Actual extension of erysipelas from one patient to another can usually be traced. The scales of loose epidermis, or epidermis cut from an affected area, the sweat, and even the contents of blebs, as long as they are not purulent, are found to be free from streptococci. In fection proceeds from the discharge of erysipelatous wounds, and these should be treated as other infected wounds, but the patient should not be handled as though he were suffering from a con tagious disease. W. Respinger z. klin. Chir., vol. xxvi, p. 261, 1900).
The diagnosis of ordinary erysipelas is very simple. Gradually increasing and spreading redness is characteristic, and it can only be mistaken for ERYTHEMA. This latter infection, however, is not ac companied by fever, while erysipelas al ways is.
Complications.—The wound may ap parently not be interfered with in the healing process, while at the same time a deep cellulitis exists, and may finally end in suppuration. The open wound upon which erysipelas has developed will take a dry, gray, dirty, and glossy ap pearance, covered with a sort of croup ous membrane, and will retain this ap pearance until the intensity of the in fection has disappeared. On the mucous membrane a swelled condition takes place, which may also cover itself with a croupous membrane. There may be marked disturbances of the central nerv ous system as the result of a high fever. Delirium and stupor, accompanied by vomiting and convulsions, may follow. A collapsed condition of the system may take place after the disappearance of the symptoms. Hallucinations and certain motor disturbances may occur. As a rule, the lymphatic glands are not affected in superficial erysipelas, while they may suppurate in a deeper form of the infection. Internal complications known as metastatic inflammations may take place. These may be septic bron chitis, pneumonia, or meningitis, while peritonitis may follow erysipelas of the neighboring parts. The local sequel of erysipelas are a thickened condition of the cellular tissue due to the obstruction of the lymphatic vessels and an impaired condition of the vitality of the skin, pre disposing the parts to eczematous ulcer ations. Deep cicatrices may also form as a permanent result.
Etiology and Pathology.—Erysipelas is a violent inflammation of the lymph channels, caused by the streptococcus. Although it. is now generally conceded that the infectious agent, as described by Fehleisen as the cause of erysipelas, is identical with the streptococcus of sup puration, the symptoms of erysipelas are sufficiently different to warrant a de scription of this infection as a form of affection separate from ordinary suppu ration. It has been proved that the vir
ulence of the streptococcus varies ma terially with the nature of the soil upon which it grows; that it will frequently acquire a greater virulence when the re sistance of the subject is lessened, as in tuberculosis, diphtheria, scarlet fever, small-pox, typhoid fever, and influenza, and when the vitality of the body is materially reduced, as by overwork. Its virulence materially differs in various animal organisms, as it is by no means equal to the virulence of the same strep tococcus in mice or rabbits. Erysipelas can be produced in rabbits by the injec tion of the ordinary streptococcus of suppuration, and by that means acquire a greater virulence, and, if not attenu ated, would reproduce symptoms of ery sipelas in an ordinary wound infected with it. From its etiology, therefore, erysipelas is a non-specific disease, but is due to a higher state of virulence which the streptococcus happens to pos sess at the time it enters the tissues, or which it can soon acquire when the tis sues are suited to its development in a virulent shape. It has also been demon strated that erysipelas cocci may enter the blood; but, as a rule, they are not found in this fluid.
dan (Miinchener mod. Wochen., Aug. 27. 1901).
Series of 11 personal cases of erysipelas in which some of the patients presented a previous rheumatic history, while others exhibited manifestations of the arthritic diathesis, either personally or in their ancestry, and still others were neither rheumatic nor arthritic. In the latter it was thought that the erysipelas was responsible for the development of rheu matism.
This acute polyarthritis following ery sipelas usually sets in during convales cence, as desquamation is taking place, from a day to a week after defervescence. The temperature rises again, the pulse is accelerated, and various joints become successively painful, red, and swollen. Characteristic acid sweats take place, and cardiac complications may occur. The salicylates afford speedy relief. Edi torial (Medicine, Apr., '99).