ERYSIPELAS.
erysipelas is meant a violent inflammation of the superficial lymph-channels.
is most fre quently found about the face and head, probably because of the excessive num ber of superficial lymphatic vessels. The affection has gradually lessened through the use of antiseptic principles in surgical practice.
Case of erysipelas manifesting itself first in the fauces and tongue and ex tending painlessly up the Eustachian tube to the face. On three separate occasions the disease started from the same site—i.e., the neighborhood of the left ear—and spread all over the face, and was complicated by infective endo earditis. Magill (Lancet, Feb. 19, '98).
True cutaneous erysipelas is charac terized by severe elevation of ture, attended by a disseminated inflam mation of the skin. This is sometimes preceded by a chill. The elevation of temperature continues until the erysip elatous process reaches its end. There may be a wound from which the redness starts, or there may be no cutaneous evi dence of the seat of infection. A mere scratch, though healed, may have al lowed the streptococcus to enter; hav ing traveled up the lymphatics, the ganism starts the erysipelatous process at a distance from the seat of entrance. There may be red streaks showing lym phatic glands extending from the wound to the special place where the poison now develops very freely.
Case reported where a woman, using the tuft which her husband had used to dust his face with rice-flour during an attack of erysipelas a month previously, was seized with purulent ophthalmia and lost an eye. Saint-Phillippe (Jour. de Med. de Bordeaux, Nov. 1S, 'SS).
The lesions in erysipelas of the new born are nearly the same as in adults, the skin and the subcutaneous layer be ing almost normal. Morel (Revue Men suelle des Mal. de l'Enfance, Mar., '91).
Erysipelas in the newborn may de velop not only about the umbilical wound, but also around a vaccination wound and around the conjunctiva. Histological examination shows accumu lations of streptococci in the lymphatic vessels. There may be a few bacilli in
the superficial region of the derma, but none in the epidermis. At first the fever is not excessive, and it may not be note worthy until the second or third day. If the child do not quickly die there may be several resulting abscesses, and death may ensue from the fifteenth to the twentieth day. If recovery take place it may be long in coming, being delayed by athrepsia or infectious diarrhoea.
Lemaire (Revue des Sci. Med. en France et a l'Etranger, Jan. 15, '94).
Erysipelas of the face and head follow ing otitis observed seven times within a period of six months. Hessler (Le Bull. Md., July 7,'95).
In 100 cases of erysipelas just one-half were clearly traceable to pre-existing skin lesion. Charles W. Allen (Med. Record, Nov. 23, '95).
In some places in Nevada erysipelas is epidemic, and there is a considerable dif ference in the virulence of the disease. Furley (Kansas City Med. Record, Jan., '90).
Tension of the cellular tissues now be comes very marked; blebs may form on the surface from the intense irritation of the papillary layer of the skin. It sometimes happens that the process, having started in one part of the body, may be arrested, only to manifest itself elsewhere. As a rule, after the process subsides the parts are soon restored to their normal condition, although a cer tain amount of desquamation takes place.
When the deeper lymphatics are af fected a great deal of effusion takes place in the cellular tissue, and cellu litis results, which is much more intense than that described as arising from the streptococcus in its ordinary degree of virulence. It bears, however, a great analogy to it, only the symptoms may be much more intense. A suppurative process takes place with a great disin tegration of cellular tissue. This has been characterized as phlegmonous, or suppurative, erysipelas. It may come to the surface, and subsequently change its coarse as an erysipelas of the skin. It is also possible that other bacteria should contaminate this infection.