THE SAD OUTCOME OF AN INFANT WITH ST. ANTHONY'S FIRE IN 1828

Abstract

Erysipelas, or St. Anthony's fire, formerly very common, is rarely seen today. It is a distinctive type of acute cellulitis of the skin and subcutaneous tissues caused by group A betahemolytic streptococci. The case history below, written in 1828 by Sir Arthur Clarke, a member of the Royal College of Surgeons, London, is a vivid reminder of the gravity of paraumbilical infections in the preantibiotic era:

A lady in the country sent for me, while writing these pages, to visit her infant the tenth day after its birth. She informed me that she had just discovered an inflammation round the navel, which the midwife had concealed from her. Upon examination I found its entire belly covered with cloths, wetted with some cold solution of sugar of lead in water, on removing which the navel appeared in a sloughy gangrenous state, surrounded by a most extensive erysipelatous inflammation, which spread almost over the whole abdomen. About the navel, was hard, swelled and painful. The screems of the infant were piercing and incessant, and increasing the inflammation and pain by the action produced in the surrounding muscles. I directed its bowels to be kept open, twice or three times a day, with castor oil, and occasionally with rhubarb and calomel: the navel to be covered with an emollient poultice every eight hours, and the surrounding inflammation to be dusted with fine powdered starch. The appearances were so changeable as to compel me to alter the applications almost daily, from the simple bread and milk, to the carrot and fermenting poultices, camphorated spirits, etc.