our day, 
however, when micro-organisms are held to 
be the cause of all diseases, the erysipelatous 
microbe-the streptococcus erysipelatosus- 
is charged with being its chief, if not its only 
origin. 
Erysipelas seems to be a true dermatitis, 
an especial or specific dermatitis, qualified 
by the term erysipelas,-an erysipelatous der- 
matitis. This particular erysipelas generally 
attacks the face only. Why it should attack 
the face, and a particular portion of the face 
in the beginning and not the whole face at 
once, is not known. It has its beginning, like 
a wheal or spot of urticaria, or sting of an 
insect, and from that small area spreads to 
the entire face, sparing no portion, except 
perhaps the globe of the eye, the ears, scalp, 
or neck. The lymphatics are always af- 
fected,-swollen, inflamed, and tender,-and 
in many cases this is its point of departure. 
It is believed at first to be a local disease, 
confined to the dermic tissues, extending to 
the subcutaneous area, and between the 
cutis and epidermis. The parts swell from 
serous infiltration, and become tense and 
shiny. But it may become constitutional if 
the local lesion is allowed to run on un- 
checked. Its tendency is to extend itself to 
the meninges of the brain, not by metastasis, 
but by simple extension, usually through the 
nasal passages, and it may be the consequence 
of the malignant character of the disease, or 
from incipient collapse. 
Sometimes the delirium, which is often 
manifested, is due to fever alone, and not to 
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implication of the meninges. Violent epis- 
taxis may come on in such a condition and 
arrest its progress. I have seen such a re- 
sult. It occurred in my own case, and was, 
doubtless, salutary. It acted as a revulsive, 
relieved the engorged vessels, and relieved 
the delirium. It is occasionally complicated 
with bronchial or with intestinal catarrh, with 
intense hyperaemia of the kidneys, or with 
catarrhal or croupous inflammation of urinif- 
erous tubules, and it may end in gangrene. 
It is a disfiguring disease, and makes the 
subject of it look hideous, deformed, and un- 
recognizable, and it is not without its danger. 
It is usually regular in its course, and ter- 
minates favorably in from six to twelve days, 
according to its degree of severity, and as to 
whether its type is mild or malignant. It is 
in the latter type, if complicated by or asso- 
ciated with a broken-down or depressed con- 
stitution, physical or mental overwork, with 
their congener,-anaemia,-that it becomes 
fatal. 
Facial erysipelas is self-limited, is in a 
large per cent, of the cases remediable, is 
to a great extent self-curable, and gets well 
without the intervention of medicines. It 
may be true that erysipelas, as it ordina- 
rily occurs, may require little or no treat- 
ment, yet this non-interference would not be 
the proper attitude for the physician, nor 
would it be satisfactory to the patient or his 
friends, and it would be very hazardous, for 
it frequently and unexpectedly takes on alarm- 
ing symptoms, from its malignancy, and may 
cause death in a very few days. 
The old plan of local treatment, by sur- rounding the diseased parts with iodine or 
nitrate of silver, with the notion that it would 
stop its extension,-arrest its spreading,-is, 
I am glad to say, now almost abandoned. 
No one knows how much injury such prac- 
tice entailed. I was foolish enough in the 
beginning of my career to follow the teach- 
ings and promptings of my elders to pursue 
the same line of treatment, but I have long 
since discarded it for what I conceive is far 
better, or, at least, a practice more conserva- 
tive and quite as successful. I saw the last 
of a medical gentleman, whose face was 
blackened beyond recognition, and uncon- 
scious, whose kind medical confreres could 
not save, notwithstanding they plied him vig- 
orously, hypodermically, with whiskey and 
digitalis. This gave me additional proof 
that such proceedings were wrong. I have 
treated many a case successfully with no 
other application than wheat flour dusted 
over the face with an eider-down puff or soft 
flannel, and a few drops of muriated tincture 
of iron and a few grains of quinine, with 
plenty of liquid nourishment. 
There is no doubt in the world that the 
simplest, most emollient, most soothing, and 
least irritating application is the best in these 
cases. If " striking in" can take place, it is 
certainly hurried or facilitated by irritant 
substances, which are calculated also to still 
further excite the inflammatory process 
and give a tendency to still further overload 
the already engorged dermic and subdermic 
tissues, and lead to gangrene. 
The simple application of vaseline or 
coca-butter or olive oil, without the addition 
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of mineral substances, as zinc or bismuth, 
will, in a large per cent, of the cases, be suf- 
ficient. I think nothing is gained by the ap- 
plication of the ice compress or by minute 
incisions, as recommended. I think it is 
time lost, and neither would answer in pri- 
vate practice. 
I am quite pleased with ichthyol as a local 
application in this affection. The few cases 
I have treated with it may not be sufficient to 
form an opinion, but in each case I obtained 
uniform and unvarying success, and, as each 
patient exclaimed, it "acted like a charm." 
I was directed to it, or influenced to use it, 
by the report of Dr. Klein (Berlin. Klin. 
Wochenschrift, September 28, 1891, and sup- 
plement, British Medical Journal, November 
7, 1891), who regards it almost as a specific, 
from its powerful action in retarding the 
growth of the streptococcus erysipelatosus, 
thereby shortening the average length of an 
attack of erysipelas by one-half. He finds the 
average duration of an attack, when ichthyol 
is used, only six days, three days after the 
actual application has been begun. He ob- 
served a marked action in lowering the tem- 
perature and allaying the fever. This is the 
experience I have had with ichthyol. In 
three days after the treatment was begun in 
my cases by washing off the applications, the 
improvement was manifest, and the fever 
never rose after the second day, but grad- 
ually declined. The ichthyol is not at all un- 
pleasant, and was not objected to by patients. 
It makes the skin a dark-brown color, and, of 
course, looks unsightly while on, but it does 
not stain the skin, and is easily washed off. 6 
The bedclothing and pillows, as well as the 
garments of the patient, should be protected, 
as wherever it touches it leaves a brown mark, 
which is easily removed by washing. The 
best plan of using it is to compound an oint- 
ment of equal parts of ichthyol and vaseline 
or lanolin, or, if a weaker or thinner one is 
desired, equal parts of ichthyol, lanolin, and 
water will be better where a large cutaneous 
surface is under treatment. My plan is to 
order two drachms each of ichthyol, lanolin, 
and water, and have this applied uniformly 
over every part of the erysipelatous inflamma- 
tion, ears, eyelids, and all, and repeat this at 
least twice daily. In three days, on washing it 
off with a little tepid water, and with or with- 
out a little lather of fine quality of soap, it will 
be found that the swelling has subsided, and 
the erysipelatous process has been arrested, 
except perhaps on the extreme borders. I 
have discontinued it after three days, and 
dusted the paler parts with flour, applying 
the ichthyol only to the outskirts, the irregu- 
lar parts of the pinna of the ear and back 
of the neck. But a better plan is to con- 
tinue the application until the sixth day, or 
until all traces of the disease externally have 
disappeared. This will not be beyond the 
fifth or sixth day. In addition to this, I 
order io drops of a mixture of thirty grains 
of quinine in one ounce of muriated tincture 
of iron every three hours, and nourish the 
patient well. The remarkable part of the 
treatment is that the temperature is at once 
reduced, and is not elevated again, never 
going beyond 100 or 102, and may be normal 
after the first day. No relapses have taken place in my cases, and convalescences were 
satisfactory and without sequelae. I know of 
no more satisfactory remedy. 
1523 K Street N. W. 
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