DIAGNOSIS. 169 



tion of the superimposed tissue and the formation of an 

 irregular, ill-conditioned sore. 



When the constitutional fever, having reached its height, 

 does not steadily although slowly defervesce, but seems rather 

 to experience a fresh exacerbation, resulting in the develop- 

 ment of truly hectic symptoms terminating in extreme exhaus- 

 tion and prostration ; when the local sores, upon which the 

 constitutional disturbance seems now to depend, continue to 

 extend by destructive infiltration and steady disintegration of 

 tissue, a fatal termination is alone to be looked for. 



Diagnosis. — The recognition of erysipelas, although ordi- 

 narily not a difficult matter, may in particular instances be 

 confounded with some of those disturbances in which hoemal 

 contamination is a prominent feature, as scarlatina or purpura, 

 with acute farcy, or with lymphangitis. With the exercise of 

 a little care, however, it is easily enough differentiated from 

 all of these. From scarlatina it is distinguished by its non- 

 association with a previously diseased condition, and by, in the 

 severer cases, the more sthenic character of the pyrexial and 

 inflammatory symptoms. In erysipelas the tumefaction of the 

 limb is uniform and firm, not in patches as in scarlatina; 

 although both have oozing of serous fluid from the skin, the 

 manner of oozing is different. In erysipelas pain on manipu- 

 lation is more marked, while in scarlatina there are no circum- 

 scribed or diffused ruptures of the cutaneous tissue ; infiltration 

 and swellmg of gland-textures are characteristic of scarlatina, 

 not so of erysipelas. From purpura it differs by the more 

 sthenic character of the entire morbid process, by the local 

 tumefaction being uniform and confined to one particular part 

 of the body, usually the limbs, and most frequently a hind 

 limb ; while in purpura the swellings are irregularly distributed, 

 sharply defined, and the head is early and markedly affected 

 by these. The swellings in purpura are also comparatively 

 painless, not, as in erysipelas, acutely sensitive. 



From the local swelling of acute farcy it differs in that here 

 we have no corded lymphatics nor any of the j)eculiar growths, 

 farcy-buds or nodules ; for although there may be sores m both 

 cases, the character of these sores is dissimilar ; they have no 

 hard base and circumference of indurated tissue as in farcy, 

 while the exquisitely sensitive condition of the entire dermal 



