SYMPTOMS. 167 



indentation being as rapidly filled up again when the pressure 

 is removed. As the disease advances, however, the eftiision is 

 more strictly inflammatory, the pain is greater, the skin feels 

 resisting, tension being increased; the material extravasated is 

 less susceptible of mdentation when pressed upon, and the 

 parts acquire a firm, brawny feeling. 



The presence of numerous well-defined phlyctenaj or vesicles, 

 although a characteristic symptom of the disease, is neverthe- 

 less not met with in every case, and the serous exudation found 

 preceding as well as accompanying them occurs at intervals 

 over considerable areas of the skin. The tendency of the 

 epidermis to become detached is well shown by pressing on 

 the vesicles, when the contained fluid is readily distributed 

 over a large surface ; while the character of this fluid may be 

 taken as a fair criterion of the severity or malignancy of the 

 seizure, it is more truly serous in the milder forms, and bloody 

 and albuminous in the less benignant. 



When the inflammation in the subcutaneous tissue has 

 terminated in the process of suppuration, or when patches of 

 skin are losing their vitality, ultimately to be removed by 

 sloughing, the hair falls off or is easily removed, and the sldn 

 appears of a leaden hue and of a moist feeling. 



Pus, whether in circumscribed cavities or diffused through 

 the areolar tissue, is detected beneath the skin by the sense of 

 fluctuation imparted to the finger, this more distinctly in the 

 former than in the latter case. When this is evacuated, either 

 by natural processes in the course of the disease or through 

 incision, it will rarely be found of a laudable well-developed 

 character; it is more frequently watery, mixed with blood, 

 shreds of imperfectly organized lymph, and the debris of 

 broken-down tissues. The wounds thus formed are uncovered 

 by any plastic exudation, while the areolar tissue becomes 

 infiltrated, the skin undermined, and both take on ulceration 

 and sloughing. In very severe cases the inflammatory and 

 subsequent disintegrative action does not rest with the inva- 

 sion and destruction of the textures primarily involved, the 

 skin and subjacent areolar tissues, but may, either in virtue of 

 the character and severity of the action, or as the result of 

 maltreatment, extend to the structures deeper seated, or to 

 those contiofuous to them. The muscular and intermuscular 



