164 ERYSIPELAS. 



The connection between the two changes and structural 

 alterations, the one proceeding in the underlying layer of the 

 connective-tissue of the skin, the other in the same layer of 

 the mucous membranes, is evidently close and intimate, if not 

 precisely similar in character. 



c. Anatomical Characters. — The pathological changes which 

 occur during the progress of the disease vary with its nature 

 and intensity. In the milder forms there is simply furfuraceous 

 shedding of the scarf-skin from desiccation of the serous exu- 

 dation, or rupture of the vesicles with discharge of the con- 

 tained fluid, follow^ed by the healthy reproduction of tissue 

 beneath. In the more common and severe cases, where the 

 vesicles are larger or more numerous, and filled with a darker- 

 coloured fluid Avith accompanying infiltration on the inferior 

 surface of the skin and amongst the subdermal connective- 

 tissue, circumscribed patches of skin gradually lose their 

 vitality, and are ultimately removed by sloughing, leaving an 

 open and not rapidly healing sore with rough edges, inchned 

 at first to extend from the disintegration of the effused 

 material occupying the subcutaneous connective-tissue, and 

 discharging a foetid sanious fluid mingled with shreds of lymph 

 and areolar tissue; this death and removal of tissue may extend 

 to sloughing and laying bare of tendons, ligaments, and joints. 

 In other instances again, where the inflammation seems to 

 have more rapidly reached its height in the subjacent struc- 

 tures, and where the efl'usion has been extensive and the 

 tension great, collections of pus are apt to form, and to be met 

 with both circumscribed and diffuse. 



It is in such cases of gangrene of the skin, and extensive 

 destruction of the cellular and other tissues, that we may look 

 for changes of an analogous nature to occur in connection with 

 the membrane of the mouth and nose. Previous, however, to 

 the erosion or actually idcerated condition of these membranes, 

 marked changes occur at the parts, which ultimately sufter 

 destruction ; these changes are represented by irregularly 

 formed but circumscribed spots, varying in colour from dirty 

 yellow to dark purple. These markings, as far as can be dis- 

 tinguished, are in every respect analogous to those which occur 

 in scarlatina, and seem, as in that disease, to bear a direct 

 relationship to the period and severity of the fever. 



