The constitutional symptoms cor respond to the intensity and extent of the local process. The temperature rises to about 104° F., and may reach 107° F. The fever may be of a continuous remit tent or intermittent type, and is in direct proportion to the extent of the inflam mation. There may be gastric symp toms, loss of appetite, nausea, vomiting, excessive thirst, and a highly-coated tongue. The urine is generally dark colored, and may contain albumin, blood, bile-pigment, and micrococci. The spleen is sometimes swelled, and there may be pain in the region of the kidneys. If the process be not arrested, death may result from the extension of the local in fection to some vital organ, as the brain or peritoneum.
Suppurative arthritis of the knee fol lowing erysipelas observed, in which was found Fehleisen's streptococcus. Schrei ber (Bolnitchnaja gazeta Botkina, No. 2, '91).
Case considered as one of infective pneumonia, due to extension of an ery sipelas of the pharynx down the bron chial tract to the parenchyma. Collins (II Morgagni, Aug. 29, Oct. 15, '91).
In the majority of cases erysipelas does not cause abortion. If confinement or miscarriage occur during its course, there is no genital infection, provided obstetrical antisepsis be rigorously prac ticed; moreover, the children at birth show no trace of erysipelas. Le Gendre (Gaz. des Hopitaux, Dec. 23, '92).
Two cases of blindness from facial ery sipelas observed. Snell (Ophthalmic Re view, May, '93).
Synovitis or suppurative arthritis may occur as a complication of erysipelas. In SI; cases of erysipelas one or the other of these conditions took place. The complication may arise at any time during the attack. The suppurative form requires the promptest and most heroic treatment. Disorganization of the joint will follow, even the death of the patient, otherwise. Gamgee (Bir mingham Med. Rev., vol. xxxviii, No. 205, '95).
Following after a relapse of erysipelas, in a young woman of 22 years, there de veloped peculiar black abscesses and fu runcles. In the course of a year and a quarter about 650 of these were noted, affecting all parts of the body, including the hairy scalp. Fever, up to 100 de grees and more, but without distinct re lation to the abscess-formation, was ob served. There was little depression of the general health, and the termination was complete cure. The abscesses were confined to the skin and subcutaneous tissues, and varied in size from that of a millet-seed to that of a large nut, and were marked by formation of gas in their centre and by the dark pig mentation. Bacteriological examination
showed streptococci and indefinite cocci and bacilli. Zeller and Arnold (Vir chow's Archly, vol. cxxxix, H. 2).
Leucin and tyrosin demonstrated both microscopically and chemically in the urine of a girl, 13 years old, who was passing through an attack of facial ery sipelas. Kirkbride (Centralb. f. innere Med., No. 41, p. 1057, '97).
Death may also result from exhaustion consequent upon the febrile process and weakening of the organs by gradual in fection.
The duration of the infection is very uncertain. It may seem to have disap peared, and subsequently starts up again. It may last a few hours, and continue for several weeks. Again, it may travel over the whole body and possibly attack the same locality several times. As a rule, it delineates its course within two or three weeks.
Examination of the blood, whether made during an attack or during the period of convalescence, furnishes valu able information regarding the course of an attack of erysipelas. The curve of the number of leucocytes in a case of erysipelas follows very closely that of the temperature, but this leucocytosis does not show equally throughout the various blood-elements. The polynuele ated cells show an increase as soon as the malady is established, while at the same time the number of mononucleated cells diminish, such diminution occurring chiefly in the lymphocytes. When re covery takes place it is signalized by a fall in the number of polynucleated cells.
The eosinophile-cells, which fell in num ber during the course of the illness, only appear again when the blood-infection is altogether at an end. Chantemesse (Lancet, Mar. 11, '99).
Some persons are subject to "habitual attacks" of erysipelas, generally about the face and probably repeated infections from a chronic nasal catarrh.
Case of recurring erysipelas in a young woman of 22 years. The disease first occurred at the sixteenth year, when she was ill with it for several months. After the establishment of the menses in the seventeenth year the disease recurred with each menstruation, there having been, in all, some sixty attacks. The attacks occurred invariably on the first, second, or third day. Massalonga (Ri forma Med., No. 229, '94).